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Compulsive Buying

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Abstract

Compulsive buying is a chronic, repetitive purchasing that becomes a primary response to negative events and feelings, and may include symptoms equivalent to craving and withdrawal. This article describes the addictive characteristics of compulsive buying, the psychiatric comorbidity, and the possibilities of treatment. Using PubMed and MedLine search engines, we performed a review of published literature over the period 1990-2010 using the keyword "compulsive buying". A key feature distinguishing compulsive buyers from normal consumers, collectors, and hoarders is that the former focuses on the buying process itself, rather than the items bought. In this instance, the purchased items are usually never used, but tend to be hidden or thrown away. A recent screening study found that up to 5% of adult Americans appear to be afflicted with this compulsion. Compulsive buying results in adverse consequences, including financial and legal problems, psychological distress (depression, guilt), and interpersonal conflict. The most commonly associated comorbidities are depression and eating disorders. Nothing is known about the neurobiology and genetics of compulsive buying and relatively little about its treatment. Cognitive behavioral therapy has some efficacy, but no medication has been effective in controlled trials. Compulsive buying can be described as a behavioral dependence. A great deal of future research is needed to improve our understanding of compulsive buying.
The American Journal of Drug and Alcohol Abuse, Early Online:1–6, 2010
Copyright © Informa Healthcare USA, Inc.
ISSN: 0095-2990 print / 1097-9891 online
DOI: 10.3109/00952990.2010.493590
Compulsive Buying
Michel Lejoyeux, Ph.D.
Paris 7 University, Department of Psychiatry, Paris, France, and Hospital Bichat Claude Bernard,
AP-HP and Maison Blanche Hospital, Paris, France
Aviv Weinstein, Ph.D.
Hadassah Medical Organization, Jerusalem, Israel
Background: Compulsive buying is a chronic, repetitive pur-
chasing that becomes a primary response to negative events and
feelings, and may include symptoms equivalent to craving and
withdrawal. Objectives: This article describes the addictive char-
acteristics of compulsive buying, the psychiatric comorbidity, and
the possibilities of treatment. Methods: Using PubMed and Med-
Line search engines, we performed a review of published litera-
ture over the period 1990–2010 using the keyword “compulsive
buying”. Results: A key feature distinguishing compulsive buyers
from normal consumers, collectors, and hoarders is that the for-
mer focuses on the buying process itself, rather than the items
bought. In this instance, the purchased items are usually never
used, but tend to be hidden or thrown away. A recent screening
study found that up to 5% of adult Americans appear to be af-
flicted with this compulsion. Compulsive buying results in adverse
consequences, including financial and legal problems, psychologi-
cal distress (depression, guilt), and interpersonal conflict. The most
commonly associated comorbidities are depression and eating dis-
orders. Nothing is known about the neurobiology and genetics of
compulsive buying and relatively little about its treatment. Cogni-
tive behavioral therapy has some efficacy, but no medication has
been effective in controlled trials. Conclusions: Compulsive buying
can be described as a behavioral dependence. A great deal of future
research is needed to improve our understanding of compulsive
buying.
Keywords behavioral addiction, compulsive buying, compulsive
shopping
INTRODUCTION
The purpose of this article is to perform a review of recent
works on compulsive buying and to evaluate whether compul-
sive buying should be regarded as an impulsive-compulsive dis-
order or also as behavioral addiction. Buying is a routine part
of everyday life. However, in specific situations, buying may
be unplanned and sudden, initiated on the spot, and associated
Address correspondence to Professor Michel Lejoyeux, M.D.,
Ph.D., Bichat Hospital AP HP, Psychiatry, Rue Henri Huchard, Paris,
75018, France. E-mail: michel.lejoyeux@bch.aphp.fr
with a strong urge and feeling of pleasure and excitement. When
it is repetitive and associated with adverse consequences (usu-
ally psychological and financial), this kind of buying is known as
compulsive buying (1). Compulsive buying was first described
in the early 20th century by Emil Kraepplin (2) and Eugen
Bleuler (3). Diagnostic criteria for compulsive or addictive buy-
ing were first proposed in 1994 (4) and later refined (5). These
criteria describe symptoms equivalent of craving and withdrawal
applied to buying behavior (6). However, compulsive buying is
not yet represented in the Diagnostic and Statistical Manual
(DSM) or International Classification of Diseases (ICD) clas-
sifications. The Diagnostic and Statistical Manual Fifth Edi-
tion (DSM-V) task force proposed two important changes re-
lated to compulsive buying: separating obsessive-compulsive
disorder from the anxiety disorders and placing it in a separate
category—the obsessive-compulsive disorder spectrum disor-
ders; and creating several new autonomous disorders from those
currently described as impulse control disorders not otherwise
specified. The task force suggested including in this group of
disorders compulsive-impulsive (C-I) shopping, C-I internet use
disorder, C-I sexual behavior, and C-I skin-picking. Compulsive
buying (C-I shopping) has much in common with the other dis-
orders in the proposed DSM-V C-I disorder category, and little
in common with the anxiety disorders in that proposed DSM-V
grouping.
