View Article

  • Onychophagia (Nail Biting): An in Depth Look of Problems, Risk Factors, Various Treatments and Management Strategies

  • Photo Neha N. Kadam* Photo Rutuja Shinde

  • Pravara Rural Education Society College Of Pharmacy For Women, Chincholi, Nashik

Abstract

Introduction: Onychophagia, or nail biting, is a common but undertreated disorder marked by unusual oral behaviour. It is frequently linked with obsessive-compulsive disorder, stress, and anxiety. All ages are affected by onychophagia, however it is most common in puberty and between the ages of 4 and 6. Malocclusion, infections, and nail damage among among the most of the serious physical and psychological effects of this condition. Risk Factor: Emotional imbalances, tension, anxiety, boredom, and habit creation are all linked to nail biting. Genetics and family history additionally come into play. Imitation, anxiety, and perfectionism are other influences. Long-term bottle feeding and the usage of pacifiers are possible risk factors. Effective management requires an understanding of the root causes. Complication: Nail biting causes multiple complications, including nail dystrophy, malocclusion, and infections. It can also occur in stomach issues, herpetic whitlow, and nail fungus. Permanent nail damage and longitudinal melanonychia may occur. In addition, nail biting can influence self-worth and quality of life. Treatment: Aversion therapy, medication, and habit reversal training are available forms of treatment. Dialectical behaviour therapy, cognitive-behavioral therapy, and interpersonal psychotherapy are helpful. Apps for smart watches, wearable technologies, and self-help methods can all help with management. For treatment to be effective, a thorough strategy that addresses underlying problems and encourages healthy behaviours is essential. Management: Using bitter-tasting nail polish, seeking help, and keeping hands and mouth active are prevention techniques. Treatments that work include cognitive-behavioral therapy, stimulation control, and habit reversal training. In extreme situations, pharmacological treatments such selective serotonin reuptake inhibitors could be required. It is crucial to have a multidisciplinary strategy that addresses behavioral change, education, and emotional support.

Keywords

Onychophagia, Nail Biting.

Introduction

Nail biting, or onychophagia, is a prevalent but untreated condition. The act of putting and biting one's fingertip and nails is a pathological oral behavior. This category of illnesses is underdiagnosed, poorly understood, and undertreated. It is also a less reported subject in the fields of dermatology and psychiatry.1 The Greek word onychophagia is derived from the words "onycho," which means finger or toe nail, and "phagia," which means to eat or devour. This issue is a misdiagnosed, poorly understood, and undertreated group of illnesses. In both dermatology and psychiatry, it is a less published field1. Another name for the chronic nail-biting habit is Body-Focused Repetitive Behaviors (BFRBs).[2] Before the age of three or four, the issue is typically not seen. The majority of nail biting or onychophagia instances occur between the ages of 4 and 6; they stabilize between 7 and 10 and then significantly increase throughout adolescence, which is a time of crisis. For the majority of teenagers, this is a challenging and even terrible time. The prevalence of nail biting is about the same for children up to the age of ten, after which it is shown that boys bite their nails far more frequently than girls.[3]

Both children and young adults frequently exhibit onychophagia, the habit of biting one's nails. In addition to biting the nail itself, nail biting also involves chewing the cuticle and soft tissue which surround the nail. A nail condition called onychophagy is brought on by frequent nail damage. Its most extreme forms include onychophagy and nail biting as auto destruction. Anxiety is a psychoemotional condition that is linked to the urge to bite or eat fingernails.[4] Chronic nail biting is a hallmark of obsessive compulsive disorder, which includes onychophagia. Adolescents who are experiencing elevated anxiety frequently bite their nails.[5] Psychiatry, internal medicine, dermatology, pediatrics, and other medical specialties may encounter onychophagia, which is a common issue.[6]

