570 Substance-Related and Addictive Disorders
Associated Features Supporting Diagnosis
Acute withdrawal symptoms (“a crash”) are ofte n seen after periods of repetitive high-dose
use (“runs” or “binges”). These periods are char acterized by intense and unpleasant feelings of
lassitude and depression and increased appetite, generally requiring several days of rest and
recuperation. Depressive symptoms with suicidal  ideation or behavior can occur and are gen-
erally the most serious problems seen during “crashing” or other forms of stimulant with-
drawal. The majority of individuals with st imulant use disorder experience a withdrawal
syndrome at some point, and virtually all in dividuals with the diso rder report tolerance.
Differential Diagnosis 
Stimulant use disorder and other stimulant-induced disorders. Stimulant withdrawal
is distinguished from stimulan t use disorder and from the other stimulant-induced disor-
ders (e.g., stimulant-induced intoxication delirium, depressi ve disorder, bipolar disorder,
psychotic disorder, anxiety disorder, sexual  dysfunction, sleep disorder) because the
symptoms of withdrawal predominate the clin ical presentation and are severe enough to
warrant independent clinical attention.
Other Stimulant-Induced Disorders
The following stimulant-induced disorders (w hich include amphetamine-, cocaine-, and
other stimulant–induced disorder s) are described in other chapters of the manual with dis-
orders with which they share phenomenol ogy (see the substance/medication-induced
mental disorders in these chapters): stimulan t-induced psychotic disorder (“Schizophrenia
Spectrum and Other Psychotic Disorders”); st imulant-induced bipolar disorder (“Bipolar
and Related Disorders”); stimulant-induced de pressive disorder (“De pressive Disorders”);