Does the evidence now available support the concept of premenstrual dysphoric disorder (PMDD) as a distinct clinical disorder such that the relative safety and efficacy of potential treatment can be evaluated? In a roundtable discussion of this question, a wealth of information was reviewed by a panel of experts. The key characteristics of PMDD, with clear onset and offset of symptoms closely linked to the menstrual cycle and the prominence of symptoms of anger, irritability, and internal tension, were contrasted with those of known mood and anxiety disorders. PMDD displays a distinct clinical picture that, in the absence of treatment, is remarkably stable from cycle to cycle and over time. Effective treatment of PMDD can be accomplished with serotinergic agents. At least 60% of patients respond to selective serotonin reuptake inhibitors (SSRIs). In comparison with other disorders, PMDD symptoms respond to low doses of SSRIs and to intermittent dosing. Normal functioning of the hypothalamic-pituitary-adrenal (HPA) axis, biologic characteristics generally related to the serotonin system, and a genetic component unrelated to major depression are further features of PMDD that separate it from other affective (mood) disorders. Based on this evidence, the consensus of the group was that PMDD is a distinct clinical entity. Potential treatments for this disorder can now be evaluated on this basis to meet the clear need for effective therapy.

Premenstrual syndrome is a legitimate illness consisting of the cyclic recurrence of symptoms (physical, mental and behavioural) in the late luteal phase of the menstrual cycle of sufficient severity to require treatment. The syndrome has a yet unknown aetiology, an uncertain and variable course, and an unidentified family history. Methods are available for diagnosis including obtaining a reliable history, thorough physical and mental examinations, laboratory tests to exclude other possible causes of symptoms, and daily prospective symptom ratings to confirm symptom patterns. Because there is no known aetiology, treatment consists of symptom management of the specific symptoms experienced, based on prospective symptom ratings.

The variability in the frequency of LLPDD diagnosis according to method of assessing symptom change underscores the need for a uniform assessment method. The five additional symptoms with frequencies comparable to those of the DSM-III-R symptoms should be studied further for possible inclusion in the criteria.

Changes in contents and language style of dream reports during the menstrual cycle were evaluated in seven women diagnosed as having Premenstrual Syndrome (PMS). Dream diaries were scored for Referential Activity (RA), i.e., the degree to which subjective emotional experience is captured and expressed in the communicative verbal code. Mean scores for overall RA and for the four individual RA scales (Specificity, Concreteness, Imagery and Clarity), showed peaks in the early luteal phase, i.e., at the time of high gonadal hormone concentration. The dominant contents of dreams in the early luteal phase reflected emotions directed towards other people, in contrast to the early follicular and late luteal phase themes of passivity and self care. The results support the interaction of physiological, emotional and cognitive events as postulated by the multiple code theory. Several questions are considered concerning the precise impact of hormonal fluctuation on emotional information processing as reflected in dreams.

Seventy-six women completed a three-month prospective evaluation for premenstrual syndrome (PMS). As a part of the evaluation, they completed Rotter's Locus of Control (LOC) form in the follicular phase and premenstrually. It was found that the LOC scores of women meeting criteria for PMS rose significantly (became more "external") premenstrually, while scores of women without PMS did not show significant change. In addition, the premenstrual LOC scores of women meeting criteria for PMS were significantly higher than were scores of the non-PMS women. The results are consistent with the idea that cycle related changes in self-perception occur in women demonstrating PMS symptomatology.