EPIDEMIOLOGY
Prevalence
Population-based surveys in the United States suggest that
up to 5% of adults may have compulsive buying (7–9). The vast
majority (up to 92%) of compulsive buyers are women (10) in
clinical samples. Koran et al. (9), however, did not find a signif-
icant gender effect in their study which included 2,513 adults
from the general population. The mean age of onset is 30 years
(8). A study of 200 women who shopped at a renowned Parisian
department store found that 32.5% met McElroy’s diagnostic
1
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2M. LEJOYEUX AND A. WEINSTEIN
criteria for compulsive buying (11). There was no difference
from a control group in age, education level, or professional
status. Among 1,490 customers of an Internet women’s clothing
retailer, 17.7% were compulsive buyers (12).
CLINICAL CHARACTERISTICS
Phenomenology of Compulsive Buying
According to our clinical experience as a psychiatrist and
psychologist specializing in the treatment of substance and be-
havioral addictions, compulsive buyers experience repetitive,
irresistible, and overpowering urges to purchase goods, per-
haps similar to the attitude of substance addicts towards their
substance of choice. These goods are frequently useless and/or
unused items (6). Availability of the Internet retail environment
may promote compulsive buying because it permits avoidance
of direct, face-to-face social contact, allows the transactions to
be kept private (e.g., hidden from family), and provides con-
tinuous electronic feedback about product offerings and prices.
Compulsive buyers strongly focus on the buying process itself,
i.e., are more interested in the acquisition than in possession or
use of the item purchased (6). All these clinical characteristics
may suggest similarities between compulsive buying and addic-
tion. Research on addiction could help to identify compulsive
buying as behavioral addiction.
Intoxication
Mc Elroy et al. (4) noted that 70% of patients presenting with
compulsive buying described buying as “a high,” “a buzz,” “a
rush,” the positive feeling (e.g., pleasure, excitement) experi-
enced while buying.
Equivalent of Withdrawal
Compulsive buyers consider that they miss important occa-
sions to buy items that will not be again available (13).
Adverse Consequences
Compulsive buying regularly results in adverse conse-
quences, including substantial financial debts (14), legal prob-
lems, psychological distress (e.g., depression, feelings of guilt),
interpersonal conflict, and marital conflict (15). For compulsive
buyers, money and possibility to buy could be considered as an
equivalent of a drug.
Compulsive buyers, according to a study conducted in de-
pressed patients, are no more sensitive than others to advertis-
ing and marketing (13). They do not seek sales, use loans, or
change their purchase choices significantly more than others.
These observations have not been replicated in non-depressed
compulsive buyers.
Differential Diagnosis
Collectors
Both collectors and compulsive buyers spend time, money,
and energy in the hunt for “precious” goods, but the attitude
towards and fate of the purchases are different. For collectors,
the focus is the item acquired, so they keep their purchases and
often display them with pride. For compulsive buyers, the focus
is the buying process, not the item, so they usually lose interest
in their purchase and keep it hidden (e.g., in a closet) or give it
or throw it away.
Compulsive Hoarding
Compulsive hoarding has been defined as the acquisition of,
and failure to discard, possessions which appear to be useless
or of limited value (16). Hoarding involves not only buying,
but also acquiring “free things,” “freebies,” and things other
people have discarded. Compulsive buying may be associated
with compulsive hoarding. Compulsive buying is more frequent
among people who hoard than among controls (17). Among
patients (18) who met criteria for clinically significant hoard-
ing, 61% presented compulsive buying and 85% reported ex-
cessive acquisition. Those who acquired excessively had more
severe hoarding; their hoarding had an earlier onset and re-
sulted in more psychiatric work impairment days, and they ex-
perienced more symptoms of obsessive compulsive disorder,
depression, and anxiety. Two forms of excessive acquisition
(buying and accumulation of free things) each contributed in-
dependent variance in the prediction of hoarding severity and
related symptoms.
