From 1931 to now: the good, the bad and the ugly
PMDD was first mentioned in 1931: before the NHS was founded, before we knew smoking caused cancer, and even before the chocolate chip cookie was invented. And yet, where are we today? Still fighting to get PMDD recognised, believed and properly treated.
In this article, we take a walk into the past to find out why it has taken so long for PMDD to get into diagnostic manuals. Still today, it’s a fight to get this debilitating condition recognised and believed. But positive shifts are happening..
The first mention “Like jumping out of their skin”
In 1931, Dr Robert Frank wrote a paper that opened “My attention has been increasingly directed to a large group of women who have premenstrual disturbances of manifold nature”.
He described severe premenstrual tension as personal suffering, striking 7-10 days before menstruation, with complete relief a few hours after the onset of menstrual flow (1). He described how his patients felt:
“Like jumping out of their skin”
Frank’s paper set out much of what still shapes PMDD criteria today, alongside experiences many still recognise: irritability, unrest, intense personal suffering, and feeling "conscience-stricken" about the strain on their relationships.This first account had its flaws, but it was an extraordinary description of what so many women go through.
In 1953, Katharina Dalton renamed the condition. She argued that "premenstrual tension" did not capture the whole picture (2), and coined "premenstrual syndrome" instead - including headache, depression, emotional instability, breast pain, increased appetite and weight gain. At this stage, PMS and PMDD weren’t yet distinguished; Dalton described a spectrum “unpleasant at their mildest, and at their severest incapacitating”.
Male researchers and doctors before her had hypothesised that these symptoms might come down to sexual dissatisfaction. Dalton disproved this in her study and set out the real triggers she saw, with puberty and childbirth among the most common. She opened one of the first clinics dedicated to PMS.
Psychiatrists fought over whether PMDD was a real diagnosis, or a weapon to be used against women
As Dalton's work continued, PMS became better known. Conferences were dedicated to it, and mental health professionals took notice.
In 1985, a committee was convened to consider adding a "subset of PMS conditions in which mood disturbance is a predominant symptom" to the next diagnostic manual, the DSM-3-R) (4).
It was controversial from the start. Some wanted this subset of premenstrual symptoms formally recognised as a diagnosis; others, including prominent feminists, worried that its inclusion would hand ammunition to misogynistic and discriminatory claims, such as workplace exclusion. The compromise: late luteal phase dysphoric disorder (LLPD) was placed in the appendix of the DSM-III-R, marked as a condition “requiring further study”.
After this, huge debates opened up over including LLPDD in the DSM-4. A widely circulated petition argued against classifying premenstrual distress as a mental illness. The work group voted to keep it in the appendix rather than move it into the main body of the manual- but renamed it premenstrual dysphoric disorder (PMDD).
Medications became approved
In 2000, fluoxetine, rebranded as Sarafem, was approved for PMDD by the FDA. The debate stopped being purely philosophical. Doctors could now prescribe for it, regardless of what the DSM officially said.
In 2006, hormonal contraceptives entered the picture. The FDA approved Yaz, the first combined oral contraceptive for PMDD.
Both types of treatments remain first-line today, despite recent research reviews showing inconsistent results (5).
PMDD Finally Becomes an Approved Diagnosis
As discussions on the DSM-5 began, the approach shifted. Where the DSM-5 had focused on reducing harm, the DSM-5 was bolder, - willing to include conditions that had sat in that "borderline" position.
In 2013, PMDD finally entered the main DSM-5 manual, under "depressive disorders" for routine clinical use. The committee pointed to consistent prevalence rates across countries, some efficacy of SSRIs, a clear distinction between PMDD and other mood disorders, and negative responses to hormonal add-back therapy.
The inclusion also reflected a shift in feminism at the time. A newer generation of feminists held a more secure view of women's status, where recognising a menstrual-cycle-related condition as empowering, was not a threat to the movement.
Gynaecological vs Psychiatric: The World Other Diagnostic Manual Disagrees
The world's other major diagnostic manual, the ICD-11, finally added PMDD when the revision was released in 2019 (effective from 2022).
