Study of impulse control disorders among women presenting nicotine dependence

Objective. Impulse control disorders (ICDs) include intermittent explosive disorder, kleptomania, trichotillomania, pyromania and pathological gambling. Several studies have showed an association between ICDs and alcohol use disorders. The rate of co-occurrence ICDs and nicotine dependence has never been investigated. We thus assessed the frequency of all ICDs in a population of nicotine-dependent women compared to non-smoking women. We also checked criteria of two other impulsive behaviours, compulsive buying and bulimia. Methods. Five hundred consecutive patients were assessed by a general practitioner in Paris (France). One hundred and twenty-seven women presenting the DSM-IV-R criteria for nicotine dependence were included. They were compared to 127 women consulting the same practitioner but who did not smoke. Diagnosis of ICD (pyromania, kleptomania, trichotillomania, intermittent explosive disorder, pathological gambling) and of bulimia was based on DSM-IV criteria and a modified version of the Minnesota Impulsive Disorders Interview (MIDI). Diagnosis of compulsive buying was made with the McElroy et al. criteria and a specific questionnaire. Cigarette smoking was studied using the Fagerström questionnaire and the DSM-IV-R criteria for nicotine dependence. Alcohol use disorders were assessed with the DSM-IV-R criteria for dependence and the CAGE and the MAST questionnaires. Results. Thirteen patients presented trichotillomania, 22 explosive intermittent disorder and 12 pathological gambling. All these diagnoses were equally frequent in the nicotine-positive and nicotine-negative groups. We found no case of pyromania. Compulsive buying was the most frequent impulse control disorder. It was significantly more frequent in the nicotine-positive group than in the nicotine-negative group (58 vs. 39 cases, P=0.01). Scores of the compulsive buying scale were higher in the nicotine-positive group (4.07 vs. 2.9, P=0.01). None of the patients presented an association of two or more ICDs. Patients from the nicotine-positive group drunk higher quantities of alcohol each day, consumed alcohol more frequently each week and were more often intoxicated each week with alcohol. Their mean MAST scores of alcohol abuse disorders were higher. Conclusion. A total of 45.6% of the nicotine-dependent women presented compulsive buying and 23.6% bulimia. Compulsive buying was significantly more frequent among nicotine-dependent subjects than controls. Other impulse control disorders were as frequent among nicotine-dependent women as in controls. A total of 8.6% presented explosive intermittent disorder, 4.7% pathological gambling and 5% trichotillomania. Nicotine dependence in women was also associated with a higher level of alcohol consumption. These results indicate the possible need to systematically screen nicotine-dependent women, regardless of their motivation for consultation, for alcohol dependence, bulimia and compulsive buying.