A. In the majority of menstrual cycles, at least five symptoms must be present in the final week before the onset of menses, start to improve within a few days after the onset of menses, and become minimal or absent in the week postmenses. |
B. One (or more) of the following symptoms must be present: |
| 1. Marked affective lability (e.g., mood swings; feeling suddenly sad or tearful, or increased sensitivity to rejection). |
| 2. Marked irritability or anger or increased interpersonal conflicts. |
| 3. Marked depressed mood, feelings of hopelessness, or self-deprecating thoughts. |
| 4. Marked anxiety, tension, and/or feelings of being keyed up or on edge. |
C. One (or more) of the following symptoms must additionally be present, to reach a total of five symptoms when combined with symptoms from Criterion B above. |
| 1. Decreased interest in usual activities (e.g., work, school, friends, hobbies). |
| 2. Subjective difficulty in concentration. |
| 3. Lethargy, easy fatigability, or marked lack of energy. |
| 4. Marked change in appetite; overeating; or specific food cravings. |
| 5. Hypersomnia or insomnia. |
| 6. A sense of being overwhelmed or out of control. |
| 7. Physical symptoms such as breast tenderness or swelling, joint or muscle pain, a sensation of “bloating,” or weight gain. |
note: The symptoms in Criteria A–C must have been met for most menstrual cycles that occurred in the preceding year. |
D. The symptoms are associated with clinically significant distress or interference with work, school, usual social activities, or relationships with others (e.g., avoidance of social activities; decreased productivity and efficiency at work, school, or home). |
E. The disturbance is not merely an exacerbation of the symptoms of another disorder, such as major depressive disorder, panic disorder, persistent depressive disorder (dysthymia), or a personality disorder (although it may co-occur with any of these disorders). |
F. Criterion A should be confirmed by prospective daily ratings during at least two symptomatic cycles. (note: The diagnosis may be made provisionally before this confirmation.) |
G. The symptoms are not attributable to the physiologic effects of a substance (e.g., a drug of abuse, a medication, other treatment) or another medical condition (e.g., hyperthyroidism). |