Barriers to Diagnosis and Treatment for Premenstrual Dysphoric Disorder (PMDD): A Scoping Review

Premenstrual dysphoric disorder (PMDD) is a significant public health challenge. While research has increased over the past decade, barriers to PMDD diagnosis and treatment persist. This paper explores the global barriers to diagnosis and treatment for PMDD. A scoping review of the literature was performed using the PubMed, PsycINFO, and CINAHL Plus databases to compile existing data on barriers to PMDD diagnosis and treatment. Eligibility criteria for articles included original research published within the last 10 years, written in English, and focused on PMDD with explicit assessment of at least one barrier to diagnosis and/or treatment. Findings were organized into four domains: individual, medical, cultural, and structural barriers. At the individual level, barriers include internalized norms and stigma that deter help-seeking; medical trauma and mistrust; feelings of fear, shame, self-blame, and confusion; and diminished autonomy and increased side effects from prescribed PMDD treatments. Medical barriers include limited provider knowledge, nonadherence to diagnostic and treatment guidelines, and negative patient-provider interactions. Cultural barriers include reproductive and mental health stigma; gender and cultural norms; and cultural preferences for alternative medicine that reduce access to pharmacological treatment. At the structural level, barriers include fragmented healthcare and limited access to health services. These findings highlight the many diagnostic and treatment barriers for individuals living with PMDD, underscoring the need for future research and intersectional approaches to improve health outcomes for this population.