With a description of "body-focused repetitive behaviors (BFRBs)," NB is listed as a "Other Specified Obsessive-Compulsive And Related Disorder" in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM–5). On the other hand, the practice is classified as "Other Specified Behavioural and Emotional Disorders with Onset Usually Occurring in Childhood and Adolescence" by the International Statistical Classification of Diseases and Related Health Problems (ICD-10).[7] In an attempt to assist their children, the parents of a significant proportion of youngsters who are referred to clinics for the treatment of NB have coated their nail plates with substances that taste bad. Rubber or cloth finger guards have occasionally been used to hide the nails. Usually, these actions don't cause this behavior to permanently fade. Parents or other family members may discipline many kids who exhibit NB conduct. Threats and punishment might not reduce the incidence of NB; on the contrary, they might increase it. People that engage in NB conduct occasionally claim that they have no control over or ability to quit this undesirable activity. It is hypothesized that NB could help doctors treat youngsters with attention deficit hyperactivity disorder (ADHD) more effectively with medication.[8]

Etiology

Emotional imbalances are thought to be the cause of nail biting, which is a sign of anxiety exacerbated by stressful situations. Four different positions are used in the nail-biting segment.

1. During a few seconds to a half-minute, the hands are kept close to the mouth.

2. The fingernails are forced firmly against the teeth's biting edge during a series of rapid spasmodic bites.

3. The front teeth are rapidly touched by the fingers.

4. The finger is taken out of the mouth.[9]

       
            Onychophagia.jpg
       
Onychophagia has an uncertain and probably complex etiology. A significant genetic component is believed to be involved. The majority (63%) of nail-biting patients had at least one family member with onychophagia, according to survey-based research of 281 participants, ages 3 to 21, at an outpatient pediatric clinic [10]. Similarly, 55.8% of nail biters with one or more siblings had at least one parent or sibling who bit their nails regularly, according to the previously cited survey-based study that examined mental health and nail-biting behaviors in 743 children[11]. However, compared to people without the practice, nail biters have been found to experience higher levels of anxiety. When people are under stress, they bite their fingernails. Children do it when they are distressed, when they are unable to learn a lesson, when they are watching television, reading depressing or scary books, or when they are on the phone. Another possibility is that family members taught you the behavior [9]. Onychophagia may emerge as a result of contextual circumstances, such as mimicking the behavior of parents or siblings, in addition to hereditary influences.[12]

Causes of Nail Biting:

i. Stress and Anxiety: Stress, anxiety, or boredom are commonly associated with nail biting. People frequently utilize it as a coping mechanism or stress reliever.

ii. Habit Formation: If left untreated, it can begin in childhood and continue throughout maturity. It could emerge as a taught behavior or imitation of other people.

iii. Perfectionism: A need for neatness or perfectionist inclinations may cause some people to bite their nails.

iv. Nervousness: A result of tension and worry. In this case, the relaxing effect nail biting exerts on the neurological system makes it momentarily desirable.

v. Emotions: A major factor in why we bite our nails is our emotional makeup. In addition to the suffering brought on by really traumatic life events like divorce or death, shyness and low self-esteem can also have an impact.

vi. Boredom: brought on by idleness or a lack of activities to do

vii. Imitation: kids imitating the actions of adults. Psychosomatic: This is typically observed in violent households.[13]

viii. Psychosomatic: Especially prevalent in violent households [7].

Result: After biting nails

Risk factor

There aren't many known risk factors for nail biting at this time. Both the usage of pacifiers and prolonged bottle feeding are seen as possible risk factors (Sabuncuogluetal., 2014). Thumb and pacifier sucking are examples of soothing activities that are thought to be the first coordinated muscle movements that newborn forms (Turgeon-O'Brien et al., 1996). Infants must first have the suckling reflex in order to feed. The initiation of nail biting is thought to represent a pathologic continuation of these activities, which typically stop by the age of three (Tanaka et al., 2008).[14]

Complication

Children who bite their nails run the chance of acquiring anterior tooth malocclusion. A frequent and undesired side effect of orthodontic therapy, especially for the maxillary central incisors, is apical root resorption. Because the teeth are ligated to the arch wire during treatment, nonphysiological forces acting on the teeth, like nail-biting, can accelerate resorption or cause apical root resorption. Biting forces can also be transmitted through the wire to the neighbouring teeth, putting undue pressure on the periodontium even in the absence of orthodontic treatment.28 Clinical examinations of these patients may reveal protrusion of the maxillary incisors and crowding, rotation, and attrition on the mandibular incisor incisal margins. The stresses of the onychophagia habit are what cause these malocclusions [15]. When nail biting is linked to other issues, it becomes more complicated and calls for expert assistance. Aside from the hygiene issue of nails, which are rarely clean, a youngster who swallows bitten-off nails may suffer stomach issues, such as a stomach infection, and contract other diseases. Onychophagia typically gives way to habits like lip-pinching, pencil or item chewing, nose-scratching, or hair-twirling after adolescence. Adults who smoke or chew gum appear to use these as substitutes frequently.[16]

