atic cycles. ( Note:  The diagnosis may be made provisionally prior to this confirmation.)
G. The symptoms are not attributable to the physiological effects of a substance (e.g., a
drug of abuse, a medication, other treatment ) or another medical condition (e.g., hy-
perthyroidism).
Recording Procedures
If symptoms have not been confirmed by prospective daily ratings of at least two symp-
tomatic cycles, “provisional” should be noted after the name of the diagnosis (i.e., “pre-
menstrual dysphoric disorder, provisional”).
Diagnostic Features
The essential features of premenstrual dyspho ric disorder are the expression of mood la-
bility, irritability, dysphoria, and anxiety symptoms that occur repeatedly during the pre-
menstrual phase of the cycle and remit around the onset of me nses or shortl y thereafter.
These symptoms may be accompanied by behavioral and physical symptoms. Symptoms
must have occurred in most of the menstrual cycles during the past year and must have an
adverse effect on work or social functioning.  The intensity and/or expressivity of the ac-
companying symptoms may be closely related to social and cultural background charac-
teristics of the affected female, family pers pectives, and more specific factors such as
religious beliefs, social tolerance,  and female gender role issues.
Typically, symptoms peak around the time of  the onset of menses. Although it is not
uncommon for symptoms to linger into the first few days of menses, the individual must
have a symptom-free period in the follicular  phase after the menstrual period begins.
While the core symptoms include mood and anxiety symptoms, behavioral and somatic
symptoms commonly also occur. However, the presence of physic al and/or behavioral