A 23-year-old woman who regularly smokes cannabis presents to a psychiatry clinic. She reports that over the past year she has needed to use substantially more cannabis to achieve the same effect, and when she tries to stop she becomes irritable, restless, has disturbed sleep, and decreased appetite. These withdrawal symptoms resolve when she resumes use. How many criteria from the DSM-5-TR substance use disorder list must be present over a 12-month period for a diagnosis of 'severe' cannabis use disorder?
- A 2 or 3 criteria
- B 6 or more criteria ✓
- C 4 or 5 criteria
- D All 11 criteria must be present
Correct answer: B. 6 or more criteria
Explanation
DSM-5-TR classifies substance use disorders by severity based on the number of 11 diagnostic criteria met within a 12-month period: mild (2–3), moderate (4–5), and severe (6 or more). This patient demonstrates tolerance and withdrawal, confirming physiological dependence. Cannabis withdrawal — characterized by irritability, sleep disturbance, anxiety, and decreased appetite — was formally recognized in DSM-5, reflecting growing evidence of cannabis use disorder as a clinically significant condition with measurable neurobiological correlates.
Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.
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Written and medically reviewed by the StethoPrep medical team.