Onychomycosis, paronychia, and other nail disorders can result in secondary bacterial infections, and nail-biting may cause the infection to move to the mouth. In contrast, herpetic whitlow of the bitten finger may occur in a nailbiter who has oral herpes. The fact that nail-biting does not slow down nail growth is a benefit [17]. Permanent nail dystrophy may arise from persistent nail unit manipulation and picking. Longitudinal melanonychia may arise from melanocytic activation of nail matrix melanocytes brought on by trauma to the proximal nail folds. These alterations are typicallyirreversible and do not go away when nail-picking stops [18]. Acute bacterial paronychia, herpes simplex virus, and human papilloma virus are among the bacterial and viral illnesses that may cause onychotillomania [19]. Regularly manipulating the nail unit can also lead to chronic paronychia. Severe nail picking can result in pterygium, anonychia, or total nail loss.[20]

       
            nail picking .png
       
PREVENTION FROM NAIL BITING

By concentrating on strategy and exerting some effort, nail biters can prevent the need to bite their nails. You can avoid nail biting by using regular preventive measures or anxiety-reduction approaches. The following are some acts that could be helpful:

  1. Always keep your mouth and hands engaged: to keep your hands engaged with other things, including playing music, practicing sports, or hanging out with friends more. Chew gum and be active while you're alone or in a tense circumstance to keep the biter from putting his finger in his mouth.
  2. Encouragement and support from a loved one: Close friends, family, and loved ones can offer their loved one’s nonjudgmental support and motivate them to get treatment for this potentially dangerous condition as soon as possible.
  3.  Follow the Replacement Habit: When nail biters catch themselves biting their nails, they should replace their habit with something that is more beneficial. To do this, they can discover engaging activities like writing, painting, or squeezing a stress ball or Silly Putty.
  4. To participate in support groups: Support groups are beneficial and can be formed to help people manage their symptoms and enhance their quality of life.
  5. Tell people to point out: Request that those who are close to you and understand you do so rather than causing fun of or criticizing you. When somebody put your finger in your mouth, tell them to point it out to you.
  6.  To relieve stress: If you bite your nails when you're nervous or stressed, consider stress-reduction tactics. They can help you deal with nail-biting episodes and minimize their frequency. One of the things that causes the temptation to bite one's nails is stress. Including ways to relieve stress like yoga, meditation, or other relaxation techniques is a fantastic idea.
  7. Setting up an alarm reminder: If a nail biter tends to bite at specific times of day or locations, an alarm may be set up to remind them not to bite.
  8.  Wearing gloves may seem foolish, but it helps the biter resist biting. Whenever possible, place stickers or sticky bandages to the biter's finger to remind them not to bite.
  9. Applying something to your hands or fingers: You can stop a bite by applying an irritant to the skin on your fingertips to stop it from biting. Olive oil can also be used to soften and detract from the physical appearance of nails.
  10. To cover a finger with a bitter flavor: There are nail polishes on the market that have a bitter taste that can be applied to the finger to stop chewing. Denatonium benzoate is a bitter chemical that you can apply on your fingertips. The propensity of chewing one's nails is discouraged by the bitter taste.
  11. Get regular manicures: Maintaining neatly filed and trimmed nails may reduce the likelihood that you may bite them. As an alternative, you might use tape or stickers to hide your nails.[21]

Treatment

Although nail biting is a hard tendency to overcome, onychophagia can be successfully managed with a multidisciplinary approach. Treatment includes the use of medication, habit reversal training (HRT), and stimulus management either separately or more frequently in combination.

