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 looking how to stop biting their nails.
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.
Body-focused repetitive behaviors (BFRBs) include any repetitive self-grooming behavior that involves biting, pulling, picking, or scraping one’s own hair, skin, lips, cheeks, or nails that can lead to physical damage to the body and have been met with multiple attempts to stop or decrease the behavior.
Common BFRBs include hair pulling, skin picking, nail biting, and cheek biting. Other body-focused repetitive behaviors include hair eating, nail picking, skin biting, lip biting, tongue chewing, and hair cutting.
For some, the BFRB journey can last a lifetime. For others, their BFRBs wax and wane, with periods of no picking, pulling, or biting. For some, they are able to regulate and stop their behaviors completely.
It's important to remember that this is a very personal, individual journey. No two BFRB journeys are alike. It's up to you to decide how to best manage your BFRBs. Finding space and grace to make good choices for yourself will help you gain clarity on what you want.
Getting connected to community and meeting others on the BFRB journey gives you a variety of perspectives from which to grow. Strive for progress over perfection. You've got this and we've got you!
Research indicates that some people may have an inherited predisposition for skin picking or hair pulling. Several studies have shown a higher number of BFRBs in immediate family members of persons with skin picking or hair pulling disorders than would be expected in the general population. In addition, a recent study examined hair pulling in both identical and fraternal twins and produced results consistent with a significant inherited component in hair pulling disorder. So we can safely say that BFRBs are more than likely inherited, at least to some degree.
Research into treatments for BFRBs, particularly hair pulling disorder and skin picking disorder, 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.