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What is cheek biting?

Chronic cheek biting (morsicatio buccarum) is a compulsive behavior whereby an individual repeatedly bites the inside of their cheek, causing damage to the tissue. This behavior may result in ulcerations, sores, and infections within the oral tissue.

Furthermore, repetitive biting in a target area typically leads to the development of white patches of keratosis– a callus-like formation. Cheek and lip biting are estimated to occur in approximately 3% of U.S. adults, with more than half of individuals reporting childhood onset. Similar to skin picking (excoriation) and hair pulling (trichotillomania), chronic cheek biting is classified as Other Obsessive-Compulsive and Related Disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).

Signs and Symptoms

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.