PMS vs. PMDD: What’s the difference?

Most people who menstruate experience mild physical symptoms in the week before their periods start. Some may also experience mild emotional symptoms. Called premenstrual syndrome (PMS), these symptoms can include tender breasts, bloating, and increased hunger as well as emotional changes like irritability or crying spells.

While PMS can range in severity, PMS typically doesn’t disrupt people’s lives very much. It is not a mental illness, and it doesn’t require much intervention.

Premenstrual dysphoric disorder (PMDD), by contrast, leads to severe emotional symptoms, such as anger, anxiety, depression, and mood swings, in the week or 2 weeks before the period begins. Thought to affect about 6% of those who menstruate, PMDD disrupts day-to-day life, interfering with work or relationships with others. It can even be life-threatening, with those who have PMDD experiencing a heightened risk of accidents and suicide.

PMDD is so serious that it is an official diagnosis in the Diagnostic and Statistical Manual of Mental Disorders.

To be diagnosed with PMDD, individuals must have at least one of these emotional symptoms:

• Mood swings. Feeling sad, weepy, or sensitive to rejection.
• Anger. Feeling irritable or angry or experiencing a lot of relationship conflict.
• Depression. Feeling sad, hopeless, or self-critical.
• Anxiety. Feeling anxious, tense, or on edge.

In addition to these core symptoms, individuals must also have at least one of the following symptoms, bringing the total number of symptoms to five:

• Decreased interest in usual activities
• Trouble concentrating
• Lethargy or lack of energy
• A change in appetite, overeating, or particular food cravings
• Insomnia or sleeping too much
• Feeling overwhelmed or out of control
• Physical symptoms like bloating, breast tenderness, or pain in muscles or joints

[Related: Why are some people more susceptible to severe PMS? Psychologists seek answers]

For an official diagnosis of PMDD, these symptoms must “turn on” premenstrually and then “shut off” again, typically by the time menstrual bleeding ends and before ovulation begins.

Not every severe emotional change that occurs premenstrually is PMDD, however. People with other mental illnesses, such as depression or anxiety, can experience premenstrual exacerbation of their symptoms.

[Related: Four questions to ask patients about their menstrual cycles]

Do you think you might have PMDD? Take the International Association for Premenstrual Disorder’s online self-screening testopens in new window to learn more.