506 Substance-Related and Addictive Disorders
Comorbidity
Typical dietary doses of caffeine have not been  consistently associated with medical prob-
lems. However, heavy use (e.g., >400 mg) can cause or exacerbate anxiety and somatic
symptoms and gastrointestinal distress. With  acute, extremely high doses of caffeine,
grand mal seizures and respiratory failure may re sult in death. Excessive caffeine use is as-
sociated with depressive diso rders, bipolar disorders, eati ng disorders, psychotic disor-
ders, sleep disorders, and subs tance-related disorders, wher eas individuals with anxiety
disorders are more likely to avoid caffeine.
Caffeine Withdrawal
Diagnostic Criteria 292.0 (F15.93)
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 signs or 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 or 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.
Diagnostic Features
The essential feature of caffeine withdrawal is the presence of a characteristic withdrawal
syndrome that develops after the abrupt cessation of (or substantial reduction in) pro-
longed daily caffeine ingestion (Criterion B) . The caffeine withdrawal syndrome is indi-