Smoking Prevalence, Nicotine Dependence, and Impulsivity in Obsessive-Compulsive Disorder

  • Oguz Tan
  • Ayce. F. Koroglu
Original Article


This study compared obsessive-compulsive disorder (OCD) and control participants in terms of smoking prevalence, nicotine dependence, and impulsivity. Data derived from 314 OCD patients and 319 control participants revealed that smoking prevalence did not differ between the two groups yet the severity of nicotine dependence was higher among OCD patients. OCD group also exhibited greater total, cognitive, and non-planning impulsivity than controls, and this pattern of differences was also evidenced in OCD and control current and never smokers. In both OCD and control group, modest positive associations were found between impulsivity and nicotine dependence, yet the relationships were relatively stronger for the OCD group. Results are discussed in terms of how smoking, dependence, and impulsivity might articulate to play a role in obsessive-compulsive disorder.


Smoking Nicotine Dependence Obsessive-compulsive disorder Impulsivity 


Compliance with Ethical Standards

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000 (5). Informed consent was obtained from all patients for being included in the study.

Conflict of Interest

The authors declare that they have no conflict of interest.


  1. Abramovitch, A., Pizzagalli, D. A., Geller, D. A., Reuman, L., & Wilhelm, S. (2015). Cigarette smoking in obsessive-compulsive disorder and unaffected parents of OCD patients. European Psychiatry, 30(1), 137–144. Scholar
  2. Akdemir, A., Orsel, S., Dag, İ., Turkcapar, H., Iscan, N., & Ozbay, H. (1996). Hamilton Depresyon Derecelendirme Ölçeği’nin geçerliği, güvenilirliği ve klinikte kullanımı. Psikiyatri Psikoloji Psikofarmakoloji Dergisi, 4, 251–259.Google Scholar
  3. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.Google Scholar
  4. Baker-Morissette, S. L., Gulliver, S. B., Wiegel, M., & Barlow, D. H. (2004). Prevalence of smoking in anxiety disorders uncomplicated by comorbid alcohol or substance abuse. Journal of Psychopathology and Behavioral Assessment, 26(2), 107–112.CrossRefGoogle Scholar
  5. Beck, A. T., Epstein, N., Brown, G., & Steer, R. A. (1988). An inventory for measuring clinical anxiety: psychometric properties. Journal of Consulting and Clinical Psychology, 56(6), 893–897.CrossRefPubMedGoogle Scholar
  6. Bejerot, S., & Humble, M. (1999). Low prevalence of smoking among patients with obsessive-compulsive disorder. Comprehensive Psychiatry, 40(4), 268–272.CrossRefPubMedGoogle Scholar
  7. Bejerot, S., von Knorring, L., & Ekselius, L. (2000). Personality traits and smoking in patients with obsessive-compulsive disorder. European Psychiatry, 15(7), 395–401.CrossRefPubMedGoogle Scholar
  8. Benatti, B., Dell’Osso, B., Arici, C., Hollander, E., & Altamura, A. C. (2014). Characterizing impulsivity profile in patients with obsessive-compulsive disorder. International Journal of Psychiatry in Clinical Practice, 18(3), 156–160. Scholar
  9. Bloom, E. L., Matsko, S. V., & Cimino, C. R. (2014). The relationship between cigarette smoking and impulsivity: a review of personality, behavioral, and neurobiological assessment. Addiction Research & Theory, 22(5), 386–397. Scholar
