To be diagnosed with PMDD, a person must experience at least five diagnostic symptoms. These five symptoms must include at least one symptom from the following list:
- Affective lability,which can include mood swings, feeling suddenly sad or tearful, or being very sensitive to rejection
- Irritability or anger, or increased interpersonal conflicts
- Depressed mood, hopelessness, or self-deprecating thoughts,or
- Anxiety, tension, or restlessness
The five symptoms must also include at least one symptom from the following list:
- Anhedonia, or decreased interest in one's usual activities
- Difficulty concentrating
- Lethargy or fatigue
- Appetite disturbance, including marked change in appetite, overeating, or specific food cravings
- Sleep disturbance, including insomnia or hypersomnia
- Overwhelmed or out of control feelings
- Physical symptoms, such as breast swelling or tenderness, joint or muscle pain, a sensation of bloating, or weight gain
PMDD should not be diagnosed if the symptoms are solely an exacerbation of another disorder, such as major depressive disorder.
PMDD symptoms may be subject to memory biases. For example, a person may misremember when symptoms occur, attributing them to the menstrual cycle when in fact there is no association. Therefore, PMDD diagnoses should be confirmed through the use of prospective daily symptom ratings for at least two menstrual cycles. Prior to confirmation, the diagnosis should be listed as provisional.