DSM-IV

Research Criteria

A. Prolonged daily use of caffeine.

B. Abrupt cessation of caffeine use, or reduction in the amount of caffeine used, closely followed by headache and one (or more) of the following symptoms:

  1. marked fatigue or drowsiness
  2. marked anxiety or depression
  3. nausea or vomiting

C. The symptoms in Criterion B cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

D. The symptoms are not due to the direct physiological effects of a general medical condition (e.g., migraine, viral illness) and are not better accounted for by another mental disorder.

Differential Diagnosis

For more information, see Substance-Related Disorders

In DSM-IV, individuals whose presentation meets these research criteria would be diagnosed as having Caffeine-Related Disorder Not Otherwise Specified.

General medical conditions, other mental disorders, and medication use

The symptoms must not be due to the direct physiological effects of a general medical condition (e.g., migraine, viral illness) and must not be better accounted for by another mental disorder. Headaches, fatigue, nausea, or vomiting due to a general medical condition or due to the initiation or cessation of a medication can cause a clinical picture similar to caffeine withdrawal.

Amphetamine and Cocaine Withdrawal

Drowsiness, fatigue, and mood changes from caffeine withdrawal can mimic Amphetamine or Cocaine Withdrawal.

The temporal relationship of symptoms to caffeine cessation and the time-limited course of the symptoms usually establish the diagnosis. If the diagnosis is unclear, a diagnostic trial of caffeine can be of help.

DSM-5

Diagnostic Criteria

A. Prolonged daily use of caffeine.

B. Abrupt cessation of or reduction in caffeine use, followed within 24 hours by three (or more) of the following symptoms:

  1. Headache.
  2. Marked fatigue or drowsiness.
  3. Dysphoric mood, depressed mood, or irritability.
  4. Difficulty concentrating.
  5. Flu-like symptoms (nausea, vomiting, or muscle pain/stiffness).

C. The signs of symptoms in Criterion B cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

D. The signs or symptoms are not associated with the physiological effects of another medical condition (e.g., migraine, viral illness) and are not better explained by another mental disorder, including intoxication or withdrawal from another substance.

Differential Diagnosis

Other medical disorders and medical side effects

Severe disorders should be considered in the differential diagnosis of caffeine withdrawal. Caffeine withdrawal can mimic migraine and other headache disorders, viral illnesses, sinus conditions, tension, other drug withdrawal states (e.g., from amphetamines, cocaine), and medication side effects. The final determination of caffeine withdrawal should rest on a determination of the pattern and amount consumed, the time interval between caffeine abstinence and onset of symptoms, and the particular clinical features presented by the individual. A challenge does of caffeine followed by symptom remission may be used to confirm the diagnosis.

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