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Book Reviews   |    
The PMDD Phenomenon: Breakthrough Treatments for Premenstrual Dysphoric Disorder (PMDD) and Extreme Premenstrual Syndrome (PMS)
Reviewed by Leslie Hartley Gise, M.D.
Psychiatric Services 2003; doi: 10.1176/appi.ps.54.9.1294
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by Diana L. Dell, M.D., F.A.C.O.G., and Carol Svec; Chicago, Contemporary Books, 2003, 239 pages, $14.95 softcover

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This useful little book is both simple and comprehensible to the lay audience for whom it is intended, yet technical enough to be scientifically correct. Such an accomplishment is difficult given the paradoxes, uncertainties, and complexities in this field. The scope of The PMDD Phenomenon is comprehensive and the tone nonjudgmental. The authors "have experienced some form of these disorders" themselves, which makes them sensitive to the predicaments that women encounter in the face of jokes, ignorance, and negative attitudes about premenstrual problems. The book is enriched by extensive quotes from affected women. For example: "It's like having severe sunburn of your emotions." Hypotheses about the causes of premenstrual problems, myths about medication, and drug interactions are reviewed.

In three cases a table would have been helpful: in the review of the hormonal changes during the menstrual cycle, in the discussion of the differences between depression and premenstrual problems, and in the discussion of the mechanism of action of medications that affect the serotonergic system. The table showing the patterns of symptom presentation across the menstrual cycle, taken from a classic 1995 article, is helpful.

In general, this book covers complex ideas in plain language that only rarely lapses into jargon that may not be easily understood by everyone. More discussion could have been given to the mind-body problem and the interaction of genes and the environment. The important issues of empowerment and validation are addressed. An important point that is explained well is that women may incorrectly perceive that their work suffers during the premenstrual phase.

Although premenstrual problems are both over- and underdiagnosed, this book stresses underdiagnosis and emphasizes the importance of rating symptoms on a daily basis. The discussion of differential diagnosis could have been extended, given that this is a complex issue that involves such confounders as drug and alcohol abuse, marital problems, and endometriosis.

A whole chapter is devoted to premenstrual exacerbation, also called premenstrual magnification, which is poorly understood yet very common. The stigma of mental illness—which I prefer to call ignorance, which can be addressed through education—is also covered. The discussion of food cravings is reassuring, because women have been brainwashed into thinking that giving in to a craving is a sign of weakness. Nutritional supplements and complementary treatments such as herbal supplements, acupuncture, and relaxation are comprehensibly reviewed, as are light and sleep therapies.

Little emphasis is placed on confirmation of ovulation, a problem in the literature that probably contributes to much of the confusion in the field. With the availability of home ovulation-detection kits, this is potentially less of a practical problem than it was in the past. The chapter on psychological therapies is somewhat confusing, because it both emphasizes and minimizes the impact of psychological factors. The second last chapter provides a practical approach for addressing premenstrual problems, and the book ends with advice for the significant others who are affected by premenstrual mood changes.

The PMDD Phenomenon is the most comprehensive and balanced book of its kind and is likely to be very helpful to women who suffer from premenstrual problems.

Dr. Gise is clinical professor of psychiatry at the University of Hawai'i and staff psychiatrist at the Maui Community Mental Health Center.

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