Date of Award

2006

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Psychology

Abstract

Premenstrual Dysphoric Disorder (PNMD) is included in the DSM-IV (APA, 1994) Appendix A, Criteria Son and Axes Provided for Further Study. Its symptoms overlap significantly with mood and anxiety disorders, but occur in the late luteal phase of the menstrual cycle and remit by the early follicular phase. Thus, PMDD is a challenging differential diagnosis that relies upon establishing a temporal relationship between symptoms and the menstrual cycle, and it provides an opportunity for examining gnostic decision making processes. A national sample of psychologists (n = 155) and psychiatrists (n = 139) were presented with an Internet web page with a case of a patient with PMDD and asked to provide diagnostic ratings and diagnoses. They also were asked to select from among four types of additional information (medical, psychosocial, test, mental status examination) to facilitate their decision-making and to simulate the diagnostic process. Few diagnoses of PMDD were assigned and most diagnosed mood disorders. Contrary to expectations, psychologists assigned more PMDD rule-out diagnoses and rated the case as more representative of PMDD compared to psychiatrists. Psychologists were also more likely than psychiatrists to initially select the medical information which contained the essential information about the relationship of the symptoms to the menstrual cycle and medical conditions that must be ruled out. Psychiatrists were more likely to choose the mental status examination first. These differences were only partly explained by gender differences and the larger percentage of women among the psychologists. The majority (63.9%) of participants provided the same initial and final diagnosis. Results are discussed in terms of diagnostic decision-making strategies and clinicians' familiarity with PMDD.

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