Nail biting (onychophagia) involves the destruction of fingernails by means of habitual biting. Although not specifically indexed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), nail biting is currently classified under Obsessive-Compulsive and Related Disorders in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, with specification of body-focused repetitive behavior.
While few scientific studies have examined nail biting, it is believed to be a common behavior that typically begins in childhood and involves damage to fingernails by means of habitual biting. It is estimated that 20%-30% of the general population engages in chronic nail biting although prevalence estimates greatly vary, with estimates ranging from 12% to 44%. In addition to hair pulling disorder and skin picking disorder, frequently co-occurring behaviors include bruxism (teeth clenching or grinding), and cheek biting.
Nail biting is often associated with visible nail damage, tension prior to or when attempting to resist nail biting, feelings of pleasure after biting, nail eating, and psychological distress. Many describe the behavior as “automatic.”
The impact of nail biting on one's life may be significant. Individuals may experience shame and embarrassment, and as a result, may avoid certain social situations or activities. 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. 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.
Individuals who experience nail biting often go to great lengths to cover, hide, or camouflage damaged skin and may have difficulty with time management due to the significant time involved in engaging in the behavior as well as efforts to conceal it.
Nail biting behavior can not only result in unappealing cosmetic appearance, shame, guilt, and embarrassment, but may also cause significant damage to the cuticles and nails, bacterial and viral infection, cellulitis, abscess, injury to the soft tissue lining the mouth, dental problems, temporomandibular dysfunction, and osteomyelitis. Stigmatization by family and other social groups is also frequently of concern.
Nail biting can also lead to strained relationships with family members and friends. Family members may need professional help in coping with their loved one's 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.