Substance-Abuse Disorder, Unclarity, and Confusion

Love Latte

Exploring the definitions for eating disorders in the Diagnostic and Statistical Manual (DSM-5) is an Alice-in-Wonderland type of experience, full of surprises and contradictions. Many hundreds of professionals worked tirelessly to formulate the book’s information, yet paradoxes abound. Many questions remain unanswered, with a ragtag collection of odds and ends that may or may not add up to something.

According to the checklist used to diagnose a substance-use disorder, there are 11 or 12 potential symptoms, depending on the substance. One of the signs – withdrawal – does not apply to hallucinogens or inhalants, while it does apply to the painful process of quitting a problem food. By that reckoning, food would appear to be even more addictive than some drugs.

Every one of the symptoms on the list has been experienced by a real-life, self-identified food addict, an idea that Childhood Obesity News played with by creating a hypothetical compulsive eater who showed all the hallmarks. A drug user with only 7 of the checklist items would qualify as “severe” – the highest rating. Yet a food addict could easily fulfill every one of the criteria for substance-abuse disorder, and create a new category of seriousness that is even above “severe.” Maybe, as some researchers and clinicians believe, what people describe as food addiction could be a substance-abuse disorder, unrecognized as such by DSM-5.

Coffee Break

Caffeine is the world’s most popular psychoactive drug, and DSM-5 allows for both caffeine intoxication and caffeine withdrawal, although not caffeine addiction. Regarding caffeine intoxication:

The official diagnosis can be made when any 5 of the following symptoms are present: restlessness, nervousness, excitement, insomnia, flushed face, diuresis (you keep passing urine), gastrointestinal disturbance (upset tummy, diarrhea), muscle twitching, rambling flow of thought and speech, tachycardia or cardiac arrhythmia, periods of inexhaustibility, or psychomotor agitation.

Characterizing caffeine withdrawal as “a very unpleasant experience,” the website lists ten symptoms: headache, sleepiness, irritability, lethargy, constipation, depression, muscle pain/stiffness, lack of concentration, flu-like symptoms, and insomnia.

That all sounds fairly serious, yet clinical psychologist Robin Rosenberg does not think either caffeine intoxication or caffeine withdrawal belongs on the roster of mental disorders. She says that the intoxication is temporary and,

The symptoms of caffeine withdrawal are transitory, they take care of themselves. It’s just a natural response to stopping caffeine, and it clears up on its own in short order.

The point is, Rosenberg specifically said she doesn’t understand why either one is included in the DSM-5. So, on the one hand, a substance (caffeine) with intoxicating effects and an uncomfortable withdrawal process is not categorized as addictive. Its proponents do not want it stigmatized by inclusion in the diagnostic manual as an addictive substance. Despite this, it appears in the DSM-5 as the cause of intoxication and withdrawal. On the other hand, a different substance (food) is accused by its adherents of being addictive according to every criterion, but does not appear in the DSM-5 section on addiction.

Things are kind of mixed up.

Your responses and feedback are welcome!

Source: “Caffeine Overdose Symptoms: Facts and Fiction,”, undated
Source: “Normal or Not? How Coffee Drinking May Brew a Mental Disorder, 05/28/13
Image by PoYang_博仰

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OVERWEIGHT: What Kids Say explores the obesity problem from the often-overlooked perspective of children struggling with being overweight.

About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
You can contact Dr. Pretlow at:


Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.

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