Buying during Manic Episodes
Excessive or inappropriate buying is a common symptom
of manic episodes. This behavior, which disappears during eu-
thymic periods, is driven by grandiosity and loss of impulse
control, rather than any focus on the buying process itself (6,
14). All diagnostic criteria for compulsive buying (15, 5) ex-
clude buying sprees related to mania.
Buying Related to Psychosis
Patients with schizophrenia may engage in excessive buying.
Such buying is often discordant or bizarre and may reflect delu-
sions or other thought disorder, e.g., buying high-tech electron-
ics goods to contact aliens from another planet. In most cases,
compulsive buyers do not suffer from psychotic symptoms, and
their buying is not the result of a delusion (14).
Psychiatric Comorbidity
Mood Disorders
Depression and bipolar disorder are present among compul-
sive buyers (4, 7, 14). Furthermore, some patients report that
buying increases during depressive episodes and that shopping
made them feel good.
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COMPULSIVE BUYING 3
Among 119 inpatients with a major depressive episode Di-
agnostic and Statistical Manual Third Edition Revised (DSM-
III-R criteria), 31.9% were compulsive buyers (19). This group
was younger and more likely female and single than the pa-
tients without compulsive buying. They were also more likely
to have recurrent depression (relative risk [RR] =1.4), im-
pulse control disorders such as kleptomania (RR =8.5) or
bulimia (RR =2.8), or benzodiazepine abuse or dependence
(RR =4.68).
Obsessive-Compulsive Disorder (OCD)
Compulsive buying has been considered part of the OCD
spectrum (15), but most OCD patients spend less money than
compulsive buyers and are less impulsive in their buying be-
havior (20). Assessment of 1,500 consecutive general medical
outpatients in Paris identified 60 patients with OCD, of whom
14 (23%) also had compulsive buying (21). The prevalence of
compulsive buying among patients without OCD was 0.3%. Pa-
tients with OCD +compulsive buying met a higher number
of Diagnostic and Statistical Manual Fourth Edition Revised
(DSM-IV-R) criteria for OCD than patients with OCD only,
were more likely depressed and had higher scores on the CAGE
questionnaire (assessing alcoholism).
Eating Disorders
Compulsive buying and eating disorders frequently co-occur.
One study found that 20% of compulsive buyers also had an eat-
ing disorder; conversely, 17.6% of binge eaters had compulsive
buying (22). Among a group of 373 patients with a variety of eat-
ing disorders, the lifetime prevalence of compulsive buying was
11.8% (23). Compulsive buyers were three times more likely to
have comorbid borderline personality disorder. Another study
found that compulsive buying commonly appeared prior to the
onset of eating disorder (24).
Substance Use Disorders and Impulse Control Disorders
Little is known about the comorbidity of compulsive buying
and substance use disorders. Lejoyeux et al. (25) noted that
45.6% of women with nicotine dependence have compulsive
buying. Compulsive buying is significantly more frequent in
smokers than in non-smokers (25). Impulse control disorders
are also relatively common in patients with compulsive buying
(21–40%) (4, 14).
Personality Disorders
Schlosser et al. [26] found that nearly 60% of subjects with
compulsive buying met criteria for at least one Axis II disorder.
While there was no special “shopping” personality, the most
frequently identified personality disorders were the obsessive-
compulsive (22%), avoidant (15%), and borderline (15%) types.
Krueger (27), a psychoanalyst, described four patients who he
observed to have aspects of narcissistic character pathology.
Assessment of Compulsive Buying
The Compulsive Buying Scale (28) is a validated 7-item
screening instrument developed to measure compulsive buy-
ing behavior. Lower scores on this scale indicate greater level of
compulsive buying. A score less than or equal to 1.34 classifies
a compulsive buyer. The Yale–Brown Obsessive Compulsive
Scale-Shopping Version (Y-BOCS-SV) (29) was modelled on
the Y-BOCS (30) and assesses severity and interference caused
by buying thoughts and behavior, rather than assessing obses-
sions and compulsions. The instrument is reliable and valid
in measuring severity and change in persons with compulsive
buying.
The Questionnaire about Buying Behavior (QABB) (19)
consists of 19 yes–no items representing major basic features
of compulsive buying (e.g., urges to shop and buy, negative
feedback from family and friends, post-purchase guilt) based
on the McElroy et al. (4) criteria. The QABB is usually self-
administered.
Other clinical instruments are the Canadian Compulsive Buy-
ing Measurement Scale (31), the Edwards Compulsive Buying
Scale (32), the Minnesota Impulsive Disorder Interview (14),
and the Ridgway’s Compulsive Buying Scale (33).