  10. Boisseau, C. L., Thompson-Brenner, H., Caldwell-Harris, C., Pratt, E., Farchione, T., & Barlow, D. H. (2012). Behavioral and cognitive impulsivity in obsessive–compulsive disorder and eating disorders. Psychiatry Research, 200(2), 1062–1066.CrossRefPubMedGoogle Scholar
  11. Centers for Disease Control and Prevention. (2013). Vital signs: current cigarette smoking among adults aged ≥18 years with mental illness-United States, 2009–2011. Morbidity and Mortality Weekly Report, 62(5), 81–87.Google Scholar
  12. Chase, H. W., & Hogarth, L. (2011). Impulsivity and symptoms of nicotine dependence in a young adult population. Nicotine & Tobacco Research, 13(2), 1321–1325. Scholar
  13. Dell’Osso, B., Nicolini, H., Lanzagorta, N., Benatti, B., Spagnolin, G., Palazzo, M. C.,… & Menchon, J. M. (2015). Cigarette smoking in patients with obsessive compulsive disorder: a report from the International College of Obsessive Compulsive Spectrum Disorders (ICOCS). CNS Spectrums, 20(05), 469–473. doi:
  14. Doran, N., McChargue, D., & Cohen, L. (2007). Impulsivity and the reinforcing value of cigarette smoking. Addictive Behaviors, 32(1), 90–98.CrossRefPubMedGoogle Scholar
  15. Ettelt, S., Ruhrmann, S., Barnow, S., Buthz, F., Hochrein, A., Meyer, K., … & Falkai, P. (2007). Impulsiveness in obsessive–compulsive disorder: results from a family study. Acta Psychiatrica Scandinavica, 115(1), 41–47.Google Scholar
  16. Filomensky, T. Z., Almeida, K. M., Castro Nogueira, M. C., Diniz, J. B., Lafer, B., Borcato, S., & Tavares, H. (2012). Neither bipolar nor obsessive-compulsive disorder: compulsive buyers are impulsive acquirers. Comprehensive Psychiatry, 53(5), 554–561.CrossRefPubMedGoogle Scholar
  17. Fontenelle, L. F., Mendlowicz, M. V., & Versiani, M. (2005). Impulse control disorders in patients with obsessive–compulsive disorder. Psychiatry and Clinical Neurosciences, 59(1), 30–37. Scholar
  18. GBD 2015 Risk Factors Collaborators. (2015). Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet, 388(10053), 1659–1724.Google Scholar
  19. Glassman, A. H. (1993). Cigarette smoking: implications for psychiatric illness. American Journal of Psychiatry, 150(4), 546–593. Scholar
  20. Goodman, W. K., Price, L. H., Rasmussen, S. A., Mazure, C., Fleischmann, R. L., Hill, C. L., … & Charney, D. S. (1989). The Yale-Brown obsessive compulsive scale: I. Development, use, and reliability. Archives of General Psychiatry, 46(11), 1006–1011.Google Scholar
  21. Grant, J. E., Mancebo, M. C., Pinto, A., Eisen, J. L., & Rasmussen, S. A. (2006). Impulse control disorders in adults with obsessive compulsive disorder. Journal of Psychiatric Research, 40(6), 494–501. Scholar
  22. Güleç, H., Tamam, L., Güleç, M. Y., Turhan, M., Karakuş, G., Zengin, M., & Stanford, M. S. (2008). Psychometric properties of the Turkish version of the Barratt Impulsiveness Scale-11. Klinik Psikofarmakoloji Bülteni, 18(4), 251–258.Google Scholar
  23. Hamilton, M. (1960). A rating scale for depression. Neurosurgery & Psychiatry, 23(1), 56–62.CrossRefGoogle Scholar
  24. Heatherton, T. F., Kozlowski, L. T., Frecker, R. C., & Fagerstrom, K. O. (1991). The Fagerström test for nicotine dependence: a revision of the Fagerstrom Tolerance Questionnaire. British Journal of Addiction, 86(9), 1119–1127.CrossRefPubMedGoogle Scholar
  25. Himle, J., Thyer, B. A., & Fischer, D. J. (1988). Prevalence of smoking among anxious outpatients. Phobia Practice and Research Journal, 1(1), 25–31.Google Scholar
