Toward the content validity of premenstrual dysphoric disorder: do anger and irritability more than depressed mood represent treatment-seekers' experiences?

The content validity of Premenstrual Dysphoric Disorder in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision (DSM-IV-TR) has been questioned in the literature. We tested whether mood-related symptoms reported by 26 women seeking treatment for premenstrual disorders were among the proposed criteria. These women were asked to list their premenstrual symptoms and rate the severities of listed symptoms daily for two menstrual cycles before treatment. They completed semistructured interviews to differentiate symptoms of Premenstrual Dysphoric Disorder from those of other psychiatric disorders in women who had other disorders. All participants reported functional interference due to the symptoms. 19 symptoms of or similar to those of Premenstrual Dysphoric Disorder were among the 22 most frequent premenstrual symptoms experienced. Premenstrual depressed mood was less frequent than premenstrual irritability or anger when other psychiatric disorders such as major depression were taken into account. Results suggest that the DSM-IV-TR criteria have generally good content validity but may need revision to represent treatment-seekers experiences more accurately.