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About 75 % of women in reproductive age report premenstrual changes (Wittchen et al., 2002). These changes cover a broad spectrum, ranging from positive and common premenstrual changes to severe complaints (Campagne & Campagne, 2007). Typical examples are an increase in energy but also severe irritability and affect lability. The terms premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) are used when the complaints go along with severe impairment (Campagne & Campagne, 2007; O’Brien, Bäckström, et al., 2011). Due to the heterogeneous definitions and operationalizations of the diseases the diagnostics and criteria used to determine if treatment is necessary remain imprecise (O’Brien, Rapkin, et al., 2011). Even though first evidences for the efficacy of cognitive behavioral therapy (CBT) exist, these studies have several methodological limitations (Busse et al., 2009; Kleinstäuber et al., 2012; Lustyk et al., 2009). Furthermore, the mentioned positive premenstrual changes are not yet considered in diagnostics and psychoeducation.
Based on current research, the present dissertation focused on three main points: First, the use of a prospective diary (study I) and the development of an impairment questionnaire (study II) were studied in order to optimize the insufficient diagnostics. Criteria for severe PMS and PMDD were operationalized. The results showed that the developed scores of the diary as well as the impairment questionnaire were reliable and valid. Differences between women with PMS and PMDD were found in the scores based on the diary and not in the perceived global impairment, measured by the questionnaire.
Second, we developed a study protocol for the implementation and evaluation of an internet-based self-help for the treatment of premenstrual complaints based on cognitive-behavioral approaches (study III). The study protocol includes a routine according to which participants are diagnosed with a prospective diary over two men-strual cycles, a structured clinical interview and an individually calculated premenstrual phase for the completion of a questionnaire aiming at measuring the primary and secondary outcome.
Third, an experimental study helped to examine the influence of information about premenstrual changes on the retrospective report of positive and negative premenstrual changes (study IV). The findings indicated that information about negative pre-menstrual changes leads to less positive and more negative changes in comparison to neutral information and information about positive and negative changes.
The results emphasize the importance of a comprising diagnostic that should also measure positive premenstrual changes and of psychoeduation about PMS, which should be extended to include information about such positive changes. The results are discussed in the context of a potential pathologization of the female cycle (Chrisler & Caplan, 2002; Epperson & Steiner, 2012) and a negation of premenstrual complaints (Markens, 1996) and implications for clinical practice and research are derived.