Is caffeine withdrawal really a mental illness?

Credit: Priotr Skubisz

I had a hard time believing that caffeine withdrawal is now classified as a mental illness in the new DSM-5 manual of psychiatric diagnoses, despite what news reports have proclaimed. But it is indeed listed there under the heading “Caffeine-Related Disorders.”

Getting headaches, or feeling excessively tired or down in the dumps after you break a coffee or energy drink habit can qualify as a mental health condition, according to the new guide, but only if it’s interfering with your daily functioning.

Caffeine withdrawal is a new listing in the guide, but caffeine disorders are not. They’ve been listed before with other disorders involving substance abuse like cocaine addiction or alcoholism.

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The previous DSM manual had included “caffeine intoxication”; this describes the jitteriness, nervousness, insomnia, muscle twitching, and rapid heartbeat, that can occur if we down a Starbucks double or triple latte or a can of Monster Energy.

But our bodies and brains may become dependent on the caffeine leading to withdrawal symptoms—headachese, fatigue, trouble focusing, mild depression—when we go without our daily java or energy shot.

“Caffeine is a drug, a mild stimulant, which is used by almost everybody on a daily basis,” Dr. Charles O’Brien, who chairs the Substance-Related Disorder Work Group for DSM-5, told the New York Post. “But it does have a letdown afterwards. If you drink a lot of coffee, at least two or three [236 ml] cups at a time, there will be a rebound or withdrawal effect.”

But is this withdrawal really a mental disorder? I posed this question to psychologist Alan Budney at the Geisel School of Medicine at Dartmouth who served on the DSM committee with O’Brien.

“The caffeine consideration isn’t really any different from alcohol which is a legal substance but can also be misused and produce a clinically significant (transitory) withdrawal syndrome,” Budney said. “All mental disorders are not long-term. All substance use conditions that have a psychological and behavioral component are classified as ‘mental’ disorders in the DSM.”

He added that the committee determined that caffeine withdrawal was important to add in order to make doctors and patients aware of the symptoms. He also emphasized that the diagnosis should only be made when symptoms cause “clinically significant distress” or impair how a person functions in their work or home environment.

While I understand Budney’s reasoning, I still have a hard time accepting that a temporary condition—as minor as skipping a daily dose of coffee—should be classified as a mental health disorder. After all, shouldn’t a mental illness have some sort of staying power for more than a few weeks or even a few days?

If we were to classify every poor mental health day as a full-blown disorder, we’d be medicalizing those who didn’t sleep well the night before or who had a bad breakup with a boyfriend.

I wonder if these sorts of disease classifications helped lead the National Institute of Mental Health to disavow the new DSM-V. The institute recently announced that it would no longer fund research based on the manual’s categorizations.

What do you think? Should caffeine withdrawal be considered a form of mental illness? Take our poll below.