# Navigating Unique Diagnostic and Therapeutic Challenges in Premenstrual Dysphoric Disorder: A Case Report

## TL;DR

This case report explores the challenges in diagnosing and treating premenstrual dysphoric disorder in a young woman with severe mood symptoms.

## Contribution

The paper highlights unique diagnostic and therapeutic challenges in PMDD management, particularly in adolescents.

## Key findings

- PMDD was confirmed in a 19-year-old patient through symptom charting and DSM-5 criteria.
- Treatment with SSRIs and oral contraceptives improved the patient's condition significantly.

## Abstract

Premenstrual dysphoric disorder (PMDD) is a disabling form of premenstrual syndrome affecting females of reproductive age in the premenstrual period. The presentation may vary from severe mood lability to extreme attempts to end life, usually within a week before menstruation resulting in considerable stress, functional impairment, and interpersonal conflicts. We present an interesting case of a 19-year-old sexually active girl who presented with a polysubstance overdose owing to her cyclical episodes of severe mood symptoms including irritability and uncontrolled aggression. Detailed history and thorough examination raised suspicion of PMDD which was confirmed on prospective symptom charting for two menstrual cycles as described by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) diagnostic criterion. After the establishment of diagnosis, the patient was started on selective serotonin reuptake inhibitors to target PMDD symptoms along with oral contraceptive pills for birth control which showed marked improvement in her overall condition. We herein discuss multiple diagnostic and therapeutic challenges that limit correct diagnosis and timely management of PMDD, especially in the adolescent age group.