CAJ | 학술논문

经前期心境不良障碍（PMDD）是一组严重影响女性在家庭、工作和生活等方面功能的经前期不适心理、身体和行为症状。美国精神病学协会管理委员会于2012年底正式将PMDD作为美国精神障碍诊断与统计手册第五版（DSM-V）中的单独诊断类别，这一举措标志着未来PMDD研究将成为热点。而PMDD的诊断与评估标准、发病机理并不明确，未来研究将围绕运用统一规范的PMDD诊断与评估标准，结合生理和心理两方面证据深入探讨PMDD可能的病理机制，从而促进PMDD针对性治疗。
경전기심경불량장애（PMDD）시일조엄중영향녀성재가정、공작화생활등방면공능적경전기불괄심리、신체화행위증상。미국정신병학협회관리위원회우2012년저정식장PMDD작위미국정신장애진단여통계수책제오판（DSM-V）중적단독진단유별，저일거조표지착미래PMDD연구장성위열점。이PMDD적진단여평고표준、발병궤리병불명학，미래연구장위요운용통일규범적PMDD진단여평고표준，결합생리화심리량방면증거심입탐토PMDD가능적병리궤제，종이촉진PMDD침대성치료。
Premenstrual dysphoric disorder （PMDD） is a group of premenstrual psychological, physical, and behavioral symptoms which seriously affect women at work, school, and home. PMDD was formally termed by the Diagnostic and Statistical Manual of Mental Disorders 4th Edition （DSM-IV） in 1994, and was finally approved as a distinct diagnostic category in the ？fth edition of the Diagnostic and Statistical Manual of Mental Disorders （DSM-5） by the American Psychiatric Association （APA） board of trustees in the early December of 2012. It was a milestone for the studies on PMDD, which very well progressed in both fields of phenomenology and pathology in the last two decades, and it predicted that future studies of PMDD will become hot topics. However, the exact pathogenesis of PMDD is not clear. The reason may be that the screening and diagnosis criteria of PMDD were inconsistent accorss different studies, or that PMDD had both physiological and psychological pathological basis and manifestation. Therefore, only by comprehending both physiological and psychological evidence and screening out the real PMDD women can we gain insight into the pathogenesis of PMDD and, further, carry out specific treatments. Firstly, this paper introduces the phenomenology of PMDD. Sceondly, the paper sums up the main screening and diagnosis criteria of PMDD in recent years. Thirdly, this article summaried the previous studies of the pathogenesis of PMDD. Specifically, the common diagnostic tool of PMDD was the diagnostic criteria in DSM-IV, while DSM-5 made a improvement focusing on the time, type, and specificity of the symptoms. Base on the definition and diagostic criteria of PMDD, the most distinctive feature of PMDD was that its symptoms were related to menstrual cycle. Therefore, researcher explored the pathogenesis of PMDD from two perspectives： the neuroendocine perspective, and the brain mechanism one. The results of hypothalamic-pituitary-gonadal （HPG） and neurotransmitter revealed that PMDD females had been more sensitive to normal sex hormones fluctuations, especially progesterone, which may due to the dysfunction of neurotransmitter （mainly serotonin）. On the contrary, there is still no consistent conclusions on the brain mechanism of PMDD. Yet, based on previous studies we speculated that the brain structure and function changed among PMDD females, which especially manifested on the brain region related to emotional. Besides physiology symtoms, PMDD females also had significant mental symptoms. The added psychological factors can explain the individual differences of females’ premenstrual negative affect under the same biological basis. Research showed that the history of major depressive disorder （MDD） and maltreat both affect the stress reaction of PMDD females. Based on previous studies we can preliminarily speculate that a history of MDD mainly influenced the hypothalamic-pituitary-adrenal axis （HPA） activity of PMDD females’ stress reaction, while a history of maltreat mainly influenced the autonomic nervous system response of PMDD females’ stress reaction, though the sepeculation still need further research to confirm it. In summary, future research will focus on using the unified standard for PMDD diagnosis, examining the possible physiological and psychological pathomechanism of PMDD, thereby accomplishing a pertinence therapy for clinical subcategory PMDD women.