What causes PMDD?

This preprint is a narrative review integrating neurobiological, psychological, relational, and diagnostic research on Premenstrual Dysphoric Disorder (PMDD). The manuscript synthesizes evidence on neurosteroid sensitivity, GABAergic variability, corticolimbic network differences, salience processing, interoception, executive functioning, and emotional regulation, with additional conceptual interpretations offered where empirical data are limited. The review also examines the interaction between PMDD and ADHD, highlighting shared regulatory vulnerabilities and the clinical relevance of their overlap. Relational and diagnostic implications are discussed, including the risk of misclassification when cyclical patterns are not assessed. Because this is a narrative review, several proposed mechanisms—such as interoceptive variability, episodic memory disruption, and dual‑system models of attachment and emotion regulation—are conceptual hypotheses that require direct empirical testing. The manuscript aims to clarify PMDD as a hormonally sensitive, predominantly cycle‑dependent form of dysregulation that benefits from cycle‑informed assessment, prospective tracking, and careful differential diagnosis.

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