In the current (1987) edition of the APA’s Diagnostic and Statistical Manual, the form of severe PMS called “late luteal phase dysphoric disorder” turns up in a kind of twilight zone, a special Appendix created for maladies that elude classification and need further probing. It’s also briefly cited under a nebulous category called “mental disorders-not otherwise specified.” Now, after a serious exploration and review of the whole field of PMS, the majority of the task force thinks the condition-which it now calls “pre-menstrual dysphoric disorder” (PMDD)-should appear in the main body of the text as a more specifically defined psychiatric disorder. These psychiatrists propose listing PMDD in the main text of the next edition of the manual, under disorders of mood and depression-as well as retaining the fuller description in the Appendix.
Proponents claim that the more specific designation would have several benefits. For one, they say, women suffering from PMDD won’t be as likely to be condescendingly dismissed by physicians they consult. If they receive treatment for their symptoms, they’ll have a better chance of reimbursement by insurance companies. “If there hadn’t been concern about stereotyping, and [PMDD] had been viewed on the merits of the science, there would be no doubt that it’s a disorder, says Dr. Robert Spitzer, professor of psychiatry at Columbia University College of Physicians and Surgeons and an adviser to the PMS task force.
But many women, including APA members, are outraged by the proposed reclassification. Establishing a category of mental disorder that includes only women, they insist, would stigmatize the entire gender. “It doesn’t belong anywhere in the book at all because it’s not a mental disorder,” says Paula Kaplan, former adviser to the task force and a psychologist at the Ontario Institute for Studies and Education in Toronto. “The next time a woman is nominated for attorney general, she’ll be asked: ‘Have you had PMDD?’”
Sentiments on both sides of this debate run high, and the proposed recommendation-a compromise between two feuding camps-pleases almost nobody. APA members will vote on the issue in May, and it will come up for final approval by the Board of Trustees in July. Chances are there will be tears, irrationality and outbursts of anger-elicited by neither hormones nor mental illness.
