Nail-biting has received less attention in dermatology and psychiatry. Nail-biting can be a harmless, temporary habit that only affects appearance, or it can become a serious, long-term problem. Onychophagia, also known as onychophagy, is a pathological oral habit and grooming disorder characterised by uncontrollable, persistent nail-biting that harm fingernails and tissue. As a subtype of “Other Specified Behaviour Disorder,” onychophagia is classified by the DSM-5 as “body-focused repetitive behaviour disorder.”
Nail-biting is not a disease that occurs at all times or in all peoples. However, it is unclear where the line between healthy and unhealthy behaviour is drawn for nail-biting. Nail-biting is only temporary and does not last long in healthy children. Pathological nail-biting is more common, more intense, and lasts longer than normal nail biting. The classification of psychiatric disorders reflects the uncertainty in distinguishing pathological from non-pathological nail biting. In the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), certain behavioural issues, such as trichotillomania, are classified as impulse control disorders, but nail-biting is not.
Alarming Stages of Nail-Biting
Although the act of biting one’s nails is fairly common, it’s not always easy to distinguish between “normal” and pathological nail-biting. The DSM-5 states that onychophagia falls under the category of “body-focused repetitive behaviour disorder,” which is diagnosable and is characterised by repeated, unsuccessful attempts to stop the behaviours and causes clinically significant distress. Those who experience severe shame, guilt, or anxiety as a result of their nail-biting, feel powerless to stop, and discover that it affects one or more aspects of their lives may benefit from seeking treatment.
Onychophagia may have a genetic component since some people appear to inherit a proclivity for BFRBs as well as higher than average rates of mood and anxiety disorders in close relatives. Nail-biting is frequently associated with anxiety because it is assumed to reduce stress, tension, and boredom. Nail biters frequently admit to biting their nails when they are stressed, bored, lonely, or even hungry. Another behaviour that can result from prior thumb or finger sucking is nail-biting. Although nail-biting has been linked to ADHD, oppositional defiant disorder, separation anxiety, enuresis, tic disorder, and other mental health conditions, it is possible for it to occur without any other psychiatric symptoms.
Nail-biting has a negative impact on both family members and sufferers. On occasion, parents and other family members may be embarrassed by their children’s or siblings’ behaviour. Others may make fun of or stigmatise children or adults who have nail biting. Nail-biting can make it difficult to use one’s hands for social activities like writing, drawing, or playing in front of others. Others regularly assault children who have nail biting. Patients with nail biting are frequently told that they can control or even cure their condition, but they refuse. Attacks not only do not change nail biting behaviour, but they also increase stress, frustration, helplessness, hopelessness, and anxiety in the children. Additionally, nail-biting influences Enterobacteriaceae oral carriage. Children who practise nail-biting have higher levels of Enterobacteriaceae in their oral cavities than those who do not.
Nail-biting can result in root damage, apical root resorption, alveolar destruction, malocclusions, temporomandibular disorders, and gum injuries. Furthermore, biting your nails can cause skin irritation, infection, and damage to the roots of your teeth. Furthermore, nail biting has the potential to seriously harm nail beds and cause nail loss. Nail growth can be accelerated with nail biting. The consequences of nail biting are not limited to medical consequences. Nail-biting has a negative social and psychological impact on patients and their parents. Individuals who bite their nails may have a lower self-esteem and a higher concern for the opinions of others. Meanwhile, nail biting does not appear to be linked to general medical conditions like fibromyalgia.
It is impossible to manage the habit of biting one’s nails without taking into account some related factors such as co-morbidities, precedent, and the consequences of the behaviour. Some studies suggest that treating young patients with mild nail biting is unnecessary. Along with any treatment, the parents, siblings, and teachers of the affected children should be educated. It is critical that they understand the distinction between appropriate and inappropriate responses. For example, they should be aware that punishing, threatening, or mocking children with nail-biting can aggravate the behaviour because these children are attempting to attract the attention of others through nail biting.
Parents may be embarrassed by their children’s bad habits. Recognizing and controlling these emotions is critical. Siblings may feel guilty if they must deal with their siblings’ inappropriate behaviour. As a result, they must be made aware of the management process and involved in it. Many parents have attempted to paint or coat their children’s fingernails with noxious substances, but these methods are rarely successful. Children with nail-biting habits should be encouraged and supported rather than blamed, as doing so will only make them feel even more let down. It takes several sessions to thoroughly manage and treat a child with nail-biting behaviour. These clinical findings suggest that treating nail biting is far more difficult than simply stopping it. Receiving medical attention is more difficult than it appears. Since nail biting can harm teeth and alveolar structure, children who are affected should be referred for an evaluation and management of potential damages.
Some recommended nail-biting treatments include chewing gum and wearing a rubber band around the wrist. However, control trials must be conducted to examine these methods’ efficacy. It’s important to assess the effectiveness of using alternative finger exercises like writing, drawing, holding tiny balls, or playing an instrument.
There have been few controlled clinical trials on behavioural or psychotherapeutic approaches to treating nail biting. Children’s behaviour can be managed using some cognitive behavioural management techniques. These approaches are very similar and are based on cognitive and behavioural principles, such as learning principles. Each of them teaches the children some skills that they can use to control their nail-biting behaviours.
- Analysis of Functional Evaluation
This theory serves as the foundation for nail biting behavioural analysis and treatment planning. Nail-biting functional analysis and treatment have been shown to be successful in a few case studies. Undergraduate students are more likely to bite their nails when they are bored or frustrated than when they are paying contingent or non-contingent attention. Environmental factors may play a role in the development of nail biting in some people. The environmental factors that contribute to nail biting, however, differ from person to person. Functional analysis of nail biting is a method for determining the type of precedent and effects of nail biting. It has long-lasting positive effects.
- Competitive Reaction
When using this behavioural technique, any urge to bite or the sight of someone biting their nails must be met with a competing response. A behaviour, for example, may be used to prevent or inhibit reaching for the lips or face with the upper limbs, or to prevent or inhibit sticking the fingers in the mouth. This method is more effective than not using it because the competing response type is unimportant for suppressing the target behaviour and is unlikely to serve as an incompatible behaviour.
- Adverse Sensation
A common nail-biting treatment method that employs an aversive sensation is to paint each patient’s individual nails with something bitter or unpleasant. People with nail biting benefit from aversive stimulus therapy, though its effect is less pronounced than that of the alternative response technique.
- Initiative for Self-Control
The management of nail biting may benefit from a self-control intervention because human behaviour is goal-directed and influenced by a variety of factors. This technique teaches and allows the subjects to practise a few specific self-control techniques. The process consists of several steps.
- The targeted behaviour is explained to kids as a problem that can be fixed.
- The children are told to investigate possible causes for nail biting as well as the associated feelings and thoughts.
- The children are taught self-monitoring so that they are more conscious of their actions.
- The children are taught how to use learned behaviours such as self-talk and self-reward to change automatic behaviour.
- The children are taught how to control and modify similar pathological behaviours.
One possible explanation for the failure of nail-biting management strategies such as wearing nails, coating them with unpleasant substances, and repeatedly reminding children to stop nail biting is a failure to recognise nail biting as a symptom of a more complex condition. Nail-biting isn’t the only symptom. It could be a single symptom or a group of symptoms, all of which should be evaluated, assessed, and treated in conjunction with the underlying cause of nail biting. To provide evidence-based pharmaceutical protocols for the treatment of nail-biting behaviour, randomised controlled clinical trials are required.