strual dysphoric disorder.
Dysmenorrhea. Dysmenorrhea is a syndrome of painful menses, but this is distinct from a
syndrome characterized by affective changes.  Moreover, symptoms of dysmenorrhea begin
with the onset of menses, whereas symptoms of  premenstrual dysphoric disorder, by defini-
tion, begin before the onset of menses, even if they linger into the first few days of menses. 
Bipolar disorder, major depressive disord er, and persistent depressive disorder
(dysthymia). Many women with (either naturally occurring or substance/medication-
induced) bipolar or major depressive disorder  or persistent depressive disorder believe
that they have premenstrual dysphoric disorder. However, when they chart symptoms,
they realize that the symptoms do not follo w a premenstrual pattern. Women with an-
other mental disorder may experience chronic symptoms or interm ittent symptoms that
are unrelated to menstrual cycle phase. Howeve r, because the onset of menses constitutes
a memorable event, they may report that symptoms occur only during the premenstruum
or that symptoms worsen premenstrually. This  is one of the rationales for the requirement
that symptoms be confirmed by daily prospect ive ratings. The process of differential di-
agnosis, particularly if the clinician relies on retrospective symptoms only, is made more
difficult because of the overlap between sy mptoms of premenstrual dysphoric disorder
and some other diagnoses. The overlap of symp toms is particularly salient for differenti-
ating premenstrual dysphoric disorder from major depressive episodes, persistent de-
pressive disorder, bipolar disorders, and bo rderline personality di sorder. However, the