strange case of Dr. Jekyll and Ms. Hyde: How PMS become a cultural phenomenon and a psychiatric disorder, The

Once the stereotype of the premenstrual woman became established, it was easy to maintain. Maintenance is due, at least in part, to the illusory correlation, that is, the tendency to see evidence that two phenomena are related to each because prior expectations indicate that they ought to go together. The classic example of the illusory correlation is the belief that people behave irrationally or impulsively when the moon is full. Because of the expectation of lunar madness, people remember instances of erratic behavior (e.g., drunken drivers, impulsive acts that end in injury) that they observed when the moon was full and forget those that they saw during other phases of the moon. They label the expected instances of erratic behavior as lunar in nature, but make no attributions about the same behavior at other times of the month. The tendency to "misremember" more erratic behavior during the full moon phase supports the notion of lunar madness, just as the tendency to remember headaches, backaches, irritability, anger, and tension as occurring more often during the premenstrual phase supports the notion of menstrual madness. One of the problems with retrospective questionnaires in menstrual cycle studies is that when women cannot remember exactly when they had their last headache or crying spell, they will report it as having occurred during the premenstrual phase because that is when these symptoms are "supposed" to occur. Symptoms that occur during the premenstrual phase are labeled as PMS, whereas when the same symptoms occur at other times of the month they are not connected to the menstrual cycle. The strength of the illusory correlation may explain, at least in part, the tendency of the participants in Koeske and Koeske's (1975) study to attribute a vignette character's negative emotions to PMS even when the situation was described as unpleasant.

Premenstrual Dysphoric Disorder

What is PMDD?

PMDD is defined in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) (American Psychiatric Association, 1994) as at least five of the following (at least one must be among the first four) symptoms present during most of the week before the onset of the menses: "1) feeling sad, hopeless, or self-deprecating; 2) feeling tense, anxious, or `on edge'; 3) marked lability of mood interspersed with frequent tearfulness; 4) persistent irritability, anger, and increased interpersonal conflicts; 5) decreased interest in usual activities, which may be associated with withdrawal from social relationships; 6) difficulty concentrating; 7) feeling fatigued, lethargic, or lacking in energy; 8) marked changes in appetite, which may be associated with binge eating or craving certain foods; 9) hypersomnia or insomnia; 10) a subjective sense of being overwhelmed or out of control; 11) physical symptoms such as breast tenderness or swelling, headaches, or sensations of `bloating' or weight gain, with tightness of clothing, shoes, or rings. There may also be joint or muscle pain ... [or] suicidal thoughts" (p. 716). To distinguish PMDD from other forms of depression that might simply worsen at points during the menstrual cycle, the criteria include the statement that all of the symptoms must be absent during the week after the menses. The DSM-IV description includes the estimation that at least 75% of women report minor or isolated premenstrual symptoms, but only 3%-5% experience symptoms that meet the PMDD criteria. Although the stated intention of the psychiatrists who developed PMDD (and its predecessor LLPPD) was to move away from the "kitchen sink" diagnostic criteria of PMS and define a subset of women who experienced a unique psychiatric disorder, the symptoms of PMDD virtually overlap with those of PMS. Furthermore, as will be shown below, the marketers of prescription drugs to treat PMDD attempt to portray what is generally thought to be "PMS" as "PMDD."