Onychophagia, commonly referred to as nail biting, is a chronic condition that is repetitive and compulsive in nature, and generally seen in children and young adults. Multiple factors play a role in the development of nail biting, ranging from genetic components to underlying psychiatric conditions.
While nail-biting can occur without symptoms of another psychiatric condition, it can be associated with attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder, separation anxiety, enuresis, tic disorder, and other mental health issues.
Onychophagia is a type of onychotillomania, which includes the habit of picking or otherwise manipulating the nails - for example, habit-tic nail deformity. Some researchers believe that nail biting is a result of a delay or dysfunction in the oral stage of psychological development.
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, categorizes chronic nail biting as other specified obsessive-compulsive disorder (OCD), classified in the same group as compulsive lip biting, nose picking, and hair pulling (American Psychiatric Association, 2013).
For most people, nail biting is automatic: You do it without thinking about it. While it can occur without any underlying psychiatric conditions, it's also associated with attention deficit hyperactivity disorder (ADHD), separation anxiety, tic disorder, and other mental health problems.
The psychology of nail biting
Mental health conditions associated with nail biting can involve severe emotional distress, depression, and anxiety.
Pharmacotherapy: In some cases, doctors may recommend the use of certain medications, such as selective serotonin reuptake inhibitors (SSRIs), to help with nail biting. However, doctors must make such prescriptions carefully, as SSRIs can worsen impulse-related conditions.
While nail biting is a difficult behavior to modify, a multidisciplinary approach can effectively manage onychophagia. Stimulus control, habit reversal training (HRT), and pharmacotherapy alone, or more commonly in combination, is frequently used for treatment (Table 1).
Onychophagia is defined as chronic nail biting behaviour, which usually starts during childhood. Onychotillomania results from recurrent picking and manicuring of the fingernails and/or toenails, leading to visual shortening and/or estraction of nails.
Onychophagia can be explained as a kind of a compulsion that may cause destruction of the nails. Habitual nail biting is a common behaviour among children and young adults.
While skin-picking and hair-pulling are typically associated with OCD and classified as an obsessive and compulsive-related disorder, it can also occur in the context of ADHD. Skin-picking, hair-pulling, and nail-biting may be related to anxiety, sensory stimulation, and impulsivity.
Sometimes, nail biting can be a sign of emotional or mental stress. It tends to show up in people who are nervous, anxious or feeling down. It's a way to cope with these feelings. You may also find yourself doing it when you're bored, hungry or feeling insecure.
Further, from comorbidity analyses, a nail-biting habit among ADHD children was associated with maladjustment disorder, and not with anxiety disorder commonly seen in ADHD patients. Therefore, nail biting is a possible indication of the presence of the more severe ADHD-C subtype.
“Nail biting or picking cuticles are often nervous habits or a way to relieve stress, so by engaging in an alternative behavior when you feel the urge, especially one that keeps your hands busy, you may be able to avoid biting your nails.”
But your nail-biting habit can reveal more than your stress level. According to a study out of the Journal of Behavior Therapy and Experimental Psychiatry, it is also a sign that you're a perfectionist. Researchers conducted a survey of 48 participants, half of whom had body-focused repetitive disorders.
To some degree, we all exhibit stimming behaviors. Nail biting, twirling your hair, drumming your fingers on the table, or cracking your knuckles are all forms of stimming. For a child with autism, stimming might involve motor tics like rocking back and forth, licking lips, flapping hands, or repetitive blinking.
Hyperfocusing on picking their skin, pulling/eating their hair, or chewing their nails/cheeks can send kids with ADHD into a “trance” to escape from feeling overwhelmed by a day of executive demands.
Nail biting is another behavioural disorder often observed in patients with TS. Nail biting itself affects more than a third of the general population, and its onset predominantly occurs during childhood or adolescence.
ADHD. Many ADHDers experience understimulation because dopamine receptors in ADHD brains often struggle to pick up dopamine signals. This leads to issues with impulse control, leading some people to rely on body-focused repetitive behaviors (BFRBs), including skin-picking, as common ways to lead to greater stimulation.
As Diller explains, waiting for the natural nail to grow beneath the fake nails is the best way to ensure you break your nail-biting habit. "It usually takes about 90 days to change most habits (and keep the new one), but it depends on how long-standing the habit is," adds Diller.
Restless behaviors,such as nail-biting or pacing, and signsof inattentiveness and distractibility,such as mismatched socks, misappliedmakeup, or unkempt hair, may be evident,especially in more advancedstages. A patient's speech provides especiallyimportant clues to the diagnosisof a manic or hypomanic bipolarepisode.
Although both OCD and ASD have similar symptoms, they are different conditions. OCD is a mental health disorder, whereas ASD is a developmental condition. ASD is a condition that a person is born with. OCD can develop during a person's lifetime.