Caffeine Use Disorder DSM-5

DSM-5 Category: Conditions for
Further Study

Introduction

Caffeine Use Disorder is not a specified diagnosis in DSM-5, but has been placed in the category of Conditions for Further Study (American Psychiatric Association,
2013). This category contains those conditions that appear to have some evidence of effects on psychological well-being, but not enough of a research base to warrant their inclusion in the list of classifiable disorders. The inclusion of caffeine use disorder in any category in the DSM-5 is a topic of some debate. Some 80% plus of Americans consume varying amounts of caffeine daily. Many people do not experience any significant personal distress nor any significant decrease in functioning in any life area from this consumption. These two criteria are included in every or nearly every disorder listed in the DSM-5 as requirements for the disorder. There is another set of people who require a morning, and possibly afternoon, “dose” of caffeine to function. Both Caffeine Intoxication and Caffeine Withdrawal are listed as disorders in the DSM-5.

Symptoms

Since Caffeine Use Disorder is not a listed diagnosis, there is no formal set of symptoms to be used in diagnosis. There is a set of suggested symptoms, however. All three of these symptoms must be present in order for this diagnosis to be appropriate (Addicott, 2014): (1) an ongoing desire or non-successful attempt to curtail use; (2) ‘use despite harm’; (3) withdrawal.

The symptoms presented above are more conservative than those utilized in other substance use disorders. Concern was great that an over-diagnosis of Caffeine Use
Disorder would occur with a wider range of possible symptoms. Due to the very significant use of caffeine in the United States, such an over-diagnosis could draw a high number of people into the stigma of having a mental disorder. There is insufficient clinical evidence regarding how significant this condition may be as a disorder.

Another reason for conservative criteria for the diagnosis of Caffeine Use Disorder is the possibility of the beneficial effects of caffeine to be overlooked due to the prejudices generated by it being classified as an addictive drug (Addicott, 2014).

Regarding the criterion of ‘use despite harm’, much more research is needed before this criterion can be adequately defined. Current research hasn’t added to the
knowledge base necessary. Some researchers contend there are negative health effects associated with caffeine consumption (Juliano, et al., 2012; Striley et al., 2011). Others disagree, their findings suggesting no negative health effects (Morelli & Simola, 2011; Hughes, et al., 1998).

Consuming large amounts of caffeine can lead to caffeine intoxication, a condition that is listed in the DSM-5 and which poses a significant health threat. Hospitalization has been required for some cases. The DSM-5 says consumption well in excess of 250 mg is needed to define Caffeine Intoxication (American Psychiatric Association, 2013). However, low to moderate consumption of caffeine, which is the norm, should be below this threshold. Some research has shown a risk of detrimental health effects when caffeine is consumed even at low to moderate levels, particularly with hypertension. Other research, however, has not found this same effect.

The literature on the health effects of consuming low to moderate amounts of caffeine remain inconsistent. But are there indications of psychological problems caused by or made worse by caffeine? Once again, the results of research are inconsistent. The use of caffeine with some diagnosed conditions may lead to exacerbations of symptoms of those conditions (Addicott, 2014). Some of the anxiety disorders can be aggravated by consumption of caffeine. On the other hand, caffeine may be beneficial in some cases, even for psychiatric patients. Anxiety may be reduced and mood increased with low to moderate doses of caffeine.

What does the literature contribute to further defining symptoms of Caffeine Use Disorder? Not much presently. Thus, the disorder is classified as needing
further research in order to decide whether it will be included in further editions of the DSM.

Diagnosis

Very thorough personal history is the best tool for diagnosing caffeine use disorder, once formal specific symptoms are agreed upon. Physical examination may be needed to determine any physical problems that may be caused by or exacerbated by caffeine use (Encyclopedia of Mental Disorders, 2014). This may even include laboratory analysis.

