Does a Disconnect Occur Between Research and Practice for Premenstrual Dysphoric Disorder (PMDD) Diagnostic Procedures?

Abstract

Diagnostic assessment recommendations for premenstrual dysphoric disorder (PMDD) include the use of daily symptom monitoring for two consecutive menstrual cycles; however, it is unclear whether medical providers use this established procedure in practice. This study explored typical diagnostic procedures for PMDD among a sample of physicians (N = 87) who were recruited by mail and completed questions about current practices. Results indicated that only 11.5% of physicians in this sample reported routinely using 60-day symptom monitoring, and only 18.4% of physicians reported regular use of any type of daily symptom monitoring. No differences were observed in these procedures based on frequency of contact with patients with PMDD or physician type (obstetrics and gynecology [OB/GYN] or family medicine). Overall, these results indicated that it is important to establish standard assessment methods for PMDD that have clinical utility for physicians, as well as increase awareness of research-based practice in diagnosing PMDD.

Toward the Reliable Diagnosis of DSM-5 Premenstrual Dysphoric Disorder: The Carolina Premenstrual Assessment Scoring System (C-PASS)

“…Despite evidence for the existence and burden of PMDD 6 , inconsistent diagnostic practices compromise the construct validity of PMDD 10 , undermine accurate clinical diagnosis 19 , and threaten the clarity of efforts to characterize the pathophysiology of the disorder. In an effort to hasten and standardize the translation of the DSM-5 PMDD criteria into terms compatible with existing research practices, the present paper presents the Carolina Premenstrual Assessment Scoring System (C-PASS), a scoring system for prospective ratings on the DRSP that can be used either manually or with macro programs for SAS and Excel.…”

“…Given the time involved in prospective assessment, nearly 90% of clinicians who treat PMDD rely on patient retrospective self-report, which we know to be prone to false positives, to make diagnoses 19 . This is troubling when considered in tandem with the present evidence that (1) there is a relatively low prevalence of true PMDD even among women seeking assessment for premenstrual symptoms, and (2) variability on retrospective self-report of premenstrual symptoms does not provide information about whether a standardized, prospective diagnosis of PMDD is present.…”

“…In order to reduce the risk of diagnosing normal affective experiences as a mental disorder 8–10 , we recommend that this cutoff of “4-moderate” be implemented consistently as the threshold for absolute severity (premenstrual symptoms must reach 4) and absolute symptom clearance (postmenstrual symptoms must not exceed 3). Second, although 30% premenstrual elevation (or premenstrual “change”) is generally used 5,11 as the elevation threshold, at least five different methods have been used to calculate this premenstrual change variable (listed in Table 3 note) 18,19,20,7,12,13 . Therefore, the present study begins by examining the interactive effects of both differing calculation methods and differing thresholds on diagnostic prevalence.…”

Premenstrual Syndrome (PMS) and the Myth of the Irrational Female

“…For example, if certain physical symptoms are severe, a General Practitioner (GP) might simply diagnose a more chronic health condition, without first assessing if symptoms are cyclical in nature. Especially since even when PMS is suspected, many clinicians do not ask patients to record their symptoms over two cycles, as is required for formal diagnosis (Craner, Sigmon, and McGillicuddy 2014). (Menstrual migraine is an exception, since its high prevalence rate ensures that most clinicians are aware of a possible link to the menstrual cycle.)…”

The magnitude, long-term trend and lifestyle risk factors of dysmenorrhea and premenstrual syndrome

“…The relative timing of symptom occurrence within a cycle, which provides important information for the diagnosis of the conditions, especially PMS, is also unable to be confirmed. However, despite currently being recommended as the validated method to diagnose premenstrual disorder, particularly PMS/PMDD [107], prospective daily symptom reporting has not been widely adopted in clinical practice [234]. It may not be practical in this large population setting over a long follow-up period.…”