(HealthDay News) – Women with four or more symptoms of premenstrual dysphoric disorder (PMDD) are likely to experience impairment.

S. Ann Hartlage, PhD, of the Rush University Medical Center and Rush Medical College in Chicago, and colleagues conducted a prospective survey of two cohorts, which included a community sample and a self-identified treatment-seeking cohort, to measure daily ratings of perimenstrual symptoms and functioning to help inform the Diagnostic and Statistical Manual IV (DSM-IV) definition of and criteria for establishing PMDD.

The researchers found that, for the self-identified group, mood and physical symptoms were most severe and accompanied by impairment for four days before through the first two days of menses. In the community sample, symptoms were most severe for three days before through three days of menses. The symptoms listed in the DSM-IV were the most problematic, but depressed mood was less frequent than other symptoms. The optimal cut-off point in the combined sample was four or more symptoms for maximizing the sensitivity and specificity for predicting impairment.

“This is informative for DSM-5 in that the most symptomatic period typically includes the few days before through the first three days of menses rather than only the premenstrual phase,” the authors write. “Although the number of symptoms most associated with distress and impairment differed between the two cohorts, results from the combined cohort suggest that four symptoms are linked with impairment from PMDD.”

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