 

study

Design

Materials and Measures

Number of subject (M, F)

Subject Demographics, Mean Age,

(Age Range)

Results

Conclusion

Twohig et al. (2003) [22]

The efficacy of HRT (awareness training, competitive response training, and social support) (n = 15) against placebo control (nail-biting conversations) (n = 15) for two hours over three sessions was investigated in a randomized clinical experiment.

 

Measurements of nail length (mm) have been taken prior to, throughout, and five months following treatment.

 

30 (7, 23)

Adults, 21.5, (18–49)

The length of the nails increased by 22% with HRT and only 3% with a placebo.
The HRT group's nail lengths were substantially longer (12.1 ± 1.9 mm) than those of the placebo group (8.8 ± 1.6 mm; F = 21.2, df = 1.22; p < 0 xss=removed xss=removed>

HRT is a productive therapy for onychophagia that produces long-lasting results.

 

Azrin, Nunn, and Frantz (1980) [23]

Five months complying with a single two-hour training session, a randomized clinical trial comparing the results of HRT (awareness training, competing response training, and social support) (n = 45) versus negative practice (subjects mimic nail biting and tell themselves how absurd the habit appears) (n = 45).

The number of nail-biting incidents that participants self-recorded each day for five months.

 

97 (38, 59)

Adults, HRT: 28 (11–56), negative practice: 31 (11–64)

The HRT group saw a 99% drop in nail biting episodes (10 to 0.3× per day), whereas the negative practice group experienced a 60% reduction (12 to 4× per day) (p < 0>

 

Whenever it related to reducing the frequency of nail biting, HRT topped the negative practice treatment.

 

Silber and Haynes (1992) [24]

when one week of baseline self-monitoring to enhance awareness of the nail biting habit, a clinical trial comparing mild aversion therapy (applying bitter-tasting polish twice daily) (n = 7) versus the use of competing response (fist clenching) (n = 7) versus control (nail biting monitoring and positive encouragement) (n = 7) was conducted for three weeks.

The measurements of nail length (mm), a self-control questionnaire at the start and end of the trial, the nail fold erosion scale, and the Malone-Massler scale for the severity of nail biting.

 

21

Adults, mild aversion: 21, competing: 24, control: 22

Improvements in nail length were observed with both aversion therapy and competitive response (F1.18 = 26.27; p < 0> In comparison to the aversion treatment group, the competing group had less nail fold erosions (U7.7 = 8.50; p < 0 xss=removed xss=removed>

 

Onychophagia can be successfully managed using aversion treatment and competing response strategies.
Compared the competing reaction to aversion treatment, the former indicated more efficacy in treating nail biting.

Ghanizadehet al. (2013) [25]

A two-month, double-blind, randomized, placebo-controlled clinical trial investigating the intake of 800 mg/day NAC (n = 21) to a placebo (n = 21).

 

Measurements of nail length (mm) occurred before to therapy, one month after enrollment, and two months after enrollment

42 (14, 28)

Children and adolescents, NAC: 9.28, placebo: 10.76, (6–18

After a month, patients on 800 mg/day or NAC had significantly longer nails (5.21 mm) than those on a placebo (1.18 mm; p < 0>

In the short manage, NAC decreases children's and children's nail-biting behavior.

 

Leonard et al. (1991) [26]

Clomipramine hydrochloride (mean dose: 120 ± 48 mg/day) and desipramine hydrochloride (mean dose: 135 ± 53 mg/day) were tested in a double-blind, cross-over played for 10 weeks (five weeks of clomipramine + five weeks of desipramine) following a two-week single-blind placebo.

At baseline and each week during 12 weeks, use the Nail-Biting Severity Scale, Nail Biting Impairment Scale, and Clinical Progress Scale.

 

25 (6, 19)

Adults, 32.7, (21–42)

according to the Nail-Biting Severity (F = 3.75, df = 1.12; p < 0 xss=removed xss=removed xss=removed xss=removed>

Based on the three clinical biting scales, clomipramine decreases nail biting more than desipramine.

