Subtypes of Premenstrual Dysphoric Disorder: Network analyses of temporal symptom trajectories and the role of sex hormones

• Applicant: Dr. Sibel Nayman
• Subject Area: Personality Psychology, Clinical and Medical Psychology, Methodology
• Term: since 2025
• Project identifier: Deutsche Forschungsgemeinschaft (DFG) - Project number 565812188

Premenstrual Dysphoric Disorder (PMDD) is a new diagnostic entity in the ICD-11 and DSM-5, characterized by marked affective core symptoms and additional psychological and/or somatic symptoms. PMDD symptoms are closely linked to the menstrual cycle, occurring during the luteal phase and resolving within a week after menstruation onset during the follicular phase. Current evidence suggests that PMDD symptoms result from increased central nervous system sensitivity to normal fluctuations in the sex hormones progesterone and estradiol. There may be subtypes of hormone sensitivity, manifested by variability in symptom characteristics, severity and timing of symptom onset (early vs late luteal phase) and postmenstrual symptom clearance (rapid vs gradual). However, PMDD has hitherto been largely treated as homogeneous across and stable within individuals. In turn, the categorical diagnosis of PMDD may have limited utility for treatment, whereas etiological subtyping may help to develop of cycle-phase tailored treatment approaches. This project will take a mechanism-based approach to quantify inter- and intra-individual variability in PMDD symptomatology and hormone sensitivity. In particular, I aim 1) to identify differences in temporal trajectories of PMDD symptomatology across individuals and specific symptom clusters, 2) to examine the within-person covariation of specific PMDD symptom trajectories with trajectories in sex hormones and cortisol activity, considering early life adversity as a moderating psychosocial factor, and 3) to explore time-varying, proximal psychological, physiological and behavioral moderators of specific within-person symptom networks. A total of 120 women with PMDD will be recruited. Following a baseline session, participants will complete a PMDD-specific symptom diary and Ambulatory Assessments (AA) over two menstrual cycles. Participants will report on their momentary mood and cognitions three times and on their PMDD symptoms and perceived stress once a day. On every third assessment day, participants will provide four saliva samples throughout the day to assess cortisol activity, progesterone and estradiol. Assessments of cortisol activity will be paired with self-reported AA prompts with a 10-minute time lag. Potential behavioral markers (i.e. sleep duration and physical activity) will be assessed continuously over the two cycles using smart finger rings. Using the dynamic network approach of Subgrouping within Group Iterative Multiple Model Estimation (sGIMME), I expect to identify three PMDD subtypes based on differences in symptom timing and hormone sensitivity, as well as proximal psycho-bio-behavioural symptom drivers across the cycle, which will a) contribute to intra-individual variability, b) complement existing etiological models of PMDD, and c) allow to identify early warning signs and to move towards personalized medicine for PMDD.

• DFG Programme: Research Grants