Caffeine-related disorders are a group of conditions that revolve in some way around the use of coffee or other caffeine-containing substances.
The American Psychiatric Association lists these disorders as mental health issues in its Diagnostic and Statistical Manual of Mental Disorders (DSM), which functions as an everyday guide for identifying and categorizing psychological/psychiatric symptoms. One caffeine-related condition, called caffeine withdrawal, appears for the first time in the 5th edition of the DSM, released in 2013. Another condition — called caffeine use disorder — does not qualify as a diagnosable problem, but is still listed in DSM 5 in a category designated for future research.
Caffeine-related disorder basics
DSM 5 contains four officially recognized caffeine-related diagnoses: caffeine intoxication, caffeine withdrawal, “other” caffeine-induced disorders and “unspecified” caffeine-related disorder.
In turn, all caffeine-related disorders belong to a group of conditions known as substance-related disorders. Only one of the caffeine-related disorders, caffeine intoxication, appeared in the previous edition of the DSM.
The “other” caffeine-induced disorders listing replaces two more specific listings in DSM IV, called caffeine-induced sleep disorder and caffeine-induced anxiety disorder. “Unspecified” caffeine-related disorder replaces a condition in DSM IV known as caffeine-related disorder not otherwise specified.
Caffeine withdrawal was included in DSM 5 in response to research findings regarding the potential impact of an abrupt cessation or decrease in regular caffeine usage.
The definition for caffeine intoxication in DSM 5 is the same as the definition for caffeine intoxication listed in DSM IV. People affected by this disorder are typically under the influence of more than 250 mg of caffeine (equivalent to more than 16-24 oz of coffee).
They also have a minimum of five physical and mental symptoms that stem from caffeine’s effects. The potential symptoms include:
- Unusual twitching of the muscles
- Unusual excitability
- Intestinal upset
- Heightened urine output
- An abnormally nervous disposition
- An abnormally restless disposition
- Facial redness
- An accelerated or irregular heartbeat
- Unusually high energy reserves
- Disjointed speech or thought
- The presence of aimless, uncontrolled body movements.
In order to qualify for a caffeine intoxication diagnosis, the affected individual must experience substantial life disruption or mental distress as a result of his or her condition.
He or she must also lack other physical or mental problems that explain the symptoms in effect.
Before it can qualify as a mental health concern, caffeine withdrawal (and all other forms of substance withdrawal) must meet certain criteria listed in the DSM.
The first of these criteria states that the negative effects of stopping or reducing substance intake must appear in long-term, heavy users of that substance.
The second criterion states that the unpleasant feelings associated with withdrawal must cause meaningful mental anguish or disrupt some key aspect of everyday life.
The third withdrawal criterion states that the affected individual’s symptoms must not stem from some other psychological or physical issue.
Caffeine withdrawal was given official status as a mental health problem in DSM 5 because current findings indicate that it meets all three of these criteria in at least some circumstances.
“Other” and “unspecified” disorders
The “other” caffeine-induced disorders diagnosis was created out of recognition of the fact that caffeine use can potentially trigger other mental health concerns apart from sleep-related problems or anxiety.
When making a diagnosis, doctors must identify the specific caffeine-related conditions present in their patients.
The “unspecified” caffeine-related disorder diagnosis is designed to address caffeine-related mental health problems that don’t fit well within the definitions of any of the other caffeine-related disorders.
Caffeine use disorder
Some of the substances listed in the DSM are subject to abuse by their users, and can also produce some form of psychological or physical dependence.
In previous editions of the DSM, abuse-related problems and dependence-related problems were listed separately for each substance (e.g., cocaine abuse and cocaine dependence, or alcohol abuse and alcohol dependence). However, current scientific knowledge does not support the interpretation of abuse and dependence as strictly distinct issues; rather, abuse- and dependence-related issues typically overlap with some degree of unpredictability. In recognition of this reality, DSM 5 does not allow the separate diagnosis of abuse or dependence.
Instead, it allows the diagnosis of various substance use disorders, which include symptoms once split between substance abuse and substance dependence.
Some doctors believe that, in at least certain cases, caffeine intake can lead to the onset of problems that merit a diagnosis of caffeine use disorder. However, not all doctors agree with this position, and caffeine use disorder is not a diagnosable condition in DSM 5.
Instead, this disorder is listed in a portion of DSM 5 — called Section III — reserved for unofficial conditions that are well defined enough to warrant more research and conceptual exploration. At some point in the future, the American Psychiatric Association will decide whether to include caffeine use disorder with the officially designated caffeine-related disorders or remove it entirely from the Diagnostic and Statistical Manual.