Diagnostic criteria for<unk>  are provided by a number of expert medical guides. Diagnosis can be supported by having women who are seeking treatment for<unk>  use a daily charting method to record their symptoms. Daily charting helps to distinguish when mood disturbances are experienced and allows<unk>  to be more easily distinguished from other mood<unk> s. With<unk> , mood symptoms are present only during the luteal phase, or last two weeks, of the menstrual cycle. While<unk>  mood symptoms are of a cyclical nature, other mood<unk> s are variable or constant over time. Although there is a lack of consensus on the most efficient instrument by which to confirm a<unk>  diagnosis, several validated scales for recording<unk>  symptoms include the Calendar of<unk>  Experiences (COPE), Daily Record of Severity of Problems (DRSP), and Prospective Record of the Severity of Menstruation (PRISM). In the context of research, standardized numerical cutoffs are often applied to verify the diagnosis. The difficulty of diagnosing<unk>  is one reason that it can be challenging for lawyers to cite the<unk>  as a defense of crime, in the very rare cases where<unk>  is allegedly associated with criminal violence. DSM-5 The DSM-5 which established seven criteria (A through G) for the diagnosis of<unk>  which is paraphrased below. There is overlap between the criteria for<unk>  in the DSM-5 and the criteria found in the Daily Record of Severity of Problems (DRSP). According to the DSM-5, a diagnosis of<unk>  requires the presence of at least five of these symptoms with one of the symptoms being numbers 1-4. These symptoms should occur during the week before menses and remit after initiation of menses. In order to meet criteria for the diagnosis, the symptoms should be charted prospectively for two consecutive ovulation cycles in order to confirm a temporal and cyclical nature of the symptoms. The symptoms should also be severe enough to affect normal work, school, social activities, and/or relationships with others. The symptoms of Criteria A-C must have been met for most menstrual cycles that occurred in the preceding year, and have to have cause significant impairment in family, work, school, or social functioning. (Criterion D). Timing Criterion A: During most menstrual cycles throughout the past year, at least 5 of the symptoms outlined in Criterion B and Criterion C must be present in the final week before the onset of menses, must start to improve within a few days after the onset of menses, and become minimal or absent in the week post-menses. Symptoms Criterion B: One (or more) of the following symptoms must be present: # Marked affective lability (e.g., mood swings, feeling suddenly sad or tearful, or increased sensitivity to rejection) # Marked irritability or anger or increased interpersonal conflicts # Marked depressed mood, feelings of hopelessness, or self-deprecating thoughts # Marked anxiety, tension, and/or feelings of being keyed up or on edge Criterion C: One (or more) of the following symptoms must be present additionally, to reach a total of 5 symptoms when combined with present symptoms from Criterion B above: # Decreased interest in usual activities (e.g., work, school, friends, hobbies). # Subjective difficulty in concentration. # Lethargy, easy fatigability, or marked lack of energy. # Marked change in appetite; overeating; or specific food cravings. # Hypersomnia or insomnia. # A sense of being overwhelmed or out of control. # Physical symptoms such as breast tenderness or swelling, joint or muscle pain, a sensation of "bloating," or weight gain. Severity Criterion D: The symptoms observed in Criteria A-C are associated with clinically significant distress or interference with work, school, usual social activities, or relationships with others (e.g., avoidance of social activities; decreased productivity and efficiency at work, school, or home). Consideration of Other Psychiatric<unk> s Criterion E: The disturbance is not merely an exacerbation of the symptoms of another<unk> , such as major depressive<unk> , panic<unk> , persistent depressive<unk>  (Dysthymia), or a personality<unk> —although it may co-occur with any of these<unk> s. Confirmation of the<unk>  Criterion F: Criterion A should be confirmed by prospective daily ratings during at least two symptomatic cycles. The diagnosis may be made provisionally prior to this confirmation. Criterion G: The symptoms are not attributable to the physiological effects of a substance (e.g., drug abuse, a medication, other treatments) or another medical condition (e.g., hyperthyroidism). Clinically significant distress is not defined explicitly by the DSM-IV, where it has been critiqued by multiple scholars as being too vague, and potentially detrimental for those who have symptoms of depression, anxiety, or other mood<unk> s because they do not meet the clinical significance requirement. ICD 11 Diagnostic criteria for<unk>  are also provided by the 2016 World Health Organization's International Classification of Diseases (ICD-11-CM): GA34.41<unk>  Description During a majority of menstrual cycles within the past year, a pattern of mood symptoms (depressed mood, irritability), somatic symptoms (lethargy, joint pain, overeating), or cognitive symptoms (concentration difficulties, forgetfulness) that begin several days before the onset of menses, start to improve within a few days after the onset of menses, and then become minimal or absent within approximately 1 week following the onset of menses. The temporal relationship of the symptoms and luteal and menstrual phases of the cycle may be confirmed by a prospective symptom diary. The symptoms are severe enough to cause significant distress or significant impairment in personal, family, social, educational, occupational or other important areas of functioning and do not represent the exacerbation of a mental<unk> . Royal College of Obstetricians and Gynecologists and the International Society for the Study of<unk><unk> s Other organizations that have published diagnostic criteria for<unk>  include the Royal College of Obstetricians and Gynecologists and the International Society for the Study of<unk><unk> s (ISPMD). The ISPMD was a consensus group established by an international multidisciplinary group of experts. The group's diagnostic criteria for<unk>  focuses on the cyclic nature of the symptoms occurring during the luteal phase of the menstrual cycle, as well as the symptoms being absent after menstruation and before ovulation and causing significant impairment. The ISPMD diagnostic criteria for<unk>  do not specify symptom characteristics or number of symptoms. Differential diagnosis A critical part of diagnosing<unk>  is ruling out underlying psychiatric<unk>  or physical illness that can cause similar symptoms. That exhibits<unk>  exacerbation, the menopausal transition, hyperthyroidism, hypothyroidism, as well as other mood<unk> s. Furthermore, many medical<unk> s are worsened prior to ordering menses, but these typically do not present strictly during the luteal phase. Mood<unk> s – there is potential for patients to have psychiatric<unk> s with superimposed<unk>  or psychiatric<unk> s. In order to establish the timeline of symptoms required for a diagnosis of<unk>  symptoms need to be tracked using scales like the Calendar of<unk>  Experiences or the Daily Record of Severity of Problems. Menopausal transition – affective symptoms associated with the menopausal transition most commonly start when menstrual cycle starts to become irregular or anovulatory whereas<unk>  symptoms occur during the luteal phase of ovulatory cycles. Thyroid<unk> s—patients with both hyperthyroidism and hypothyroidism may present with affective symptoms. The patient's history is very important to determine whether the provider should suspect thyroid<unk> s. Patients should also have thyroid hormone levels checked to ensure no underlying thyroid<unk>  is present.
Premenstrual dysphoric disorder
Major depressive disorder
Premenstrual syndrome
Anxiety disorder
Menstrual disorder
Postpartum depression
Postpartum psychosis
Minor depressive disorder