| Sumario: | Objective: Premenstrual dysphoric disorder (PMDD) is highly prevalent among women of reproductive age. However, the heterogeneity and complexity of PMDD symptoms present considerable challenges for accurate diagnosis. This study aims to investigate the heterogeneity of symptoms among Chinese female college students to identify clinical subtypes based on PMDD symptomatology. Methods: A total of 669 Chinese female college students participated in the study and were assessed using a standardized set of questionnaires, including the Chinese version of CTDP‐DSM‐5 (CTDP‐C), the Patient Health Questionnaire‐9 (PHQ‐9), and the General Anxiety Disorder‐7 (GAD‐7). A total of 218 participants were identified as PMDD‐positive based on the Chinese version of the CTDP‐DSM‐5. Latent class analysis (LCA) was conducted on the CTDP‐C scores of the 218 participants diagnosed with PMDD to empirically evaluate the validity of proposed PMDD subtype classifications. Results: LCA identified two distinct phenotypic subtypes of PMDD. Class 1 (severe subtype; mean CTDP‐C score = 8.78) was characterized by a range of comorbid psychological symptoms (e.g., emotional lability, irritability, and anxiety) as well as physical manifestations (e.g., fatigue, bloating, and pain). In contrast, Class 2 (mild subtype; mean CTDP‐C score = 1.52) exhibited attenuated and atypical symptoms. Notably, significant differences were observed between the two classes in 90% of the CTDP‐C items (p < 0.001). Physical comorbidities, especially dysmenorrhea (p < 0.001), were identified as key contributing factors, suggesting potential shared pathophysiological mechanisms. Conclusions: Two distinct subtypes of PMDD were identified: one characterized by severe symptoms and the other by milder manifestations, with either psychological or physical symptoms predominating, or a combination of both. Further investigation into the heterogeneity of PMDD is crucial to delineate more distinct phenotypes, which will facilitate advancements in future biological and genetic research.
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