Profile and predictors of premenstrual dysphoric disorder in women with bipolar I disorder: An exploratory study from India
Abstract
Bipolar disorder (BD) and premenstrual dysphoric disorder (PMDD) are recurring affective disorders that significantly impact the mental wellbeing of affected women, particularly when they co-occur. Despite the recent recognition of PMDD as a distinct mood disorder in Diagnostic and Statistical Manual of Mental Disorders (DSM), Fifth Edition, it remains understudied. The study aimed to assess the clinical characteristics and predictors of PMDD in women with BD-I. Premenopausal women aged 18–45 years with DSM-5 BD-I in clinical remission (Young’s Mania Rating Scale ≤4, 17-item Hamilton Rating Scale for Depression ≤7) were enrolled. Participants were assessed using a clinical proforma, National Institute of Mental Health life-chart, International Group for the Study of Lithium-treated Patients scale for typical/atypical features, Columbia Suicide Severity Rating Scale, Seasonal Pattern Assessment Questionnaire, DSM-IV-based Premenstrual Symptoms Screening Tool, Premenstrual Tension Syndrome Observer Rating Scale-Revised, and Premenstrual Tension Syndrome Self-Rating Visual Analogue Scale. Among 85 women with DSM-5 BD-I, 36.5% met the threshold for PMDD (30.68 years, standard deviation [SD]: 6.47). The age of onset for BD and PMDD was 21.77 (SD: 4.56) and 21.81 (SD: 4.15) years, respectively. Women with BD-PMDD had a distinct profile, including an earlier onset for BD, depressive polarity at onset, and higher atypicality. The regression model was significant ( χ ² =42.079, P < 0.001; Nagelkerke R ² =0.534), with a good fit. The global seasonality score (odds ratio [OR]: 1.274, 95% confidence interval [CI]: 1.077–1.508; P = 0.005), lifetime suicide attempt (OR: 5.954, 1.532–23.135), and family psychiatric history (OR = 6.513, 1.734–24.463) were associated with an increased likelihood of PMDD, while history of pregnancy (OR = 0.207, 95% CI: 0.058–0.735) was associated with a lower likelihood. The regression model demonstrated strong discriminative ability in predicting PMDD in BD (area under the curve = 0.889). The study underscores lifetime suicidality, seasonality, and familiality as predictors of PMDD in women with BD.