  26. Johnson, J. G., Cohen, P., Pine, D. S., Klein, D. F., Kasen, S., & Brook, J. S. (2000). Association between cigarette smoking and anxiety disorders during adolescence and early adulthood. Jama, 284(18), 2348–2351.CrossRefPubMedGoogle Scholar
  27. Karamustafalıoğlu, K. O., Üçışık, A. M., Ulusoy, M., & Erkmen, H. (1993). Yale-Brown Obsesyon Kompülsiyon Derecelendirme Ölçeği’nin geçerlik ve güvenilirlik çalışması: 29. Ulusal Psikiyatri Kongresi Program ve Bildiri Özetleri Kitabı, 86. Bursa: Savaş Ofset.Google Scholar
  28. Kashyap, H., Fontenelle, L. F., Miguel, E. C., Ferrão, Y. A., Torres, A. R., Shavitt, R. G., Ferreira-Garcia, R., do Rosário, M. C., & Yücel, M. (2012). ‘Impulsive compulsivity’ in obsessive-compulsive disorder: a phenotypic marker of patients with poor clinical outcome. Journal of Psychiatric Research, 46(9), 1146–1152. Scholar
  29. Lasser, K., Boyd, J. W., Woolhandler, S., Himmelstein, D. U., McCormick, D., & Bor, D. H. (2000). Smoking and mental illness: a population-based prevalence study. Jama, 284(20), 2606–2610.CrossRefPubMedGoogle Scholar
  30. Lawrence, D., Mitrou, F., & Zubrick, S. R. (2009). Smoking and mental illness: results from population surveys in Australia and the United States. BMC Public Health, 9(1), 285. Scholar
  31. Lundberg, S., Carlsson, A., Norfeldt, P., & Carlsson, M. L. (2004). Nicotine treatment of obsessive–compulsive disorder. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 28(7), 1195–1199. Scholar
  32. Matsunaga, H., Kiriike, N., Matsui, T., Oya, K., Okino, K., & Stein, D. J. (2005). Impulsive disorders in Japanese adult patients with obsessive-compulsive disorder. Comprehensive Psychiatry, 46(1), 43–49. Scholar
  33. McCabe, R. E., Chudzik, S. M., Antony, M. M., Young, l., Swinson, R. P., & Zvolensky, M. J. (2004). Smoking behaviors across anxiety disorders. Journal of Anxiety Disorders, 18, 7–18.CrossRefPubMedGoogle Scholar
  34. Mitchell, J. E., & Dahlgren, L. A. (1986). Prevalence of smoking among psychiatric outpatients. The American Journal of Psychiatry, 143(8), 993–997.CrossRefPubMedGoogle Scholar
  35. Morissette, S. B., Brown, T. A., Kamholz, B. W., & Gulliver, S. B. (2006). Differences between smokers and nonsmokers with anxiety disorders. Journal of Anxiety Disorders, 20, 597–613. Scholar
  36. Ögel, K. (2010). Sigara, Alkol ve Madde Kullanım Bozuklukları: Tanı, Tedavi ve Önleme (Tobacco, alcohol and substance use disorders: diagnosis, treatment and prevention). İstanbul: Yeniden Yayınları.Google Scholar
  37. Pampel, F. (2010). Divergent patterns of smoking across high-income nations. In E. Crimmins, S. H. Preston, & B. Cohen (Eds.), International differences in mortality at older ages: dimensions and sources (pp. 132–163). Washington, DC: National Academy Press.Google Scholar
  38. Patton, J. H., & Stanford, M. S. (1995). Factor structure of the Barratt impulsiveness scale. Journal of Clinical Psychology, 51(6), 768–774.CrossRefPubMedGoogle Scholar
  39. Robinson, S., & Lader, D. (2007). Smoking and drinking among adults.  General Household Survey (pp. 6-8). London: HM Stationary Office. Google Scholar
  40. Roh, D., Kim, S. J., & Kim, C. H. (2009). The relationship between clinical characteristics and impulsiveness in obsessive-compulsive disorder. Journal of Korean Neuropsychiatric Association, 48, 336–343.Google Scholar
