only occur in the presence of a moderate or severe sedative, hypnotic, or anxiolytic use
disorder. It is not permissible to code a comorbid mild sedative, hypnotic, or anxiolytic use
disorder with sedative, hypnotic, or anxiolytic withdrawal.
Note:  For information on Developm ent and Course; Risk and Prognostic Factors; Culture-
Related Diagnostic Issues; Functional Conseq uences of Sedative, Hypnotic, or Anxiolytic
Withdrawal; and Comorbidity, see the corresp onding sections in sedative, hypnotic, or
anxiolytic use disorder.
Diagnostic Features
The essential feature of sedative, hypnotic, or anxiolytic withdrawal is the presence of a char-
acteristic syndrome that develops  after a marked decrease in or cessation of intake after several
weeks or more of regular use (C riteria A and B). This withdrawal  syndrome is characterized by
two or more symptoms (similar to alcohol with drawal) that include au tonomic hyperactivity
(e.g., increases in heart rate, respiratory rate, blood pressure, or body temperature, along with
sweating); a tremor of the hands; insomnia ; nausea, sometimes accompanied by vomiting;
anxiety; and psychomotor agitation. A grand mal seizure may occur in perhaps as many as
20%–30% of individuals undergoing untreated withdrawal from these substances. In severe
withdrawal, visual, tactile, or auditory hallucinations or illus ions can occur but are usually in
the context of a delirium. If the individual’s rea lity testing is intact (i.e., he or she knows the
substance is causing the hallucinations) and the illusions occur in a clear sensorium, the spec-