Premenstrual Dysphoric Disorder requires symptoms to start a week before menses and total at least five symptoms. Which option correctly reflects the initial timing?

• A. Start a week before menses
• B. Start during menses
• C. Start two weeks before menses
• D. Start after menses ends

Answer: (A)

PMDD symptoms start in the luteal phase, the final week before menses, and typically ease once menses begins. This premenstrual onset is what makes a week before menses the correct initial timing. If symptoms began during menses, two weeks before, or after menses ends, they wouldn’t fit PMDD’s pattern of luteal-phase onset. (Note: diagnosis also requires at least five symptoms in that final week, but the question specifically asks when symptoms first appear.) Therefore, starting a week before menses best reflects the initial timing.