What is Onychophagia?

 Onychophagia, commonly known as nail biting, is a pathological oral habit wherein there is an uncontrollable urge to bite the nails. While this may appear to be a non-destructive habit with only cosmetic concerns, it may develop into a severe, long-term problem that can cause damage to the fingernails and surrounding skin and tissue.

Is Nail Biting a Medical Condition?

Medically, chronic nail biting habit is considered to be a mental condition categorised by repetitive and uncontrollable behaviour. Nail biting is medically classified in the DSM-IV category called the “Other Specified Obsessive-Compulsive and Related Disorder”. All conditions categorised under the DSM-IV list are typically linked to body-focused repetitive behaviour disorders (BFRBs). In severe onychophagia patients, the condition can be linked to other underlying psychiatric disorders, namely:

Attention Deficit Hyperactivity Disorder: Impulsive and hyperactive behaviour with difficulty in paying attention 

Separation Anxiety Disorder: Experiencing excessive anxiety when separated from a loved one  

Tourette Syndrome: Creating involuntary sounds and movements

Oppositional Defiant Disorder: Characterised by non-cooperation; tendency to defy and disobey people in authority         

Obsessive-Compulsive Disorder: Characterised by compulsive behaviour

Onychophagia Symptoms

People suffering from Onychophagia experience and exhibit the following symptoms: 

A general feeling of anxiousness, excitement, uneasiness, etc.

Itching, tingling, or pain sensations that create the urge to bite nails

Generating pleasure or feeling relieved after a nail-biting episode

Feeling guilty or shameful about their habit of nail-biting

The bad condition of nails with damaged cuticles and skin around the fingertips

Injuries in the mouth, dental issues, boils, and infections

Onychophagia Causes

The exact cause of nail biting is not known. Some research studies establish that there is a genetic link and the habit is inherited from immediate family members who have mood and anxiety disorders. However, people who are into the habit of nail biting report that anxiety, stress, boredom, nervousness, loneliness, adolescence issues, and even hunger maybe causing their nail biting behaviour.

Nail biting can also be caused by other psychiatric conditions like Obsessive Compulsive Disorder, Attention Deficit Hyperactivity Disorder, oppositional defiant disorder, separation anxiety, Tourette syndrome, and other mental conditions.

Onychophagia Prevalence

Onychophagia is widely prevalent with almost 30% of the population biting their nails. The onset of the condition is typically seen in children aged 3 and above and grows till adolescence. It has been observed that almost 40% of the children and nearly half of the teenagers are nail biters. Invariably, the habit starts to wane off after the teenage ends. However, in very few cases it may continue through adulthood.

Risks Associated with Onychophagia

On the face of it, nail biting is a very innocuous habit causing no damage. But if the condition fails to cease and continues over a long time, it may get risky. The risks involved are:

Damage to the skin around the fingernails and cuticles increases the risk of local infection, especially fungal infection of the nail plate 

Stomach infections resulting from swallowing bitten nails       

Damaged skin can lead to raw wounds which can get infected, spreading germs to the body         

Nail biting can lead to swallowing germs present in the nails and on the fingertips. This may give rise to digestive problems, internal infections, and gastrointestinal troubles.

Continuous nail biting can chip off teeth and lead to developing Malocclusion, the imperfect positioning of the front teeth

How to Treat Onychophagia?

Depending upon the severity of the condition, a treatment plan for Onychophagia is curated. In children and young adolescents who exhibit mild symptoms, the condition is invariably left untreated because children outgrow the habit with age. However, there are a few tips and tricks that can help prevent children from nail biting:

Avoid situations that act as stimulants and trigger nail biting

Keep the mouth occupied with a chewing gum

Manage stress through regular exercise

Keep the nails short and neatly trimmed

In addition to the aforementioned general tips, a few dedicated therapies are also available:

Use of barrier-type interventions that obstruct easy contact between the mouth and nails. Gloves, socks, and mittens are typically used.     

Retainer-style or bite-plate mechanisms also act as barrier devices. They act as obstructions and physical reminders to shun the habit.       

Applying bitter-tasting lacquers or compounds on the nails discourages nail biting, especially in people whose habit is not very severe.

In severe cases of onychophagia, the affected might have to undergo behavioural therapies like Cognitive Behavioural Therapy (CBT), Acceptance and Commitment Therapy (ACT), and Habit Reversal Training (HRT) that will help identify and address the underlying mental health condition or disorder. 

Conclusion

Nail biting itself is harmless. It is relatively very common and invariably requires no treatment or corrective action. However, if you feel that the urge to bite your nails gets uncontrollable and your condition is worsening, it’s advisable to consult a medical expert. Depending upon the severity of the problem, a suitable plan will be chalked out to help you overcome this habit.  

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