174 Depressive Disorders
Daily Rating of Severity of Problems and the Visual Analogue Sc ales for Premenstrual
Mood Symptoms, have undergone validation and are commonly used in clinical trials for
premenstrual dysphoric disorder. The Premenst rual Tension Syndrome Rating Scale has a
self-report and an observer vers ion, both of which have been validated and used widely to
measure illness severity in women who ha ve premenstrual dysphoric disorder.
Functional Consequences of 
Premenstrual Dysphoric Disorder
Symptoms must be associated with clinically  meaningful distress and/or an obvious and
marked impairment in the ability to function so cially or occupationally in the week prior
to menses. Impairment in social functionin g may be manifested by marital discord and
problems with children, other family members,  or friends. Chronic marital or job prob-
lems should not be confused with dysfunction that occurs only in association with pre-
menstrual dysphoric disorder. 
Differential Diagnosis
Premenstrual syndrome. Premenstrual syndrome differs from premenstrual dysphoric
disorder in that a minimum of five symptoms is not required, and there is no stipulation of
affective symptoms for individuals who have premenstrual syndrome. This condition
may be more common than premenstrual dy sphoric disorder, although the estimated
prevalence of premenstrual syndrome varies. While premen strual syndrome shares the
feature of symptom expression during the premenstrual phase of the menstrual cycle, it is
generally considered to be less severe than  premenstrual dysphoric disorder. The pres-
ence of physical or  behavioral symptoms in the pr emenstruum, without the required
affective symptoms, likely meet s criteria for prem enstrual syndrome and not for premen-