But it made an interesting choice. In this manual, PMDD sits primarily under diseases of the genitourinary system, while being cross-listed under depressive disorders because mood symptoms dominate (6). In other words, the ICD could not fully commit to one side -filing PMDD as gynaecological while flagging it as psychiatric at the same time. It’s the exact tension that has trailed this condition for almost a century.
A New Wave of Neuroscience Research
Despite the manuals' disagreement, research into PMDD has accelerated over the past decade - subtypes, neurological underpinnings and comorbidities are coming into view. PMDD is shown not to be about abnormal levels of hormones, but rather a sensitivity in the brain to the normal fluctuations of hormones across the menstrual cycle. A specific inefficiency of the GABA system (the brain’s brake or calming system) is recently found to be central to this (7).
Community and Powerful Advocates
In 2013, the International Association for Premenstrual Disorders (IAPMD) was founded - the world’s first patient led nonprofit focused on PMDD. Its purpose is to spread awareness and elevate overlooked voices - you can find more information here.
In 2024, the UK gained its very own PMDD charity, which aims to raise awareness, provide support and support research into PMDD - you can find out more here.
The takeaway
It is concerning that PMDD was first mentioned almost a century ago, and that we are only now uncovering the neurobiological detail. More striking still: the two manuals clinicians rely on to diagnose and support those with PMDD still can't agree on where it belongs. The DSM treats it as a depressive disorder; the ICD files it first as gynaecological. That split trickles down into under- and misdiagnosis, and patients being handed to and from gynaecologists and psychiatrists with nobody really owning the care of PMDD. When these two bodies reach a consensus, more correct awareness is raised, and further research is reveals more about this condition - a much stronger foundation for PMDD support can be built. With organisations like IAPMD and The PMDD Project now in place, and several passionate researchers leading the way, that support is closer than it has ever been. In the meantime, we keep fighting.
References
1. FRANK RT. THE HORMONAL CAUSES OF PREMENSTRUAL TENSION. Arch NeurPsych. 1931;26(5):1053–1057. doi:10.1001/archneurpsyc.1931.02230110151009
2. Greene R, Dalton K. The Premenstrual Syndrome Br Med J 1953; 1 :1007 doi:10.1136/bmj.1.4818.1007
3. Late luteal phase dysphoric disorder and DSM-III-R . (1989). American Journal of Psychiatry, 146(7), 892–897. https://doi.org/10.1176/ajp.146.7.892 (Original work published July 1, 1989)
4.Zachar, Peter, and Kenneth S. Kendler, 'A DSM insiders’ history of premenstrual dysphoric disorder', in Kenneth S. Kendler, and Josef Parnas (eds), Philosophical issues in psychiatry III: The Nature and Sources of Historical Change, International Perspectives in Philosophy & Psychiatry (Oxford, 2014; online edn, Oxford Academic, 1 Jan. 2015), https://doi.org/10.1093/med/9780198725978.003.0041, accessed 10 Aug. 2026.
5. Jespersen, C.; Lauritsen, M.P.; Frokjaer, V.G.; Schroll, J.B. Selective Serotonin Reuptake Inhibitors for Premenstrual Syndrome and Premenstrual Dysphoric Disorder. Cochrane Database Syst. Rev. 2024, 2024, CD001396, doi:10.1002/14651858.CD001396.pub4.
6. Schroll JB, Lauritsen MP. Premenstrual dysphoric disorder: A controversial new diagnosis. Acta Obstet Gynecol Scand. 2022 May;101(5):482-483. doi: 10.1111/aogs.14360. PMID: 35451057; PMCID: PMC9564553.
7. Stiernman, L., Comasco, E., Johansson, M. et al. Transcription of GABAA receptor subunits in circulating monocytes and association to emotional brain function in premenstrual dysphoric disorder. Transl Psychiatry 15, 255 (2025). https://doi.org/10.1038/s41398-025-03465-6