The Canadian Compulsive Buying Measurement Scale (31)
is a 13-item-scale exploring three basic dimensions: the ten-
dency to spend, a reactive aspect to triggers which may lead to
shopping, and post-purchase guilt. Valence et al. (31) found a
statistically significant difference between the addictive buying
averages of a general pool of consumers and a second pool of
compulsive consumers. Edwards (32) has developed a 13-item
scale that assesses experiences and feelings about shopping and
spending. Ridgway’scale (33) consists of nine questions identi-
fying consumers who have a strong urge to buy, regularly spend
a lot of money, and have difficulty resisting the impulse to buy.
These self-reported ratings and semistructured interviews
cannot replace clinical evaluation. Clinicians must inquire in
detail about buying attitudes, the extent of preoccupation with
buying and shopping, urges to buy, feeling and thoughts asso-
ciated with buying, and the interference with social, financial,
and occupational functioning.
PSYCHOLOGICAL FACTORS
Compulsive Buying as a Way to Escape Negative Emotions
Although factors promoting positive mood state (e.g., nice
scents, pretty colors, or pleasant music) may elicit an impulse
purchase, compulsive buying more frequently occurs in the con-
text of negative affects (1). Compulsive buying occurs in re-
sponse to negative emotions and results in a decrease in the
intensity of negative emotions. Euphoria or relief from nega-
tive emotions is the most common psychological consequence
of compulsive buying (34–36). This relief is transient and fol-
lowed by an increase in anxiety.
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4M. LEJOYEUX AND A. WEINSTEIN
Sad mood,
feeling
blue
Thought: "I am
less sad when I
have bought
something
pleasant"
Buying
something
will make me
happy
Craving
Thoughts:
"I’m entitled to a
little treat."
"I am full of
desires."
"I am worth it."
Money hunting,
action of going into a
shop
Purchase
Psychological factors of compulsive buying
Impulsivity
Impulsivity (i.e., a predisposition toward rapid, unplanned
reactions to internal or external stimuli with diminished regard to
the negative consequences) contributes to uncontrolled buying.
Compulsive buyers are significantly more impulsive than others
(37, 38) and have higher subscores for experience seeking on
the Zuckerman Sensation-Seeking Scale (38).
Billieux et al. (1) found a significant correlation between
compulsive buying and three components of impulsivity as con-
ceptualized by Whiteside and Lynam (39): urgency, lack of
premeditation, and lack of perseverance. They concluded that a
high level of urgency is related to a poorer ability to deliberately
suppress buying impulses. Due to their impulsivity, compulsive
buyers are not able to refrain from purchasing. This high level
of impulsivity supports the suggestion of including compulsive
buying as a disorder as a behavioral addiction involving prob-
lems with impulse control, more than as a compulsive disorder.
High tendency to impulsivity distinguishes compulsive buyers
from patients with OCD, who are more often collectors and only
buy after a long period of hesitation or procrastination. In most
cases, however, both compulsivity and impulsivity may play a
role in compulsive buying.
NEUROBIOLOGICAL FACTORS
The only work on neurobiology of buying was conducted
by Knutson et al. (40) using event-related Functional Magnetic
Resonance Imaging (fMRI). They suggested that distinct cir-
cuits anticipate gain and loss. Product preference activated the
nucleus accumbens (NAcc), while excessive prices activated the
insula and deactivated the mesial prefrontal cortex (MPFC) prior
to the purchase decision. Activity from each of these regions in-
dependently predicted immediately subsequent purchases above
and beyond self-report variables.
This evidence seems to suggest that compulsive buying is
similar in its neurocircuitry to other behavioral addictions such
as gambling or internet addiction and, therefore, should be re-
garded as such. In our view, compulsive buying, similar to other
behavioral addictions, may be maintained by the brain’s reward
system which can be predictive of purchasing behaviors, but
once negatively reinforced it may result in the return of negative
affective states. This point, however, has not been confirmed by
specific experiments on neurocircuitry.
Devor et al. (41) raised the hypothesis that serotonergic dys-
function may be associated with compulsive buying. They con-
sidered that deficits in impulse control and reward-mediated
learning are mediated by serotonin. They examined 21 patients
diagnosed with compulsive buying for two DNA sequence poly-
morphisms found in the gene that encodes the serotonin trans-
port (5-HTT). One polymorphism, found in the promoter region
of the 5-HTT gene, involves a 44-base pair (bp) deletion, and
the other, found in the second intron, is due to variable numbers
of a repeat sequence. When compared to a control panel, no sig-
nificant differences were seen for either 5-HTT marker among
the compulsive buyers.
