Diagnosing Pre-Menstrual Syndrome

Even though there are many women who do not notice any special symptoms, there are some whose pre-menstrual disorders hamper their everyday lives: depressive mood, anxiety, excessive emotional sensitivity, fatigue, lack of concentration, headache, etc. Nevertheless, according to Leire Aperribai, PhD holder in Psychology from the UPV/EHU-University of the Basque Country, unified criteria for defining and diagnosing this disease have yet to be agreed on, "and so it is difficult to develop suitable interventions to treat women suffering from these symptoms."

Aperribai has sought to fill this gap through her PhD thesis. Her first task was to define the disorder, and to do this she took as her basis the 4th version of the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association.

This manual defines premenstrual dysphoric disorder and proposes criteria for diagnosing it. For example, it explains that the symptoms are sufficiently serious to cause clear damage, socially as well as in the workplace, and points out that this takes place during the luteal phase, in other words, during the period between ovulation and menstruation. The manual also explains that the symptoms disappear at the onset of menstruation, and for it to be regarded as a disorder, it is necessary to display at least 5 symptoms related to it, and one of them has to be among the following: depressive mood, feelings of desperation or self-rejection; clear internal anxiety, tension, a feeling of not being able to take any more; clear emotional lability, in other words, sadness, bursting into tears or manifestations of emotional over-sensitiveness towards rejection by other people; and irascibility or irritability.

In Aperribai's view, the manual gives a special identity to premenstual dysphoric disorder, despite the fact that it is still classified among those described as "non-specific depressive disorders," so it constitutes a firm proposal as it takes the main groups of symptoms into consideration. Aperribai also added that among the current classifications, this is the one that has been most welcomed.

Reliable and useful

So, taking as the starting point the definitions and criteria provided by the manual, Aperribai has produced a set of questions and has validated them through interviews given by women who are either working or studying on any of the UPV/EHU's three campuses. And this way she has verified its reliability. In fact, and in accordance with current calculations, premenstrual dysphoric disorder is suffered by between 3% and 10% of the population; in the study done by Aperribai, by contrast, it has been found to affect 15%.

The author has explained that this difference is "normal because it concerns test screening. In other words, this is not a diagnostic tool, but a filter to distinguish those who suffer from the disorder from those who do not." In this respect, she has stressed its usefulness, both in the area of research and in health centres. It takes 10 minutes or less to do the test and a lot of progress can be made with it. After that, diagnostic tests are carried out in positive cases and these can take up to two months.

The title of the thesis is "An Evaluation of Premenstrual Dysphoric Disorder: building a screening tool" (Una evaluación del Trastorno Disfórico Premenstrual: construcción de una herramienta de screening). The test is currently being translated into Basque: "We've done one part, but there is still quite a way to go," she says.