Profile and predictors of premenstrual dysphoric disorder in women with bipolar I disorder: An exploratory study from India

ABSTRACT Background: 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. Aims: The study aimed to assess the clinical characteristics and predictors of PMDD in women with BD-I. Materials and Methods: 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. Results: 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). Conclusion: The study underscores lifetime suicidality, seasonality, and familiality as predictors of PMDD in women with BD.