Environmental Intolerances and Toxins-Chemical:  Research Article
Environmental Intolerances Menu

Cigarette Smoking and Panic: The Role of Neuroticism

CITATION:  Goodwin, R. and Hamilton, SP.  (2002).  Cigarette Smoking and Panic: The Role of Neuroticism.  Am J Psychiatry; 159:1208–1213.


Objective: The authors sought to determine the relationship of panic attacks, cigarette smoking, and neuroticism.

Method: Data were drawn from the Midlife Development in the United States Survey, a representative household survey of the adult population of the United States (N=3,032). Multivariate logistic regression analyses were used to determine the association between panic attacks and cigarette smoking and to determine whether neuroticism was an independent predictor of the co-occurrence of cigarette smoking and panic attacks.

Results: The majority of individuals with panic attacks had been regular smokers during their lifetime (81.1%), a significantly higher rate than seen among subjects without panic attacks (69.4%). Regular cigarette smoking was associated with a significantly greater risk of current panic attacks.  This significant association persisted after analyses controlled for demographic characteristics, depression, and alcohol/substance use disorders but was no longer evident after analyses adjusted for neuroticism. Neuroticism independently predicted the co-occurrence of regular cigarette smoking and panic attacks but did not predict either panic attacks or cigarette smoking in the absence of the other. 

Conclusions: Consistent with previous findings, these data suggest that panic attacks are associated with greater risk of cigarette smoking but provide new evidence that neuroticism may play an essential role in this relationship. These data are preliminary but, if replicated, suggest that neuroticism may reflect a shared vulnerability for the co-occurrence of cigarette smoking and panic attacks.
Future studies are needed to further explore the mechanism of this association.


1. Breslau N, Klein DF: Smoking and panic attacks: an epidemiologic
investigation. Arch Gen Psychiatry 1999; 56:1141–1147

2. Johnson JG, Cohen P, Pine DS, Klein DF, Kasen S, Brook JS: Association
between cigarette smoking and anxiety disorders during
adolescence and early adulthood. JAMA 2000; 284:2348–

3. Kandel DB, Johnson JG, Bird HR, Canino G, Goodman SH, Lahey
BB, Regier DA, Schwab-Stone M: Psychiatric disorders associated
with substance use among children and adolescents:
findings from the Methods for the Epidemiology of Child and
Adolescent Mental Disorders (MECA) Study. J Abnorm Child Psychol
1997; 25:121–132

4. Amering M, Bankier B, Berger P, Griengl H, Windhaber J,
Katsching H: Panic disorder and cigarette smoking behavior.
Compr Psychiatry 1998; 40:35–38

5. Patton GC, Hibbert M, Rosier MJ, Carlin JB, Caust J, Bowes G: Is
smoking associated with anxiety and depression in teenagers?
Am J Public Health 1996; 86:225–230

6. Breslau N, Kilbey MM, Andreske P: DSM-III-R nicotine dependence
in young adults: prevalence, correlates, and associated
psychiatric disorders. Addiction 1990; 89:743–754

7. Kessel JD, Shiffman S: Attentional mediation of cigarette smoking’s
effect on anxiety. Health Psychol 1997; 16:359–368

8. Pohl P, Yeragani VK, Balon R, Lycaki H, McBride R: Smoking in
patients with panic disorder. Psychiatry Res 1992; 43:253–262

9. Dilsaver SC: Nicotine and panic attacks. Am J Psychiatry 1987;

10. West R, Hajek P: What happens to anxiety levels on giving up
smoking? Am J Psychiatry 1997; 154:1589–1592

11. McCrae RR, Costa PT: Validation of the five-factor model of personality
across instruments and observers. J Pers Soc Psychol
1997; 52:81–90

12. Costa PT, McCrae RR: Personality in adulthood: a six-year longitudinal
study of self-reports and spouse ratings on the NEO
Personality Inventory. J Pers Soc Psychol 1998; 54:853–863

13. Patton D, Barnes GE, Murray RP: A personality typology of
smokers. Addict Behav 1997; 22:269–273

14. Herran A, de Santiago A, Sandoya M, Fernandez MJ, Diez-Manrique
JF, Vasquez-Barquero JL: Determinants of smoking behavior
in outpatients with schizophrenia. Schizophr Res 2000;

