504 Substance-Related and Addictive Disorders
3. Excitement.
4. Insomnia.
5. Flushed face.
6. Diuresis.
7. Gastrointestinal disturbance.
8. Muscle twitching.
9. Rambling flow of thought and speech.
10. Tachycardia or cardiac arrhythmia.
11. Periods of inexhaustibility.
12. Psychomotor agitation.
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 attributable to another medical condition and are not bet-
ter explained by another mental disorder, including intoxication with another substance.
Diagnostic Features
Caffeine can be consumed from a number of di fferent sources, including coffee, tea, caf-
feinated soda, “energy” drinks, over-the-cou nter analgesics and cold remedies, energy
aids (e.g., drinks), weight-loss aids, and chocol ate. Caffeine is also increasingly being used
as an additive to vitamins and to food prod ucts. More than 85% of children and adults con-
sume caffeine regularly. Some caffeine user s display symptoms consistent with problem-
atic use, including tolerance and withdrawal (see “Caffeine Withdrawal” later in this
chapter); the data are not available at this time  to determine the clinical significance of a
caffeine use disorder and its pr evalence. In contrast, there is  evidence that caffeine with-
drawal and caffeine intoxication are clinically significant and sufficiently prevalent.
The essential feature of caffein e intoxication is recent cons umption of caffeine and five
or more signs or symptoms th at develop during or shortly after caffeine use (Criteria A