Compulsive Nail Biting: Onychophagia

Compulsive nail biting is a body focused repetitive behavior that results in the destruction of one's own fingernails and often the skin around the nails and cuticles. Nail-biting is fairly common, but for some it is more than just a bad habit. It can become quite serious, as people who suffer from compulsive nail-biting may experience bleeding, bruises, infections, or even permanent damage to the fingers. The behavior is often unconscious, and people with this compulsion may have difficulty stopping because they may be unaware of their actions. Although is considered a behavioral problem, it is classified by psychiatrists as a type of impulse control disorder.

Although some people may consider this an Obsessive Compulsive Disorder (OCD),it is more accurately described as a obsessive compulsive spectrum disorder. Many spectrum disorders are classified as impulse control disorders — where impulsivity can be thought of as seeking a small, short term gain at the expense of a large, long term loss. In your case, this problem could result in the loss of employment, self confidence, and income.

It is important to be aware that all behavior serves a purpose or purposes. Some of the purposes that nail-biting has historically provided is (1) self-soothing or calming effects, (2) stimulation which helps keep one alert or awake opposed to becoming bored or distracted, and (3) to satisfy a need for perfectionism which can involve how one appears, to include the hands and/or nails. An important first step would be to become highly aware of what or whom triggers your nail biting at work or anywhere you do it. This could be helpful in establishing how your thoughts, feelings,and behavior could be contributing to nail-biting. There is a possibility that once you understand how this behavior serves a need or condition, you may be able to substitute nail biting with a more desirable or acceptable behavior.

I would like to commend you for trying some things on your own to conquer this problematic behavior. This problem could be part of a bigger problem which may not be readily apparent. Nail biting can become compulsive and progress into a self-perpetuating behavior. The nail biting can lead to anxiety and shame which can result or perpetuate more of this behavior.

What can you do to stop your nail biting? Initially, people who engage in nail biting do not consider it a real disorder so do not often seek help. However, when these people feel out of control and crazy with their nail biting, they may not know what kind of help is needed should they seek it out.

The good news is that nail biting responds very well to therapy and medications. SSRIs have generally become the preferred medication for anxiety disorders, including nail biting. SSRIs have less side effects than other forms of antidepressants, less withdrawal symptoms, less danger in the event of an overdose and overall are considered safer that other types of drugs Common SSRIs include Prozac, Luvox, Zoloft, Paxil, Celexa, and Lexapro.

Medications should not be considered a stand alone treatment for nail biting. Because it does fall into the obsessive compulsive spectrum, excellent results have been obtaining by utilizing Cognitive Behavioral Therapy (CBT) augumented by the use of medications. It is highly advisable that you consult with a psychotherapist trained in the use of CBT with impulse disorders and who has access to a doctor who can accurately prescribe medications, if needed, for you.

Please consider taking advantage of the free support groups on this site for people with self-mutilating or who are on the obsessive compulsive spectrum. Good luck in managing a very managable problem. If I can be of further help to you, please let me know.

All the best,

John O'Neal, Ed.S., LPC, NCC