ADHD linked to higher risk of premenstrual dysphoric disorder

ADHD linked to higher risk of premenstrual dysphoric disorder | Image Credit: © BillionPhotos.com - © BillionPhotos.com - stock.adobe.com.

The risk of premenstrual dysphoric disorder (PMDD) may be increased in patients with attention-deficit hyperactivity disorder (ADHD), according to a recent study published in the British Journal of Psychiatry.¹

Linking ADHD and PMDD risk

The results indicated an over 3-fold higher risk of PMDD among women with ADHD vs those without ADHD, with further increases reported in women with ADHD alongside anxiety or depression. This highlighted potential benefits of PMDD screening among women with ADHD.

“Our findings emphasize the need to consider issues affecting adult women with ADHD, and more specifically how females with ADHD may be at higher risk for experiencing PMDD,” said Jessica Agnew-Blais, PhD, senior lecturer at Queen Mary University of London.

ADHD vs non-ADHD participants

Participants were recruited using the Prolific online platform.² The first wave of recruited patients included those answering positively to a question asking if they considered themselves to have ADHD, while the second wave included those answering negatively.

Additional eligibility criteria included being assigned female at birth, aged 18 to 34 years, and residing in the United Kingdom. ADHD symptoms were evaluated using the Adult ADHD Self-Report Scale (ASRS), an 18-item tool with moderate reported sensitivity and high specificity.

Participants were also asked about experiences of impairment in their home life, at work or school, and in social interactions with others. ADHD was defined as falling above the DSM-5 cut-off of at least 5 symptoms and having impaired function in at least 2 of these domains.

Controls included patients not self-reporting ADHD and not meeting the diagnosis criteria. Depression and anxiety were also determined through survey items asking if they had been diagnosed with either condition. This allowed 3 subgroups to be formed: patients with ADHD and anxiety or depression, ADHD only, and non-ADHD controls.

Evaluating premenstrual symptoms

Premenstrual symptoms were evaluated using the Premenstrual Symptoms Screening Tool (PSST), which has displayed swift, effective measurements of PMDD symptoms. These symptoms include irritability, anxiety, rejection sensitivity, depressed mood, decreased interest in work or social activities, trouble concentrating, insomnia, hypersomnia, fatigue, overeating, overwhelm, and physical symptoms.

The PSST defined patients with at least 1 mood related symptom rated severe, at least 4 other symptoms rated moderate to severe, and severe impairment in at least 1 setting as having PMDD. Covariates included age, educational attainment, hormonal contraception use, and ADHD medication use.

Clinical findings of PMDD risk

Age, educational attainment, and hormonal contraceptive use did not significantly differ between groups. However, depression and anxiety rates, as well as mean ASRS scores, were increased in the ADHD group vs the non-ADHD group.

Symptoms of PMDD were also more common in patients with ADHD vs those without ADHD, with rates of 31.4% and 9.8%, respectively. This indicated a 3.19-fold increase in provisional PMDD risk. The risk was further increased in patients meeting ASRS-based criteria of ADHD vs those with no diagnosis, with a rate of 41.1% indicating a 4.17-fold increase.

Comorbid anxiety or depression further raises risk

The rate of provisional PMDD was highest in patients with anxiety or depression alongside
ADHD, at 35.1% vs 20% in those with self-reported ADHD alone. Additionally, a relative risk for PMDD of 3.56 was reported among this population vs those without any of these diagnoses.

In comparison, the relative risk among patients with ADHD alone vs no ADHD was 2.03, indicating an approximately 2-fold increase in risk. Similar results were reported regardless of whether ADHD was self-reported or based on ASRS criteria, highlighting a significant link between ADHD and PMDD.

"Our findings also suggest that further research is needed to improve understanding of the link between ADHD and times of hormonal change, including the menstrual cycle, and to reduce health inequalities and diagnostic bias in women and girls with ADHD,” said Thomas Broughton, PhD, BSc, MSc, postdoctoral researcher at Queen Mary University of London.¹

References:

1. ADHD link to severe premenstrual disorder uncovered in women. Queen Mary University of London. June 23, 2025. Accessed June 26, 2025. http://eurekalert.org/news-releases/1088481.
2. Broughton T, Lambert E, Wertz J, Agnew-Blais J. Increased risk of provisional premenstrual dysphoric disorder (PMDD) among females with attention-deficit hyperactivity disorder (ADHD): cross-sectional survey study. The British Journal of Psychiatry. 2025. doi:10.1192/bjp.2025.104