Association Between Premenstrual Dysphoric Disorder and ADHD/ASD: A Review of Current Evidence

Premenstrual dysphoric disorder (PMDD) is a severe form of menstrual cycle-related mood disorder, significantly impacting mental health, daily functioning, and quality of life. This review article analyzes data on the comorbidity of PMDD with ADHD and/or autism spectrum disorder (ASD). Studies suggest that women with ADHD, or elevated ADHD traits, may be more likely to meet the criteria for PMDD. This association may be particularly pronounced in individuals with comorbid depression and/or anxiety. By contrast, evidence regarding ASD and PMDD remains limited and inconsistent. Although one prospective study, based on the DSM-IV criteria, reported a very high prevalence of late luteal phase dysphoric disorder in autistic women with intellectual disabilities, more recent studies in intellectually capable autistic adolescents and adults did not confirm this association. The findings regarding individuals with co-occurring ASD and ADHD also remain inconclusive. Nevertheless, current evidence warrants cautious interpretation due to methodological limitations. Further research should utilize prospective longitudinal designs, include large, inclusive cohorts (with transgender and gender diverse individuals), and stratify groups according to DSM-5 or ICD-11 criteria. It is important to carefully differentiate between PMDD and premenstrual exacerbation of ADHD symptoms, especially in ADHD population. Furthermore, studies should investigate the potentially shared pathophysiological mechanisms between PMDD and ADHD. Finally, it is important to establish tailored therapeutic protocols for optimizing care in comorbid populations.