15. Kawakami N, Takai A, Takatsuka N, Shimizu H: Eysenck’s personality
and tobacco/nicotine dependence in male ever-smokers
in Japan. Addict Behav 2000; 25:585–591

16. Hu S, Brody CL, Fisher C, Gunzerath L, Nelson ML, Greenberg
BD, Murphy DL, Hames DH: Interaction between the serotonin
transporter gene and neuroticism in cigarette smoking behavior.
Mol Psychiatry 2000; 5:181–188

17. Yoshimura K: The psychological characteristics of tobacco dependence
in a rural area of Japan. J Epidemiol 2000; 10:271–

18. Byrne DG, Byrne AE, Reinhart MI: Personality, stress, and the
decision to commence cigarette smoking in adolescence. J Psychosom
Res 1995; 39:53–62

19. Kendler KS, Neale MC, Sullivan P, Corey LA, Gardner CO, Prescott
CA: A population-based twin study in women of smoking
initiation and nicotine dependence. Psychol Med 1999; 29:

20. Katon W, Hollifield M, Chapman T, Mannuzza S, Ballenger J,
Fyer AJ: Infrequent panic attacks: psychiatric comorbidity, personality
characteristics, and functional disability. J Psychiatr
Res 1997; 29:121–131

21. Hollifield M, Katon W, Skipper B, Chapman T, Ballenger JC,
Mannuzza S, Fyer AJ: Panic disorder and quality of life: variables
predictive of functional impairment. Am J Psychiatry
1997; 154:766–772

22. Kessler RC, Mickelson KD, Zhao S: Patterns and correlates of
self-help group membership in the United States. Soc Policy
1997; 27:27–46

23. Kessler RC, DuPont RL, Berglund P, Wittchen HU: Impairment
in pure and comorbid generalized anxiety disorder and major
depression at 12 months in two national surveys. Am J Psychiatry
1999; 156:1915–1923

24. Kessler RC, Andrews G, Mroczek D, Ustun B, Wittchen H-U: The
World Health Organization Composite International Diagnostic
Interview Short Form (CIDI-SF). Int J Methods in Psychiatr Res
1998; 7:171–185

25. Wittchen H-U: Reliability and validity studies of the WHO Composite
International Diagnostic Interview(CIDI): a critical review.
J Psychiatr Res 1994; 28:57–84

26. Bem SL: Bem Sex-Role Inventory Manual. Palo Alto, Calif, Consulting
Psychologists Press, 1981

27. Trapnell PD, Wiggins JS: Extension of the Interpersonal Adjective
Scales to include the big five dimensions of personality. J
Pers Soc Psychol 1990; 59:781–790

28. John OP: The “big five” factor taxonomy: dimensions of personality
in the natural language and in questionnaires, in
Handbook of Personality Theory and Research. Edited by Pervin
LA. New York, Guilford, 1990, pp 66–100

29. Goldberg LR: The development of markers for the big-five factor
structure. Psychol Assess 1992; 4:26–42

30. Digman JM: Personality structure: emergence of the five-factor
model. Annu Rev Psychol 1990; 41:417–440

31. SPSS 9.0 for Windows. Chicago, SPSS, 1998

32. Kelly C, McCreadie RG: Smoking habits, current symptoms, and
premorbid characteristics of schizophrenic patients in Nithsdale,
Scotland. Am J Psychiatry 1999; 156:1751–1757

33. Costa PT Jr, Herbst JH, McCrae RR, Siegler IC: Personality at
midlife: stability, intrinsic maturation, and response to life
events. Assessment 2000; 7:365–378

34. Eysenck HJ, Grossarth-Maticek R, Everitt B: Personality, stress,
smoking, and predisposition as synergistic risk factors for cancer
and coronary heart disease. Integr Physiol Behav Sci 1991;

35. Grossarth-Maticek R, Eysenck HJ: Personality, smoking, and alcohol
as synergistic risk factors for cancer of the mouth and
pharynx. Psychol Rev 1990; 67:1024–1026

36. Coryell W, Noyes R, Clancy J: Excess mortality in panic disorder:
a comparison with unipolar depression. Arch Gen Psychiatry
1982; 39:701–703