Introduction
Premenstrual symptoms are very common in reproductive-age women, but only a subset experience symptoms that are severe, impairing, and clinically actionable. The clinical challenge is separating “some premenstrual change” from a disorder-level pattern that disrupts functioning and may warrant targeted intervention. The PSST was developed to support that decision-making by capturing both symptom severity and impact, not just symptom presence (Steiner, Macdougall, & Brown, 2003).
From a psychological perspective, PMDD and severe PMS are important because they can produce marked mood and interpersonal difficulties, reduce productivity, and impair quality of life. The tool is also valuable pragmatically: it provides a rapid first-step screen that can be used in routine settings, rather than relying immediately on two cycles of prospective daily ratings, which are often burdensome and can delay help-seeking and treatment.
Term |
Definition |
Premenstrual syndrome (PMS) |
A pattern of recurrent physical and/or psychological symptoms (for example bloating, breast tenderness, fatigue, irritability, low mood) that emerge in the late luteal phase (the days before menstruation), improve within a few days after bleeding starts, and are at least somewhat distressing or disruptive, but typically less severe than PMDD. |
Premenstrual dysphoric disorder (PMDD) |
A severe, impairing form of premenstrual disturbance in which prominent mood symptoms (especially marked irritability/anger, mood swings, depressed mood, or anxiety/tension) recur in the week before menstruation, remit shortly after onset of menses, and cause clinically significant impairment in work, social life, or relationships. |
The Premenstrual Symptoms Screening Tool (PSST) is a brief clinician-friendly screening questionnaire designed to identify women likely to meet criteria for premenstrual dysphoric disorder (PMDD) and to flag clinically significant PMS. It “translates” DSM-style categorical criteria into a severity-rated format, asking respondents to rate a set of common premenstrual mood/behavioural and physical symptoms (for example irritability, anxiety/tension, tearfulness/sensitivity to rejection, depressed mood, concentration problems, fatigue, sleep and appetite changes, and physical symptoms) on a 4-point scale from not at all to severe.
Crucially, the PSST also measures functional impairment by asking whether symptoms interfere with key domains such as work productivity, social activities, home responsibilities, and relationships. Scoring rules then classify likely PMDD versus moderate-to-severe PMS based on the presence of core mood symptoms, overall symptom burden, and degree of impairment.
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Legal stuff
It seems the scale can be used for research.
Technically
This is a simple scale question. For the diagnostic criteria, however, we used a number of tricks using set questions.
The survey code for PsyToolkit
scale: severity - Not at all - Mild - Moderate - Severe page: begin l: PSST1 t: scale severity q: *Do you experience some or any of the following premenstrual symptoms which <i>start before</i> your period and <i>stop</i> within a few days of bleeding?* - 1. Anger/irritability - 2. Anxiety/tension - 3. Tearful/Increased sensitivity to rejection - 4. Depressed mood/hopelessness - 5. Decreased interest in work activities - 6. Decreased interest in home activities - 7. Decreased interest in social activities - 8. Difficulty concentrating - 9. Fatigue/lack of energy - 10. Overeating/food cravings - 11. Insomnia - 12. Hypersomnia (needing more sleep) - 13. Feeling overwhelmed or out of control - 14. Physical symptoms: breast tenderness, headaches, joing/muscle pain, bloating, weight gain l: PSST2 t: scale severity q: *Have your symptoms, as listed above, interfered with...* - A. Your work efficiency or productivity - B. Your relationships with co-workers - C. Your relationships with your family - D. Your social life activities - E. Your home responsibilities page: end ## -- scoring ## the following criteria must be present for a diagnosis of PMDD ## 1: at least one of items 1,2,3,4 must be severe ## 2: in additiona at least four of 1-14 are moderate to severe ## 3: at least one of A=E is severe ## ## the following for a diagnoes of moderate to severe PMS ## 1: at least one of items 1,2,3,4 is moderate or severe ## 2: in additiona at least four of 1-14 are moderate to severe ## 3: at least one of A-E is moderate to severe l: PSSTsevere1 t: set - if $PSST1.1 = 4 then 1 l: PSSTsevere2 t: set - if $PSST1.2 = 4 then 1 l: PSSTsevere3 t: set - if $PSST1.3 = 4 then 1 l: PSSTsevere4 t: set - if $PSST1.4 = 4 then 1 l: PSSTsevere5 t: set - if $PSST1.5 = 4 then 1 l: PSSTsevere6 t: set - if $PSST1.6 = 4 then 1 l: PSSTsevere7 t: set - if $PSST1.7 = 4 then 1 l: PSSTsevere8 t: set - if $PSST1.8 = 4 then 1 l: PSSTsevere9 t: set - if $PSST1.9 = 4 then 1 l: PSSTsevere10 t: set - if $PSST1.0 = 4 then 1 l: PSSTsevere11 t: set - if $PSST1.11 = 4 then 1 l: PSSTsevere12 t: set - if $PSST1.12 = 4 then 1 l: PSSTsevere13 t: set - if $PSST1.13 = 4 then 1 l: PSSTsevere14 t: set - if $PSST1.14 = 4 then 1 ## l: PSSTsevereA t: set - if $PSST2.1 = 4 then 1 l: PSSTsevereB t: set - if $PSST2.2 = 4 then 1 l: PSSTsevereC t: set - if $PSST2.3 = 4 then 1 l: PSSTsevereD t: set - if $PSST2.4 = 4 then 1 l: PSSTsevereE t: set - if $PSST2.5 = 4 then 1 ################### l: PSSTmoderate1 t: set - if $PSST1.1 > 2 then 1 l: PSSTmoderate2 t: set - if $PSST1.2 > 2 then 1 l: PSSTmoderate3 t: set - if $PSST1.3 > 2 then 1 l: PSSTmoderate4 t: set - if $PSST1.4 > 2 then 1 l: PSSTmoderate5 t: set - if $PSST1.5 > 2 then 1 l: PSSTmoderate6 t: set - if $PSST1.6 > 2 then 1 l: PSSTmoderate7 t: set - if $PSST1.7 > 2 then 1 l: PSSTmoderate8 t: set - if $PSST1.8 > 2 then 1 l: PSSTmoderate9 t: set - if $PSST1.9 > 2 then 1 l: PSSTmoderate10 t: set - if $PSST1.0 > 2 then 1 l: PSSTmoderate11 t: set - if $PSST1.11 > 2 then 1 l: PSSTmoderate12 t: set - if $PSST1.12 > 2 then 1 l: PSSTmoderate13 t: set - if $PSST1.13 > 2 then 1 l: PSSTmoderate14 t: set - if $PSST1.14 > 2 then 1 l: PSSTmoderateA t: set - if $PSST2.1 > 2 then 1 l: PSSTmoderateB t: set - if $PSST2.2 > 2 then 1 l: PSSTmoderateC t: set - if $PSST2.3 > 2 then 1 l: PSSTmoderateD t: set - if $PSST2.4 > 2 then 1 l: PSSTmoderateE t: set - if $PSST2.5 > 2 then 1 ###################################################################### ## ## this must be at least 1 l: PMMDcriterion1 t: set - sum $PSSTsevere1 $PSSTsevere2 $PSSTsevere3 $PSSTsevere4 ## this must be at least 4 l: PMMDcriterion2 t: set - sum $PSSTmoderate1 $PSSTmoderate2 $PSSTmoderate3 $PSSTmoderate4 $PSSTmoderate5 $PSSTmoderate6 $PSSTmoderate7 $PSSTmoderate8 $PSSTmoderate9 $PSSTmoderate10 $PSSTmoderate11 $PSSTmoderate12 $PSSTmoderate13 $PSSTmoderate14 ## this must be at least 1 l: PMMDcriterion3 t: set - sum $PSSTsevereA $PSSTsevereB $PSSTsevereC $PSSTsevereD $PSSTsevereE l: PMMDcriterion1satisfied t: set - if $PMMDcriterion1 >= 1 then 1 l: PMMDcriterion2satisfied t: set - if $PMMDcriterion2 >= 4 then 1 l: PMMDcriterion3satisfied t: set - if $PMMDcriterion3 >= 1 then 1 l: PMMDcriteriaSatisfied t: set - sum $PMMDcriterion1satisfied $PMMDcriterion2satisfied $PMMDcriterion3satisfied ###################################################################### ## ## this must be at least 1 l: PMScriterion1 t: set - sum $PSSTmoderate1 $PSSTmoderate2 $PSSTmoderate3 $PSSTmoderate4 ## this must be at least 4 l: PMScriterion2 t: set - sum $PSSTmoderate1 $PSSTmoderate2 $PSSTmoderate3 $PSSTmoderate4 $PSSTmoderate5 $PSSTmoderate6 $PSSTmoderate7 $PSSTmoderate8 $PSSTmoderate9 $PSSTmoderate10 $PSSTmoderate11 $PSSTmoderate12 $PSSTmoderate13 $PSSTmoderate14 ## this must be at least 1 l: PMScriterion3 t: set - sum $PSSTmoderateA $PSSTmoderateB $PSSTmoderateC $PSSTmoderateD $PSSTmoderateE l: PMScriterion1satisfied t: set - if $PMScriterion1 >= 1 then 1 l: PMScriterion2satisfied t: set - if $PMScriterion2 >= 4 then 1 l: PMScriterion3satisfied t: set - if $PMScriterion3 >= 1 then 1 l: PMScriteriaSatisfied t: set - sum $PMScriterion1satisfied $PMScriterion2satisfied $PMScriterion3satisfied #################################################################################################### j: if $PMMDcriteriaSatisfied < 3 then skip 2 l: reportPMMD t: info q: <mark>This is purely a computer/technical demonstration and we cannot guarantee that the calculation of the score is correct. Do not use this for any medical advice or decision making.</mark>¶ This survey used the premenstrual symptoms screening tool (PSST) for clinicians. According to this tool, your answers suggest that you might have Premenstrual Dysphoric Disorder (PMMD), a severe form of challenges associated with the premenstrual period ¶This is purely a computer/technical demonstration and the calculation might be wrong. ¶<mark>Do not use this for any medical advice.</mark> j: end j: if $PMScriteriaSatisfied < 3 then skip 2 l: reportPMS t: info q: <mark>This is purely a computer/technical demonstration and we cannot guarantee that the calculation of the score is correct. Do not use this for any medical advice or decision making.</mark>¶ This survey used the premenstrual symptoms screening tool (PSST) for clinicians. According to this tool, your answers suggest that you might have Premenstrual Syndrome (PMS), a set of challenges associated with the premenstrual period ¶<mark>Do not use this for any medical advice.</mark> j: end l: none t: info q: <mark>This is purely a computer/technical demonstration and we cannot guarantee that the calculation of the score is correct. Do not use this for any medical advice or decision making.</mark>¶ This survey used the premenstrual symptoms screening tool (PSST) for clinicians. According to this tool, your answers suggest that you might not have PMS or PMMD. ¶<mark>Do not use this for any medical advice or decision making.</mark>
References
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Steiner, M., Macdougall, M., & Brown, E. (2003). The premenstrual symptoms screening tool (PSST) for clinicians. Archives of women’s mental health, 6(3), 203-209. Link to article online