TREATMENT
Psychotherapy
Cognitive Behavioral Therapy
The false cognitions associated with compulsive buying (fear
of missing an exceptional occasion to buy, tendency to overesti-
mate power, and importance of items to be bought) suggest that
cognitive behavioral therapy (CBT) might be effective for this
disorder. The patient should first be evaluated for psychiatric
comorbidity, especially depression, so that appropriate pharma-
cological treatment can be instituted if indicated. For example,
if depression is found, antidepressants should be used in treat-
ment along with psychotherapy. Mitchell et al. (42) compared
28 compulsive buyers receiving 12 sessions of CBT over 10
weeks to 11 patients remaining on a waiting list. At the end
of treatment, patients receiving CBT showed significant reduc-
tions, compared to those on the waiting list, in the number of
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COMPULSIVE BUYING 5
TABLE 1
McElroy’s et al. diagnostic criteria for compulsive buying;
adapted from (4).
Inappropriate preoccupations with buying or shopping, or
inappropriate buying or shopping impulses or behavior, as
indicated by at least one of the following:
Frequent preoccupations with buying or impulses to buy that
are experienced as irresistible, intrusive, and/or senseless
Frequent buying of more than can be afforded, frequent
buying of items that are not needed, or shopping for longer
periods of time than intended
The buying preoccupations, impulses, or behaviors cause
marked distress, are time-consuming, significantly interfere
with social or occupational functioning, or result in
financial problems (e.g., indebtedness or bankruptcy)
The excessive buying or shopping behavior does not occur
exclusively during periods of hypomania or mania
compulsive buying episodes and time spent buying. Improve-
ment was maintained at 6-month follow-up. Mueller et al. (43)
conducted a randomized trial comparing the efficacy of a group
CBT to a waiting list control group in 31 patients. The treatment
was specifically aimed at interrupting and controlling the prob-
lematic buying behavior, establishing healthy purchasing pat-
terns, restructuring maladaptive thoughts and negative feelings
associated with shopping and buying, and developing healthy
coping skills. The improvement was maintained during the 6-
month follow-up. A lower number of visited group therapy
sessions and comorbid compulsive hoarding were significant
predictors for non-response.
Pharmacological Treatment
Few controlled studies have assessed the effects of phar-
macological treatment on compulsive buying, and none have
shown any medication to be effective. Two double-blind studies
with the selective serotonin reuptake inhibitor (SSRI) fluvox-
amine found no significant difference between medication and
placebo groups (44, 45). A discontinuation study with the SSRI
citalopram (after 7 weeks of open-label treatment at 20–60 mg
daily) found a lower relapse rate in those randomized to contin-
ued citalopram (0%) than in those randomized to placebo (63%)
(46). However, the sample size was too small (15 patients) to
detect statistical significance. Small open-label studies with an-
tidepressants (often in combination with mood stabilizers) (4,
47), citalopram (mean dose 35 mg daily) (48), or the opioid
antagonist naltrexone (49, 50) reported improvement in the ma-
jority of patients.
CONCLUSION
Compulsive buying is a behavioral addiction that may be
increasing in prevalence because of shopping availability. The
main characteristic of addictive buying is that items bought
are rarely used. Compulsive buying appears impulsive and
significantly different from a compulsive disorder. Screening
instruments and diagnostic criteria exist that parallel those for
substance addictions, pathological gambling, or other impulse
control disorders. Very little is known about the neurobiology
and genetics of compulsive buying, but the evidence points out to
some similarity with behavioral addictions and lack of evidence
for serotonergic abnormality, which is a characteristic of OCD.
Relatively little is known about its treatment. CBT has some ef-
ficacy, but no medication has been effective in controlled trials.
Much future research is needed to improve our understanding
of compulsive buying. It could also be useful to pursue research
works on pharmacological treatment of the disorder.
Declaration of Interest
The authors report no conflict of interest. The authors alone
are responsible for the content and writing of this paper.
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Replies to D. A. Fishbain's (see record 1995-29412-001) comment on the similarity of kleptomaniacs to the compulsive buyers in the article by R. J. Christenson et al (see record 1994-29953-001). Christenson et al suggest that the 2 groups have different underlying psychological meaning; kleptomaniacs seek challenge, and compulsive buyers seek reward. Benefits of treatment with serotonin reuptake inhibitors for both are also discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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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.