Prämenstruelle Beschwerden verstehen, diagnostizieren und behandeln. Randomisiert kontrollierte Studien zur Untersuchungkognitiv-behavioraler Ansätze bei der prämenstruellen dysphorischen Störung

Prämenstruell auftretende Symptome, beispielsweise Stimmungsschwankungen, erhöhte Reizbarkeit oder Schmerzen in der Brust, werden von 75% der Frauen im reproduktiven Alter berichtet, führen jedoch nicht automatisch zu einer Beeinträchtigung (Wittchen, Becker, Lieb, & Krause, 2002). Liegt eine B...

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Bibliographic Details
Main Author: Janda, Carolyn
Contributors: Weise, Cornelia (Dr. rer. nat.) (Thesis advisor)
Format: Doctoral Thesis
Published: Philipps-Universität Marburg 2015
Online Access:PDF Full Text
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Approximately 75% of women of reproductive age report premenstrual symptoms like mood changes, increased irritability, or breast tenderness. These symptoms do not automatically result in clinical impairment. Premenstrual symptoms that cause clinical impairment are labeled as Premenstrual Syndrome (PMS) or Premenstrual Dysphoric Disorder (PMDD). This classification follows the degree of symptom severity. PMDD is the most severe form of premenstrual symptoms. The present work encompassed four different studies which were based on previous research in the field of PMS and PMDD. The aim of these studies was to improve the interpersonal understanding of premenstrual symptoms, to standardize the diagnostic procedure of PMS and PMDS, and to present a new treatment program for PMS and PMDD. Especially women with severe premenstrual symptoms (PMDD) are faced with multiple prejudices about the premenstrual phase and report a lack of understanding by their relatives. The confrontation with these prejudices can lead to increased symptoms (Ussher & Perz, 2011). Study I analyzed whether study participants perception of a PMDD patient could be changed by textual information (psychoeducation, prejudice inducing information). The total sample encompassed 216 students. The results indicated that psychoeducation about PMDD resulted in a more positive rating of a woman with PMDD. Prejudice inducing information had no significant effect on the rating of a woman with PMDD. The diagnostic of PMS and PMDD is influenced by heterogeneous procedures. These can be traced back to (1) the existence of different definitions of PMS (e.g., American College of Obstetricians and Gynecologists [ACOG], 2000; Royal College of Obstetricians and Gynaecologists [RCOG], 2007)), (2) the infrequent use of prospective symptom diaries (Craner, Sigmon, & McGillicuddy, 2014), and (3) the application of assessments without a standardized evaluation schema (e.g., Hahn et al., 1998). Hence, the aim of Study II was to standardize the diagnostic process of PMS and PMDD within a DSM-5 based prospective symptom diary. Clearly defined criteria to diagnose PMS and PMDD were suggested. Additionally, two newly developed scores were evaluated on a sample of 98 women with severe PMS or PMDD (PMS = 70 women; PMDD = 28 women). The scores were reliable and valid. Also taken into consideration was the fact that women with PMS and PMDD receive either no treatment at all or are unsatisfied with their treatment (Kraemer & Kraemer, 1998). Although there exists evidence for the effectiveness for cognitive behavioral therapy and lifestyle interventions (e.g., change in diet), there are only a small number of well-designed randomized controlled trials (Bhatia & Bhatia, 2002; Kleinstäuber, Witthoft, & Hiller, 2012). Hence, Study III presented a randomized controlled trial to evaluate the efficacy of an internet-based treatment program for women with premenstrual burden that combines cognitive behavioral techniques (e.g., cognitive reframing) with lifestyle interventions (e.g., integration of sports in everyday life). Advantages of the study design are a detailed diagnostic with the use of a prospective symptom diary about two consecutive menstrual cycles and the individual calculation of the premenstrual phase for the completion of further questionnaires. Study IV presented the new treatment program (evaluated in Study III) for women with premenstrual burden. Previous approaches were not available for clinicians. For that reason the treatment program was adapted to an ambulant setting. Overall, the results of the present studies provide a starting point to (1) develop new psy-choeducational approaches for relatives of women with PMDD, (2) to further standardize the diagnostic of PMS and PMDD, and (3) to offer patients a new treatment.