Can one questionnaire help doctors tell the difference between PMS, PMDD, and other mood disorders?

Purpose and Design Rationale COMPASS addresses an unmet and specific clinical need: initial differentiation of premenstrual syndrome (PMS), premenstrual dysphoric disorder (PMDD), perimenopausal mood disorder, borderline personality disorder (BPD), bipolar spectrum disorder, and complex post-traumatic stress disorder (C-PTSD) in clinical settings where these conditions share substantial affective symptom overlap. It additionally serves as a longitudinal adversity tracking instrument across a patient's clinical relationship, designed for serial administration at every visit. Existing validated instruments, including the DRSP and PSST, were designed to confirm or exclude PMDD. Neither addresses differential diagnosis across six presentations, nor does either instrument capture the lifetime adversity context required to distinguish hormonally-driven mood dysregulation from trauma-driven affective instability. C-PTSD, formally recognized in ICD-11 (2018) but absent from DSM-5-TR as a distinct diagnosis, represents the most common misdiagnosis target for BPD in patients with chronic interpersonal trauma histories. No existing brief instrument supports this differential at the point of care. The instrument integrates a two-group Lifetime Adversity Profile through Sections J and K, which captures both life/relational adversity (Group A, seven domains) and occupational adversity (Group B, seven domains). This structure replaces the occupationally-specific AAES from earlier versions. The original AAES framework was appropriate for the nursing workforce population but failed to capture the full range of adult adversity in patients who have left employment, whose primary trauma was non-occupational, or who do not identify with healthcare roles. Group B retains the original occupational trauma domains, reframed to apply to any service, caregiving, or public-facing employment role. Adverse childhood experience scoring has been expanded from a binary yes/no count to a frequency-weighted scale (wACE) that reflects the neurobiological reality that sustained, repetitive adversity produces different developmental and neurosteroid consequences than singular events. The trauma pattern screen (Section I) operationalizes the ICD-11 distinction between PTSD and C-PTSD using the International Trauma Questionnaire framework, enabling the differential diagnostic distinction between C-PTSD, BPD, and compound presentations.

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