A DSM insiders’ history of premenstrual dysphoric disorder
Chapter 41 discusses a kind of in vivo case study of the interactions between science and extra-scientific processes involved in the construction of nosological categories of psychiatry. The very first medical report on a cluster of symptoms, regularly affecting some women over their menstrual cycle, the so-called syndrome of premenstrual tension, appeared in 1931. The name changed with time to premenstrual syndrome, subsequently renamed as late luteal phase dysphoric disorder (LLPDD) and is currently known as premenstrual dysphoric disorder (PMDD). It was listed as a psychiatric disorder in the DSM-III, but was later moved to the section on the condition deserving further study (aka the “appendix”). In the DSM-5, PMDD returned to the main section of the manual devoted to depressive disorders as a diagnosis approved for routine clinical use. The PDD is an ideal-type condition to stimulate a controversy about its justification as a psychiatric disorder. By its nature it affects only females (here, feminist issues may arise); it is clearly linked to physiological rhythm (is it not a somatic issue?); does it exist as a distinct behavioral abnormality or is it just a variant of female experience?: does it need to be treated pharmacologically? (the issues of medicalization and “big pharma”). It provides a detailed narrative on the vicissitudes of this psychiatric nosological category, which is not only based on a careful study by interested outsiders but is crucially enriched by the insights of one of the participants of the very process of DSM construction.