Conditions for Further Study 795
pairment in normal daily activities. Caffeine intoxication may include symptoms of
nausea and vomiting, as well as impairment of normal activities. Significant disruptions in
normal daily activities may occur during caffeine abstinence. 
Differential Diagnosis
Nonproblematic use of caffeine. The distinction between nonproblematic use of caf-
feine and caffeine use disorder can be difficul t to make because social, behavioral, or psy-
chological problems may be difficult to attribut e to the substance, espe cially in the context of
use of other substances. Regular,  heavy caffeine use that can result in tolerance and with-
drawal is relatively common, which by itself sh ould not be sufficient for making a diagnosis. 
Other stimulant use disorder. Problems related to use of other stimulant medications
or substances may approximate the fe atures of caffeine use disorder.
Anxiety disorders. Chronic heavy caffeine use may mimi c generalized anxiety disorder,
and acute caffeine cons umption may produce and mimic panic attacks. 
Comorbidity
There may be comorbidity between caffeine use disorder and daily cigarette smoking, a
family or personal history of alcohol use diso rder. Features of caffeine use disorder (e.g.,
tolerance, caffeine withdrawal) may be positive ly associated with several diagnoses: ma-
jor depression, generali zed anxiety disorder, panic disorder, adult antisocial personality
disorder, and alcohol, cannab is, and cocaine use disorders.
Internet Gaming Disorder
Proposed Criteria
Persistent and recurrent use of the Internet to engage in games, often with other players,
leading to clinically significant impairment or distress as indicated by five (or more) of the
following in a 12-month period:
1. Preoccupation with Internet games. (The individual thinks about previous gaming