Chronic cheek biting (morsicatio buccarum) is a compulsive behavior that causes an individual to repeatedly bite the inside of the cheek. Similar to to skin picking (excoriation) and hair pulling (trichotillomania), chronic cheek biting is classified as Obsessive-Compulsive and Related Disorders in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.
Often referred to as "cheek chewing," chronic cheek biting can result in a myriad of complications. Redness, painful sores, and tears can occur in the mucosa, which is the inner lining of the mouth. For some, after repetitive biting occurs, the lining of the cheek can start to feel irregular, increasing the urge to continue to bite in order to create a smooth surface. Psychologically, feelings of guilt, shame, and hopelessness may arise. Social activity can decrease in order to prevent others from observing the behavior.
As with other BFRBs, the roots of chronic cheek biting seem to be multifactorial. The behavior is more common for people who experience higher levels of stress and anxiety. Some people are compelled by the need for a smooth feeling of the inner cheek lining. Any perceived impurity such as a bump or scratch may produce the uncontrollable urge to remove the imperfection by biting the area.
Because chronic cheek biting has both behavioral and emotional components, treatment should focus on both aspects. Similar to the case with other BFRBs, managing the behavior is very difficult if you are unaware you are doing it or in a trance-like state.
The impact of cheek biting on one's life may be significant. Individuals may experience shame and embarrassment. This can lead to painful isolation and result in a great deal of emotional distress, placing people at risk for a co-occurring psychiatric disorder, such as a mood or anxiety disorder.
Chronic cheek biting, similar in nature to other BRFBs such as excoriation and trichotillomania, can cause significant distress. The most successful management strategies make use of a variety of therapeutic techniques that address actionable emotional and behavioral components. While learning how to manage the behavior, it is important to remember that emotional discomfort that influences the behavior is subjective rather than objective. This realization empowers you to choose how you experience these emotions and enables you to alter your behavior. Cheek biting can also lead to strained relationships with family members and friends. Family members may need professional help in coping with these behaviors.
Research into treatments for BFRBs, particularly hair pulling and skin picking, has grown steadily over the past decade. Although no one treatment has been found to be effective for everyone, a number of evidence-based treatment options have shown promise for many people.
Choosing a therapeutic provider to support your BFRB journey is a process that takes time. Patience and persistence are key to finding your own level of success.
Medications used for OCD and other anxiety disorders have been tested on subjects with BFRBs with limited success. There has not yet been any single medication or combined medications approved by the Food and Drug Administration (FDA) for the treatment of BFRBs.