Although premenstrual syndrome is a well-known - if not well-understood - women's health condition, premenstrual dysphoric disorder is an even lesser-known related illness. PMDD is marked by many of the same symptoms as PMS - bloating, trouble sleeping and concentrating, irritability, headaches, backaches and food cravings - but to a more intense degree.

PMDD has existed in the Diagnostic Manual of Mental Disorders since 1987, but only in the appendix as needing "further study." Next year, however, the manual's fourth edition is set to include new validity for PMDD, which may have implications for employers under the Family and Medical Leave Act and the Americans with Disabilities Act.

Women now make up almost half of American workers (49.9% in 2009), and the percentage of women in childbearing years accounts for about 60% of the working women. At least 75% of women with regular menstrual cycles report unpleasant physical or psychological symptoms, yet just 3% to 8% of women experience PMDD.

A woman needs to present her physician with a full year's worth of symptom data before she is diagnosed with PMDD. Upon receiving a diagnosis, she'll receive a personalized treatment plan, which may entail nutritional supplements, diet and exercise changes, anti-depressants, prescription contraception and mental health therapy. PMDD previously was commonly misdiagnosed as depression, which is one reason, experts say, for the enhanced validity under the DMMD.

"One of the reasons for upgrading it is because it's likely to be misdiagnosed as either depressive disorder or personality disorder, rather than something that is unique to women," says Sue K. Willman, employment attorney at Spencer Fane Britt & Browne LLP, noting the FMLA implications for employers. "So, if it is being diagnosed ... FMLA certifications" may follow.

Doctors do not have to list PMDD specifically as a woman's reason for taking FMLA, but rather just cite the symptoms. Experts say it's unlikely there will be a flood of newly diagnosed women with PMDD because of the rigid and clear guidelines to diagnosis. Yet, certifying FMLA leave to employers as related to PMDD could be tricky.

"There might be a lack of credibility. Another woman may say, 'I have cramps too. Why can't I get [time] off?'" says Dr. Nancy Molitor, assistant professor of clinical psychiatry and behavioral science at the Northwestern University Feinburg School of Medicine and a clinical psychologist in private practice. "What's important for bosses to understand is that this is a serious, well-researched disorder that has strict criteria."

Molitor says most women she treats with PMDD only take off one to two days off a month, but her ultimate goal with patients is that eventually, they can manage the disease without taking time off from work.

For the most severe cases, PMDD would fall under ADA protection and employers would have to make reasonable accommodations for patients, which could mean allowing women to come to work late, leave early or take frequent breaks.

Employers can ask for a second opinion under FMLA for a PMDD diagnosis, but must assume the cost. However, Laura Kerekes, chief knowledge officer at ThinkHR, says privacy issues likely will prevent employers for taking such action. "The laws have a fair amount of teeth in them in regards to privacy, [so employers] are worried about digging too deeply," she says.

Myra Creighton, partner and attorney at Fisher & Phillips LLC, agrees that addressing PMDD could present legal difficulty for employers when it comes to ADA. "When you're talking about a psychiatric diagnosis, it's more difficult. It's harder to say something isn't a disability."

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