Gehlert: Studies on premenstrual disorder flawedA new study of a severe premenstrual mood disorder supports previous estimates that between 2.1 million and 3.4 million women may suffer from debilitating PMS symptoms that impair basic functioning.
The American Psychiatric Association last year classified the most extreme form of PMS, premenstrual dysphoric disorder (PMDD), as a mental disorder and estimated prevalence rates between 3 percent and 5 percent of all reproductive-age women in the United States.
However, the researchers say a more precise description of PMDD will not be possible until there is consensus on how to diagnose the severity of a woman's symptoms and until studies have been conducted on more diverse populations. The research was conducted by principal investigator Sarah Gehlert, Assistant Professor in the School of Social Service Administration, and Shirley Hartlage, assistant professor at Rush-Presbyterian-St. Lukes Medical Center.
"Previous studies on PMDD were flawed by overrepresenting white women to the exclusion of women from other ethnic backgrounds. Until we consider factors such as race, age and socioeconomic status, we will not have a complete picture of who has PMDD," Gehlert said. "Psychiatrists also don't agree on how to measure the severity of the symptoms. This has meant ignoring differences in how women may report and label serious premenstrual conditions."
Gehlert and Hartlage, using four different measurements for PMDD, tested 102 Chicago women of various ethnic and social backgrounds and found that between zero and 5 percent of participants met all APA criteria for PMDD.
PMDD is currently diagnosed when a woman's premenstrual symptoms are so severe that debilitating mood and behavioral changes impair basic daily activities such as work or social relationships, resulting in a form of clinical depression. To be diagnosed, a woman must suffer from at least four of the following 11 symptoms:
_ markedly depressed mood
_ marked anxiety or tension
_ persistent irritability or anger
_ difficulty in concentrating
_ decreased interest in usual activities
_ noticeable lack of energy
_ marked change in appetite
_ insomnia or hypersomnia
_ sense of being overwhelmed or out of control
_ sudden sadness or depression
_ physical symptoms such as joint pains, headaches, breast tenderness or "bloating."
The symptoms must occur a week before a menstrual cycle begins and disappear a few days after the menstrual cycle starts. The symptoms must recur in at least two consecutive menstrual cycles and must also "markedly interfere" with work, basic functioning or social relationships. Treatments for the disorder include ovulation suppression, water-retention treatment and antidepressants.
The researchers hope to continue examining PMDD to help refine the concept, provide a more clinical description and establish more accurate profiles of women with PMDD.
"It's surprising how little is known about premenstrual disorders -- even such fundamental questions as how prevalent these disorders are in the general population still remain unanswered," Gehlert said. "Expanding our research should aid in determining actual causes and treatments for premenstrual disorders as well as the accuracy of the PMDD definition based on the APA's criteria."
In Gehlert and Hartlage's pilot study, 29 percent of the participants were African-American, 65 percent were Caucasian, 3 percent were Hispanic and 3 percent defined themselves in another racial or ethnic category. The ages ranged from 13 to 52, with a mean age of 31 years. In future studies, the researchers plan to test 2,000 women from a broad range of ages, races, incomes and geographic regions.
-- Charles Whitt