Premenstrual Dysphoric Disorder 173
nosis. Symptoms are of comparab le severity (but not duration) to those of another mental
disorder, such as a major depressive episode or generalized anxiety disorder. In order to
confirm a provisional diagnosis, daily pros pective symptom ratings are required for at
least two symptomatic cycles.
Associated Features Supporting Diagnosis
Delusions and hallucinations have been described in the late luteal phase of the menstrual
cycle but are rare. The premenstrual phase has b een considered by some to be a risk period
for suicide. 
Prevalence
Twelve-month prevalence of premenstrual dy sphoric disorder is between 1.8% and 5.8%
of menstruating women. Estimates are substant ially inflated if they are based on retro-
spective reports rather than prospective da ily ratings. However,  estimated prevalence
based on a daily record of symptoms for 1–2 months may be less representative, as indi-
viduals with the most severe symptoms may be  unable to sustain the rating process. The
most rigorous estimate of premenstrual dy sphoric disorder is 1.8% for women whose
symptoms meet the full criteria without fu nctional impairment and 1.3% for women
whose symptoms meet the current criteria wi th functional impairment and without co-oc-
curring symptoms from another mental disorder. 
Development and Course
Onset of premenstrual dysphoric disorder ca n occur at any point after menarche. Inci-
dence of new cases over a 40-month follow-up period is 2.5% (95% confidence interval =
1.7–3.7). Anecdotally, many individuals, as th ey approach menopause, report that symp-