The work proposed for this renewal application continues to have the long-term aim of better understanding the nature and course of severe premenstrual syndromes. The studies are focused upon efforts to prospectively identify characteristics of women who are vulnerable to the development of severe or extreme premenstrual problems and to better understand the natural history and correlates of premenstrual syndromes with different clinical characteristics. The findings have the potential to help guide clinical practice and planning to help focus efforts to determine the pathophysiology of severe premenstrual problems. Components specific aims are: 1. Identify characteristics of prior history and intake status that are (a) correlated with severe premenstrual dysphoric mood changes and functional impairment and (b) predictive of their subsequent development. 2. Identify the pattern of interactions between prior history and intake characteristics and intervening variables which might increase the risk for development of severe premenstrual syndromes (e.g., pregnancy, use of oral contraceptives, life stress). 3. Determine, prospectively, the relationship between severe premenstrual syndromes and severe dysphoric changes at other periods of hormonal change (miscarriage, childbirth, menopause). 4. Determine, prospectively, the degree to which premenstrual problems increase the risk for development of episodic or chronic mental or other medical disorders. 5. Determine the stability, or instability, of levels of severity of different types of premenstrual mood, behavioral, and physical changes. 6. Try to identify intervening variable that might help account for a lessening of severity of premenstrual problems (e.g., treatment, changes in levels of stress or life-style). The proposed studies involve continued follow-up evaluations of women who at intake had no current physical or mental disorder, who were without problems during the follicular phase of the menstrual cycle and were characterized by having either: (1) no or only mild premenstrual changes in mood, behavior, or physical condition and no functional impairment; or (2) moderate premenstrual changes in mood and behavior and some functional impairment but no history of ever having sought treatment for these changes; or (3) distinct and severe or extreme premenstrual syndromes characterized by anxiety, irritability, or depression and functional impairment associated with these changes.
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