  41. Sacco, K. A., Termine, A., Seyal, A., Dudas, M. M., Vessicchio, J. C., Krishnan-Sarin, S.,… & George, T. P. (2005). Effects of cigarette smoking on spatial working memory and attentional deficits in schizophrenia: involvement of nicotinic receptor mechanisms. Archives of General Psychiatry, 62(6), 649–659. doi:
  42. Sharma, P., Gale, T. M., & Fineberg, N. A. (2012). Clinical correlates of tobacco smoking in OCD: a UK, case-controlled, exploratory analysis. Journal of Behavioral Addictions, 1(4), 180–185.CrossRefPubMedGoogle Scholar
  43. Sohn, S. Y., Kang, J. I., Namkoong, K., & Kim, S. J. (2014). Multidimensional measures of impulsivity in obsessive-compulsive disorder: cannot wait and stop. PLoS One, 9(11), e111739. Scholar
  44. Stein, D. J., Hollander, E., Simeon, D., & Cohen, L. (1994). Impulsivity scores in patients with obsessive-compulsive disorder. Journal of Nervous and Mental Disease, 182(4), 240–241.CrossRefPubMedGoogle Scholar
  45. Summerfeldt, L. J., Hood, K., Antony, M. M., Richter, M. A., & Swinson, R. P. (2004). Impulsivity in obsessive-compulsive disorder: comparisons with other anxiety disorders and within tic-related subgroups. Personality and Individual Differences, 36(3), 539–553. Scholar
  46. Tan, O., & Taş, C. (2015). Symptom dimensions, smoking and impulsiveness in obsessive-compulsive disorder. Psychiatria Danubina, 27(4), 397–405.PubMedGoogle Scholar
  47. Tan, O., Sayar, G. H., Ünsalver, B. Ö., Arat, M. M., & Karamustafalıoğlu, O. (2014). The correlations of nicotine addiction with the levels of impulsiveness, depression and anxiety in obsessive-compulsive patients. Bağımlılık Dergisi-Journal of Dependence, 15(3), 124–133.Google Scholar
  48. Tavares, H., & Gentil, V. (2007). Pathological gambling and obsessive-compulsive disorder: towards a spectrum of disorders of volition. Revista Brasileira Psiquiatria (Sao Paulo, Brazil: 1999), 29(2), 107–117.CrossRefGoogle Scholar
  49. Torres, A. R., Prince, M. J., Bebbington, P. E., Bhugra, D., Brugha, T. S., Farrell, M., et al. (2006). Obsessive-compulsive disorder: prevalence, comorbidity, impact, and help-seeking in the British National Psychiatric Morbidity Survey of 2000. American Journal of Psychiatry, 163(11), 1978–1985. Scholar
  50. Ulusoy, M., Sahin, N. H., & Erkmen, H. (1998). Turkish version of the Beck Anxiety Inventory: psychometric properties. Journal of Cognitive Psychotherapy, 12(2), 28–35.Google Scholar
  51. Uysal, M. A., Kadakal, F., Karşidağ, C., Bayram, N. G., Uysal, O., & Yilmaz, V. (2004). Fagerstrom test for nicotine dependence: reliability in a Turkish sample and factor analysis. Tüberküloz ve Toraks, 52(2), 115–121.PubMedGoogle Scholar
  52. Wu, P., Goodwin, R. D., Fuller, C., Liu, X., Comer, J. S., Cohen, P., & Hoven, C. W. (2010). The relationship between anxiety disorders and substance use among adolescents in the community: specificity and gender differences. Journal of Youth and Adolescence, 39(2), 177–188. Scholar

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© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Uskudar UniversityFeneryolu Medical CenterIstanbulTurkey
  2. 2.Department of Humanities and Social SciencesYildiz Technical UniversityIstanbulTurkey

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