Quitting Caffeine is Now Listed as a Mental-Health Disorder in the DSM
1:00 pm, June 13th | by Grace Rasmus
During the first semester of my freshman year of college, I started to get weekly, sick-to-my-stomach, there’s-no-way-I’m-getting-out-of-bed-today migraines. While I learned that I could stop a migraine in its tracks with some Excedrin and a prayer, I was still totally frustrated that I couldn’t pinpoint any of my migraine triggers. Even though I cut soda, artificial sweeteners, and super salty foods from my diet, the migraines persisted, coming at random and increasingly often.
One day during vacation, I was lying in a hotel bed with a pounding headache, angry with with myself for forgetting to bring my migraine pills and probably whimpering melodramatically about my first-world problem. My mom nonchalantly suggested I have a cup of coffee. So I did. And I instantly felt better.
I laughed at how simple the solution was. My migraines weren’t triggered by something I was consuming, they were triggered by something I wasn’t: caffeine. I was used to drinking coffee maybe five times a week during the school year — nothing too crazy but it turned out that was enough to make me dependent on it. I was getting migraines almost every day during the summer because I wasn’t regularly drinking coffee. Instead, I was sleeping in and getting my recommended eight (…or twelve) hours.
Caffeine, the working women’s fuel of choice, is now the basis of two official diagnoses in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, or DSM-5: caffeine intoxication and withdrawal. These conditions can even be considered mental disorders if they impair a person’s ability to function in daily life.
“The symptoms [of caffeine withdrawal] overlap with a lot of other disorders and medical problems,” said Laura Juliano, a psychology professor at American University who advised the DSM-5 work group. “We’ve heard many times people went to the doctor for chronic headaches or because they thought that they had the flu and it turns out it was caffeine withdrawal and they didn’t even know it.”
While caffeine intoxication was previously included as a diagnosis in the manuel, withdrawal recently got an upgrade from “research diagnosis” (meaning that the workgroup needed more time to study it) to “full diagnosis.” Also, Caffeine Use Disorder — when a person’s caffeine consumption causes troubling side effects and yet s/he isn’t able to quit — was added to the latest manual as a research diagnosis.
While the diagnoses have already been added to the latest DSM, there has been some controversy over their validity.
“Caffeine intoxication and withdrawal both occur fairly frequently but only rarely cause enough clinically significant impairment to be considered a mental disorder,” said Allen Frances, a chairman of the task force that developed the previous DSM and a vocal critic of the DSM-5. “We shouldn’t medicalize every aspect of life and turn everyone into a patient.”
To be diagnosed with caffeine withdrawal, a patient must stop or reduce caffeine intake and experience at least three of the five symptoms associated with the addiction: headache, fatigue or drowsiness, depressed mood or irritability, difficulty concentrating, and flu-like symptoms such as nausea or muscle pain.
Among regular caffeine drinkers who abstain from caffeine, headaches are reported about 50% of the time and functional impairment about 13%, said Dr. Griffiths, a DSM-5 work group advisor. But even when people don’t have a headache, they may have fatigue or an inability to concentrate, he said. “That’s why I think the prudent and the least painful way to do it is fade caffeine use out over time.”
If you can’t imagine living without coffee but you don’t want to become caffeine-dependent, Dr. Juliano recommends drinking coffee at irregular intervals and limiting your consumption to as close to 100 milligrams as possible. (100 milligrams is equivalent to a cup. And no, not this kind of cup.)