How are doctors and researchers diagnosing PMDD differently, and what factors are they using?

Premenstrual Dysphoric Disorder (PMDD) is a severe, cyclical mood disorder characterized by affective, behavioral and somatic symptoms occurring during the luteal phase of the menstrual cycle (O'Brien et al., 2011). It is formally recognized in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), with diagnostic criteria requiring the presence of at least five symptoms, including one core mood symptom and confirmation through prospective daily symptom ratings across at least two menstrual cycles (American Psychiatric Association, 2013). Despite its formal classification, PMDD remains underdiagnosed and inconsistently identified in both clinical and research contexts (Islas-Preciado et al., 2024). One major challenge lies in the variability of diagnostic approaches. While prospective tools such as the Daily Record of Severity of Problems (DRSP) are considered the gold standard, many studies and clinical settings rely on retrospective self-report measures, which are associated with recall bias and reduced diagnostic accuracy (Reilly et al., 2024). Furthermore, symptom presentation in PMDD is heterogeneous, with considerable variation in how symptoms are defined, measured and interpreted across studies (Reilly et al., 2024). Similarly, a range of biological, psychological and social risk factors have been proposed, including hormonal sensitivity, stress exposure and psychiatric comorbidities, yet there is no harmony on how these factors are assessed or their relative contribution to diagnosis (Jadhav et al., 2022; Reilly et al., 2024; Roy et al., 2025). This inconsistency limits comparability across studies, contributes to variability in prevalence estimates and may hinder effective clinical recognition and management (Reilly et al., 2024). Additionally, there is evidence suggesting that healthcare professionals may lack adequate training and awareness regarding PMDD diagnostic criteria and tools (Islas-Preciado et al., 2024). To date, no comprehensive synthesis has systematically mapped the diagnostic tools, symptom definitions and risk factor assessments used in PMDD research and practice. Given the methodological diversity and lack of standardisation, a scoping review is warranted to explore the breadth of existing evidence, identify patterns in diagnostic approaches and highlight gaps in the literature. Understanding diagnostic variability is essential for improving clinical practice, informing guideline development and addressing educational needs among healthcare professionals.

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