Every month, some women experience depression, anxiety, irritability, mood swings and physical symptoms such as breast tenderness or bloating.

According to the American Psychiatric Association, these women aren’t just experiencing normal premenstrual syndrome, which affects many women in varying forms once a month.

Experts say these women are dealing with PMDD – premenstrual dysphoric disorder – a severe form of PMS that has caused controversy in the psychiatric world ever since its inclusion in the APA’s Diagnostic and Statistical Manual of Mental Disorders in 1987.

This manual estimates 3 to 9 percent of menstruating women in America suffer from PMDD – about half a million women. But many critics say that this is a false diagnosis – that PMDD in fact does not exist.

The Diagnostic Manual describes the disorder as a ‘depressive disorder, not otherwise specified,’ and describes its symptoms as depression, anxiety, anger or irritability, severe mood swings and physical symptoms such as breast tenderness and bloating. These symptoms are almost identical to those of PMS.

Importantly, the symptoms are documented as disappearing soon after menstruation begins.

Some critics, like Paula Caplan, a visiting scholar at the Pembroke Center for Women at Brown University, question the existence of the disorder because they say the APA has produced no convincing evidence to show that PMDD exists.

‘If you are suffering from depression you need to be told you are depressed,’ she said in a phone interview. ‘To call it PMDD when there is no scientific evidence to show that it exists, and then to base any treatment on that, means you are being subjected to experimental treatment without informed consent.’

Supporters of the illness say PMDD is a distinct psychological problem with a specific treatment, according to a 2001 Boston Globe Magazine article. PMDD is a serious but treatable condition, Phyllis Greenberger, the executive director of the Society for Women’s Health Research, told the magazine.

PMDD’s symptoms are linked to hormonal changes that take place during the menstrual cycle, much like those of PMS, psychiatrists say. However, the Food and Drug Administration has approved drugs far more severe than Midol – Sarafem and Zoloft, for example, which are antidepressants similar to Prozac – to combat the disorder.

Eli Lilly, the drug company which produces Prozac, approached the FDA for an extension of their Prozac patent in order to market it specifically to women who suffer from PMDD.

But PMDD cannot be a bona fide mental illness because some of its symptoms, such as breast tenderness and chocolate cravings, are physical symptoms, Caplan argued.

Women who have been told they suffer from PMDD may be experiencing anxiety-related symptoms caused by other problems, Caplan continued.

‘Research shows that women diagnosed with PMDD are more likely to have a history of depression, to have been in severely abusive relationships or in situations where they are being harassed,’ she said.

She emphasized that the emotional symptoms of PMDD have no relation to the menstrual cycle, but may linked to other serious psychological problems for which patients need to be treated.

Proponents of PMDD ‘appeal to the fear that women have of not appearing ‘nice’ at all times,’ Caplan said, criticizing drug companies for marketing to women by saying, ‘Here’s a drug that will make you into a nicer woman.’

‘There is no parallel category for men … no testosterone-based aggressive disorder,’ writes Caplan in her book, ‘They Say You’re Crazy.’

While critics of PMDD are outspoken in their opposition to its recognition as a psychiatric disorder, a large number of doctors and organizations accept the classification and agree with it.

‘We’ve got to educate women that they do not have to tolerate debilitating premenstrual symptoms,’ Greenberger wrote in a 2000 Women’s Health Weekly article. ‘Women have a right to know if what they are experiencing month to month is actually PMDD, and how to get help.’

‘I frequently work with patients who have waited years to ask a doctor about premenstrual problems or have been turned away by their healthcare provider when they tried to discuss symptoms,’ Jean Endicott, of Columbia University, said.

‘They fear becoming the target of jokes or that seeking help is a sign of weakness. Informing women and providers about diagnosing and treating PMDD helps clear the way to effective medical care.’