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The prevalence of premenstrual dysphoric disorder in a randomly selected group of urban and rural women

  • S. Gehlert (a1), I. H. Song (a2), C.-H. Chang (a3) and S. A. Hartlage (a4)

Premenstrual dysphoric disorder (PMDD) was included as a provisional diagnostic category in the appendices of Diagnostic and Statistical Manual of Mental Disorders (DSM)-III-R (then called late luteal phase dysphoric disorder) and remained as an appendix in DSM-IV. Our study aimed to determine the prevalence of PMDD using all four DSM-IV research diagnostic criteria in a representative sample of women of reproductive age in the United States.


Data were collected in the homes of women between the ages of 13 and 55 years in two urban and two rural sites using a random sampling procedure developed by the National Opinion Research Center. Women completed daily symptom questionnaires and provided urine specimens each day for two consecutive ovulatory menstrual cycles (ovulation was estimated for women taking oral contraceptives) and were screened for psychiatric disorders by trained interviewers. Symptoms were counted toward a diagnosis of PMDD if they worsened significantly during the late luteal week during two consecutive ovulatory menstrual cycles, occurred on days in which women reported marked interference with functioning, and were not due to another mental disorder.


In the final analysis, 1246 women who had had at least one menstrual cycle and were neither naturally nor surgically menopausal nor pregnant were selected. Of the women in the study, 1.3% met criteria for the diagnosis as defined in DSM-IV.


The prevalence of PMDD is considerably lower than DSM-IV estimates and all but one of the estimates obtained from previous studies when all DSM-IV diagnostic criteria are considered. We suggest a new process for diagnosing PMDD based on our findings.

Corresponding author
*Address for correspondence: S. Gehlert, Ph.D., School of Social Service Administration, The University of Chicago, 969 East Sixtieth Street, Chicago, IL 60637, USA. (Email:
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APA (1987). Diagnostic and Statistical Manual of Mental Disorders, 3rd edn, revised. American Psychiatric Association: Washington, DC.
APA (1997). Diagnostic and Statistical Manual of Mental Disorders, 4th edn, revised. American Psychiatric Association: Washington, DC.
Banerjee, N, Roy, KK, Takkar, D (2000). Premenstrual dysphoric disorder – a study from India. International Journal of Fertility and Women's Medicine 45, 342344.
Chambers, WJ, Puig-Antich, J, Hirsch, M, Paez, P, Ambrosini, PJ, Tabrizi, MA, Davies, M (1985). The assessment of affective disorders in children and adolescents by semistructured interview. Test–retest reliability of the schedule for affective disorders and schizophrenia for school-age children, present episode version. Archives of General Psychiatry 42, 696702.
Cohen, LS, Soares, CN, Otto, MW, Sweeney, BH, Liberman, RF, Harlow, BL (2002). Prevalence and predictors of premenstrual dysphoric disorder (PMDD) in older premenopausal women. The Harvard Study of Moods and Cycles. Journal of Affective Disorders 70, 125132.
Eckerd, M, Hurt, S, Severino, S (1989). Late luteal phase dysphoric disorder: relationship to personality disorders. Journal of Personality Disorders 4, 338344.
First, M, Spitzer, R, Gibbon, M, Williams, J (1996). Structured Clinical Interview for DSM-IV Axis 1 Disorders – Non-Patient Edition (SCID I/NP), version 2.0. New York State Psychiatric Institute, Biometrics Research: New York, NY.
Gehlert, S, Chang, CH, Hartlage, S (1999). Symptom patterns of premenstrual dysphoric disorder as defined in the Diagnostic and Statistical Manual of Mental Disorders – IV. Journal of Women's Health 8, 7585.
Gehlert, S, Hartlage, S (1997). A design for studying the DSM-IV research criteria of premenstrual dysphoric disorder. Journal of Psychosomatic Obstetrics and Gynaecology 18, 3644.
Gray, AJ (2002). Stigma in psychiatry. Journal of the Royal Society of Medicine 95, 7276.
Halbreich, U, Borenstein, J, Pearlstein, T, Kahn, LS (2003). The prevalence, impairment, impact, and burden of premenstrual dysphoric disorder (PMS/PMDD). Psychoneuroendocrinology 28 (Suppl. 3), 123.
Hurt, SW, Schnurr, PP, Severino, SK, Freeman, EW, Gise, LH, Rivera-Tovar, A, Steege, JF (1992). Late luteal phase dysphoric disorder in 670 women evaluated for premenstrual complaints. American Journal of Psychiatry 149, 525530.
Loranger, A, Hirschfeld, R, Sartorius, N, Regier, D (1991). The WHO/ADAMHA international pilot study of personality disorders: background and purpose. Journal of Personality Disorders 5, 296306.
Rivera-Tovar, AD, Frank, E (1990). Late luteal phase dysphoric disorder in young women. American Journal of Psychiatry 147, 16341636.
Schnurr, PP (1988). Some correlates of prospectively defined premenstrual syndrome. American Journal of Psychiatry 145, 491494.
Sudman, S, Bradburn, NM (1982). Asking Questions: A Practical Guide to Questionnaire Design, 1st edn. Jossey-Bass: San Francisco.
Sveindottir, H, Backstrom, T (2000). Prevalence of menstrual cycle symptom cyclicity and premenstrual dysphoric disorder in a random sample of women using and not using oral contraceptives. Acta Obstetricia et Gynecologica Scandinavica 79, 405413.
Takeda, T, Tasaka, K, Sakata, M, Murata, Y (2006). Prevalence of premenstrual syndrome and premenstrual dysphoric disorder in Japanese women. Archive of Women's Mental Health 9, 209212.
US Census Bureau (1995). Urban and rural definitions ( Accessed 21 May 2007.
US Census Bureau (2002). Profiles of general demographic characteristics ( Accessed 21 May 2007.
Wittchen, HU, Becker, E, Lieb, R, Krause, P (2002). Prevalence, incidence and stability of premenstrual dysphoric disorder in the community. Psychological Medicine 32, 119132.
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Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
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