Risk factors for premenstrual dysphoria established
Premenstrual dysphoric disorder (PMDD) is more common in women who have suffered a traumatic event or who have a pre-existing anxiety disorder than those without, study findings indicate.
The research team, led by Axel Perkonigg (Technical University of Dresden, German), studied a community cohort of 1488 women who were aged 14-24 years at enrolment in 1995. They were followed-up for 42 months.
At baseline, 4.6% of the cohort met criteria for threshold PMDD. This increased to 7.5% by final follow-up.
Results of the Munich-Composite International Diagnostic Interview revealed that the majority of women with threshold PMDD had either post-traumatic stress disorder (PTSD) or a history of traumatic events.
Furthermore, comparisons of prevalence and incidence patterns of pure PMDD showed that almost 50% of all incident follow-up cases of PMDD occurred among women with PTSD or trauma.
In logistic regression analysis, baseline predictors of threshold PMDD included subthreshold PMDD, traumatic events, anxiety disorders, lower self-competence, negative life events, and daily hassles.
Interestingly, predictors of subthreshold PMDD were different. Rather than traumatic events or PTSD, they included nicotine dependence, anxiety disorders, and daily hassles.
Writing in the Journal of Clinical Psychiatry, Perkonigg's team says that their key finding is the "remarkably strong" association between threshold PMDD and traumatic events. This was maintained even after controlling for subthreshold PMDD, other mental disorders, and daily hassles.
They conclude: "Whereas the underlying mechanisms are still unknown and require further investigation, this poses an intriguing lead in our understanding the illness of PMDD and may be relevant for prevention and treatment of PMDD among women after traumatic events."
J Clin Psychiatry 2004; 65: 1314-1322