Assessment is needed to rule out other conditions such as manic episodes, anxiety disorders, panic, use of other more addictive substances, or withdrawal from other substances. It may be difficult to determine whether caffeine is affecting these other potential disorders or whether the other disorders lead to the caffeine consumption.

Treatment

Since this disorder is not yet listed as a viable diagnosis in DSM-5, there are no defined treatment options for it. Some researchers (Juliano et al., 2012) believe the
disorder should have similar treatment approaches in the future as those people who seek to stop smoking.

In cases where consumption of caffeine is at a low to moderate level, many people can cut down or stop consuming caffeine with little or no difficulty. Switching
types of drink or choosing decaffeinated drinks are an option for these people. Some relatively mild symptoms of withdrawal may be felt for a short time
(Encyclopedia of Mental Disorders, 2014). These symptoms may include headaches and irritation.

Social factors play less of a part in decreasing or stopping caffeine consumption than in more addictive substances. This allows people to change their drinking
habits even in social contexts with little or no notice taken by their peer group.

Should people seek more formal treatment for their caffeine use, a similar approach to that taken in treating other addictive disorders could be followed. Most of the
time, such an approach would be taken with those people who consume very large amounts of caffeine and literally cannot stop on their own. Some kind of twelve-step program could be of use, as would strong social support from peers and family members.

In some cases, medical treatment may be needed if consumption of caffeine has led to or exacerbated physical issues. Some of these physical problems may include
hypertension, even though evidence from research seems to be inconsistent (Addicott, 2014). Insomnia may also be affected by caffeine consumption, as may be gastrointestinal problems. Medical intervention may be necessary if these problems become great enough.

Living With Caffeine Use Disorder

When the consumption of caffeine in the general population of the United States is estimated at 85%, living with caffeine use assumes prominence. In general, citizens of the U.S. consume 200mg of caffeine daily on average (Encyclopedia of Mental Disorders, 2014). Caffeine is present in many commonly-used products.

Coffee is perhaps the most frequently used method of consuming caffeine. It is also found in tea, chocolate, soft drinks, and many over the counter pain relief medications. The new focus on “energy” products also highlights a whole new area in caffeine plays a large part.

Also to take into consideration when thinking about living with caffeine use are the benefits which caffeine brings with its consumption. For some types of headaches, caffeine can bring relief from the pain. Socially, consuming caffeine, usually in the form of drinking coffee, brings a great deal of comfort and reinforcement. Whether physiological or psychological, consuming caffeine also brings a certain amount of alertness at times when people typically feel drowsy or less alert than they desire.

Will Caffeine Use Disorder reach the level of formal acceptance as an addictive disorder? That remains to be seen. With the very high numbers of people who would
potentially qualify for the diagnosis, and the real possibility of the stigma of having an “addiction” being placed on this number of people, significant doubt exists that the disorder will be accepted. Also a factor to consider is the financial one. The market for products containing caffeine is enormous.
Those who are invested in those products will likely expend a huge amount of time, influence, and money to prevent this acceptance.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

Addicott, M.A. (2014). Caffeine use disorder: A review of the evidence and future implications. Curr Addict Rep 1: 186-192.

Encyclopedia of Mental Disorders. (2014). Caffeine-related disorders. Retrieved from http://www.minddisorders.com/Br-Del/Caffeine-related-disorders.html.

Hughes, J.R. et al. (1998). Endorsement of DSM-IV dependence criterial among caffeine users. Drug Alcohol Depend. 52: 99-107.

Juliano, L.M., et al. (2012). Characterization of individuals seeking treatment for caffeine dependence. Psycho Addict Behav. 26: 948-954.

Morelli, M. & Simola, N. (2011). Methylxanthines and drug dependence: A focus on interactions with substances of abuse. In: Fredholm, B.B., editor. Handbook of
Experimental Pharmacology. Berlin Heidelberg: Springer-Verlag. p.483-507.

Striley, C.W. et al. (2011). Evaluating dependence criteria for caffeine. J Caffeine Res. 1: 219-225.

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