title: Addressing concerns about the inclusion of premenstrual dysphoric disorder in DSM-5.
abstract: OBJECTIVE
  Inclusion of premenstrual dysphoric disorder (PMDD) into the main text of the DSM has been a point of controversy for many years. The purpose of this article is to address the main concerns raised by opponents to its inclusion. Concerns are presented and countered in turn.
  
  
  METHODS
  To identify the most prevalent arguments against inclusion of PMDD, we searched MEDLINE (1966-2012), PsycINFO (1930-2012), the Internet, and reference lists of identified articles during September 1-17, 2012, using the keywords PMDD, premenstrual syndrome (PMS), DSM, DSM-5, concerns, controversy, women, political power, workforce, courts, and history. The search was restricted to English-language publications. A total of 55 articles were identified and included. The most pressing arguments against inclusion were grouped by similarity and addressed if they were reported 5 or more times. Our review of the sources yielded 38 concerns regarding PMDD; 6 concerns were reported at least 5 times and are addressed in this article.
  
  
  CONCLUSIONS
  Evidence culled from historical and legal trends does not support the alleged societal use of PMS to harm women (eg, keeping women out of the workforce or using PMS against women in child custody disputes). Further, current epidemiologic research has answered all of the methodology criticisms of opponents. Studies have confirmed the existence of PMDD worldwide. The involvement of pharmaceutical companies in research has been questioned. However, irrespective of the level of association with industry, current research on PMDD has consistent results: PMDD exists in a minority of women.
  
  
  CONCLUSIONS
  Historically, the pain and suffering of women have been dismissed, minimized, and negated. Similarly, women with PMDD have often had their experience invalidated. With the preponderance of evidence in its favor, PMDD has been placed in the main text of the DSM-5, opening the door for affected women to receive the attention full diagnostic status provides.
authors.affiliation: Department of Psychiatry, Rush University Medical Center, 2150 W Harrison St, Chicago, IL 60612 ann_hartlage@rush.edu.
authors.forename: S Ann
authors.initials: SA
authors.lastname: Hartlage
authors.forename: Cynthia A
authors.initials: CA
authors.lastname: Breaux
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Yonkers
mesh_terms: D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D011293:Premenstrual Syndrome / Q000145:classification*