The Premenstrual Syndrome

CASE PRESENTATION A 30-year-old married mother of four was referred to the National Institute of Mental Health for a cyclic mood disorder. She observed that over the preceding 7 years she experienced mood and somatic symptoms seemingly related to her menstrual cycle. Approximately 9 days before her menses, she would become sad and cry, want to be alone, and experience sensitivity to rejection, guilt, self-criticism, and occasional suicidal ideation. These symptoms were not responsive to expressed concern from others. Rather, she attempted to isolate herself because she became profoundly irritable around others and demonstrated anger, impatience, "meanness," overreactivity, and verbal outbursts. Her verbal loss of control caused problems at work and in her relationships with her family. Other symptoms included a decrease in her general level of interest and energy, an inability to initiate activities or to experience pleasure, fatigue, disturbed sleep, distractibility, indecisiveness, and increased appetite and food intake