DSM-V and reproductive-related psychiatric disorders: a closer look at windows of vulnerability

Excerpt

As the discussions on how to reformulate the Diagnostic and Statistical Manual of Mental Disorders (DSM) approach a crucial moment, it would be pertinent to take a closer look at the predictive value and clinical significance of reproductive-related psychiatric events. As it stands in its current edition, the DSM fails to help clinicians and researchers to consider these events while conceptualizing clinical diagnoses or establishing therapeutic strategies for psychiatric disorders, particularly mood and anxiety disorders in women. Such omission is inconsistent with robust epidemiologic and clinical evidence gathered over the past decades that sub-populations of women present with a heightened susceptibility to develop mood disorders during periods of intense hormonal fluctuations such as the puerperal period or the menopausal transition. Based on accumulate evidence, some have hypothesized that sub-groups of women would be exposed to “windows of vulnerability” for depression throughout their lifespan (Rubinow et al. 1998; Bloch et al. 2000). The basic premise is that a heightened brain’s sensitivity to changes in levels of reproductive hormones—rather than exposure to absolute hormone levels (e.g., low estrogen concentrations)—could constitute the trigger for reproductive-related mood disorders. By recognizing the existence of these ‘windows’, the new DSM could not only promote a better conceptual framework and advance research on the biological underpinnings of mental disorders but also help clinicians to tailor clinical interventions for female-specific mood disorders with novel hormonal and non-hormonal strategies. …