Diagnostic Criteria 305.90 (F15.929)
A. Flecent consumption of caffeine (typically a high dose well in excess of 250 mg).
B. Five (or more) of the following signs or symptoms developing during, or shortly after, caffeine use: 1. Restlessness.
2. Nervousness.
3. Excitement.
4. Insomnia.
5. Flushed face.
6. Diuresis.
7. Gastrointestinaldisturbance.
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.
Caffeine can be consumed from a number of different sources, including coffee, tea, caf- feinated soda, "energy” drinks, over-the-counter analgesics and cold remedies, energy aids (e.g., drinks), weight-loss aids, and chocolate. Caffeine is also increasingly being used as an additive to vitamins and to food products. More than 85% of children and adults con- sume caffeine regularly. Some caffeine users 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 prevalence. In contrast, there is evidence that caffeine with- drawal and caffeine intoxication are clinically significant and sufficiently prevalent.
The essential feature of caffeine intoxication is recent consumption of caffeine and five and B). Symptoms include restlessness, nervousness, excitement, insomnia, ﬂushed face, diuresis, and gastrointestinal complaints, which can occur with low doses (e.g., 200 mg) in vulnerable individuals such as children, the elderly, or individuals who have not been ex- posed to caffeine previously. Symptoms that generally appear at levels of more than 1 g / day include muscle twitching, rambling flow of thought and speech, tachycardia or car- diac arrhythmia, periods of inexhaustibility, and psychomotor agitation. Caffeine intoxi- cation may not occur despite high caffeine intake because of the development of tolerance.
The signs or symptoms must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning (Criterion C). The signs or symp- toms must not be attributable to another medical condition and are not better explained by another mental disorder (e.g., an anxiety disorder) or intoxication with another substance (Criterion D).
Mild sensory disturbances (e.g., ringing in the ears and ﬂashes of light) may occur with high doses of caffeine. Although large doses of caffeine can increase heart rate, smaller doses can slow heart rate. Whether excess caffeine intake can cause headaches is unclear. On physical examination, agitation, restlessness, sweating, tachycardia, flushed face, and increased bowel motility may be seen. Caffeine blood levels may provide important information for diagnosis, particularly when the individual is a poor historian, although these levels are not diagnostic by themselves in view of the individual variation in response to caffeine.
The prevalence of caffeine intoxication in the general population is unclear. In the United
States, approximately 7% of individuals in the population may experience five or more symp- toms along with functional impairment consistent with a diagnosis of caffeine intoxication.