Late luteal phase dysphoric disorder and DSM-III-R

Article Abstract:

Late luteal phase dysphoric disorder (LLPDD), more commonly referred to as premenstrual syndrome (PMS), has been the subject of considerable controversy in the last decade. Not only has this disorder attracted much attention, but the number of over-the-counter drugs that claim to treat this condition has increased tremendously. Currently, there is insufficient evidence on the efficacy of these medications. The most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DMS-III-R) has included LLPDD in the appendix entitled "Proposed Diagnostic Categories Needing Further Study." The authors of this commentary participated on the advisory committee which composed this description of the disorder. Major points of controversy and areas needing further clarification concerning the disorder are discussed. The importance of making a differential diagnosis, i.e. the consideration of other pre-existing disorders, either mental or physical, prior to confirming LLPDD is emphasized. It has been observed that different phases of the menstrual cycle may exacerbate a pre-existing and otherwise unrelated condition and the disorder tends to be either underdiagnosed or overdiagnosed. Further clarification of the disorder as primarily a mental or physical problem was recommended. Implicit in the controversy is that LLPDD has been viewed by some as a political or ethical issue, rather than strictly a medical one. Some feel that the identification of a hormone-related condition may lead to the stigmatization of women and the reinforcement of pre-existing negative stereotypes. An appendix listing diagnostic criteria supplements this article. If it is decided that this condition be fully incorporated into the new text, the authors recommend that the name be simplified to "luteal dysphoric disorder" or LDD.

Evaluation, Identification and classification, editorial, Diagnostic and Statistical Manual of Mental Disorders (Book)

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Spectral analysis of cyclic symptoms in late luteal phase dysphoric disorder

Article Abstract:

In the days just before menstruation, some women experience a heightened mood swing which stems from a disorder known among psychiatrists as late luteal phase dysphoric disorder (LLPDD). Criteria for identifying the disorder have been included in the revised version of the Diagnostic and Statistical Manual of Mental Disorders, DSM-III-R. The criteria emphasize a number of symptoms: depression, anxiety, anger and severe impairment of psychosocial functioning. Unlike the more commonly known premenstrual syndrome or PMS, physical symptoms such as breast tenderness, headaches, and water retention are not significant aspects of LLPDD. A proper diagnosis also calls for confirmation by rating symptom severity on a daily basis for at least two menstrual cycles. Fifty-eight women who were self-referred for premenstrual difficulties were evaluated for LLPDD according to the DSM-III-R criteria. Subjects were grouped according to whether or not they had previous or present psychiatric disorders. The two groups were compared regarding both severity of symptoms and patterns of symptom change. Results indicate that at least half of the symptoms rated by the patients were exacerbated just before menstruation, regardless of psychiatric history. Severity scores were at least one third greater in the premenstrual phase. The largest average premenstrual changes were among four symptoms: anger, anxiety, depression and emotional instability. In discussing the validity of the DSM-III-R criteria, the authors acknowledge the difficulty of determining the impact of other psychiatric disorders on LLPDD and vice versa.

Abnormalities, Women, Causes of, Depression, Mental, Depression (Mood disorder), Menstruation, Luteal phase

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High nocturnal body temperature in premenstrual syndrome and late luteal phase dysphoric disorder

Article Abstract:

Women who experience emotional or physical symptoms prior to menstruation are said to suffer from premenstrual syndrome (PMS). Those with primarily affective symptoms (symptoms related to mood), such as depression, are diagnosed with late luteal phase dysphoric disorder (LLPDD). In the week preceding menstruation, women suffering from LLPDD suffer severe affective symptoms. Research has found higher than normal nighttime body temperature in depressed individuals, and depressed people often report restless sleep. It has been suggested that the sleep disruption is due to the higher than normal nighttime body temperatures. To investigate the relationship between body temperature, depression, and the four phases of the menstrual cycle, 10 women with PMS, six of whom had LLPDD as well, (the PMS/LLPDD group) were compared with six women with dysphoria but without PMS, and six normal women. Core body temperature was measured, along with sleep disruption (as indicated by wrist movements during sleep). PMS/LLPDD subjects had significantly higher nighttime body temperatures than other subjects during all four phases of the menstrual cycle. Sleep disruption, however, did not differ between groups. Interestingly, the dysphoric group had a nighttime body temperature similar to the PMS/LLPDD group, and for all subjects, nighttime temperature increased during the latter stages of menstruation. These findings are consistent with the hypothesized relationship between depression, menstruation, and body temperature. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Body temperature

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