 
 

Aversion therapy refers to the repeated pairing of an unwanted behavior with discomfort to break the habit [27] The enjoyable aspect of biting is disrupted for nail biters when an unpleasant-tasting lacquer is applied to their nails. Younger children should not receive aversion treatment since it may cause antagonism and promote nail biting as a way to get attention[28][29].  Regular reapplication of the polish is necessary for aversion treatment to be effective. An option to aversion treatment for individuals who have trouble remembering to reapply polish is a nonremovable reminder (NrR). The NrR group had a lower drop-out rate (12% vs. 26%) than the mild aversion therapy group in a study of 80 nail biters, where half received NrRs and the other half a bitter-tasting polish. However, both therapies were equally effective in reducing nail biting, including all study participants (Wilks's lambda: F2.59 = 110.94; p < 0 xss=removed xss=removed>

Pharmacotherapy is a second-line treatment for nail biting [27]. The Food and Drug Administration has yet to authorize medications to treat BFRBs, however some have been helpful in treating onychophagia. The use of N-acetylcysteine (NAC) to treat BFRBs is becoming more and more commonplace. Clinical studies addressing impulse control issues, such as onychophagia, have included NAC, a glutamate modulator. Nail length increased afterwards 800 mg/day of NAC therapy for one month (5.21 mm) compared to placebo (1.18 mm; p < 0>

In a 10-week double-blind cross-over the experiment including 25 patients, clomipramine (mean dose: 120 ± 48 mg/day), a tricyclic antidepressant (TCA), was found to be more effective in treating onychophagia than desipramine (mean dose: 135 ± 53 mg/day). The clomipramine group saw a higher reduction in biting than the desipramine group, according to three clinical biting measures (nail biting severity, nail biting impairment, and clinical progress) (F = 3.75, p < 0 xss=removed xss=removed>

Management

a lot of therapeutic options that can help stop nail biting; some focus on changing behavior, while others use physical obstacles to prevent nail biting. The patient has to be motivated in order to reduce or eliminate the nail-biting behavior. The patient must understand that quitting the habit is required, and here occurs where the professional role becomes relevant by providing practical advice on how to overcome the addiction. Rapid suppression may cause changes in personality. Some people stop onychophagia on their own initiative because they are afraid of getting infections, while others quit to imitate friends have attractive nails.[33] Telling the patient to use the rubber bite piece while they have anxiety or the temptation to bite their nails is an excellent substitute. If not done obsessively, chewing sugar-free gum may also be a strategy to keep the mouth busy and make the habit challenging or impossible. [34] As no other method of breaking the behavior is more successful, wise, and beneficial, the ideal approach to treat a nail biter is to educate them, develop good habits, cultivate conscious awareness, and ensure good results. The child should get encouragement and emotional support during treatment. The objective of a multidisciplinary approach should be to improve a child's self-esteem and confidence.[35]

One of the best methods is emotional support and encouragement, which should be part of treatment. Anxious or worried people who bite their nails are known as nail biters. As part of the treatment, teach to the affected children as well as their parents, siblings, and instructors. In order to cure nail biting, behavioral modification strategies, positive reinforcement, and routine follow-ups are crucial. Threats, teasing, punishment, and the use of bitter taste are inappropriate methods of patient management. The participation and agreement of the nail biter are essential for success. In nail biting, the placebo effect is always better to the penalties.[21]

Pharmacological Treatment

Selective serotonin reuptake inhibitors such as fluoxetine may be used if psychotherapy is ineffective, especially in extreme situations.[24] The most often prescribed drugs for the treatment of NB are tricyclics like clomipramine. Additionally, lithium is a useful drug for treating nail biting in depressed patients and those with a history of bipolar illness.[36] As NB is an underdiagnosed and disregarded disorder, it may have a detrimental impact on one's quality of life. As part of treatment, patients with NB should get sufficient psychoeducation about the issue and be encouraged to form healthy habits. Reducing the effects of NB can be achieved either by non-pharmacological treatment alone or in conjunction with pharmaceutical treatment. [37]

Non-Pharmacologic Treatment

NB may be controlled non-pharmacologicly in a variety of ways. The use of behavioral treatment [38] is the gold standard therapy for the first line. A number of strategies can be applied to behavioral treatment, including non-removable reminders for NB [30,21]

  • Interpersonal psychotherapy (IPT): The goal of this kind of psychotherapy, which is centerer on interpersonal concerns, is to enhance social support and interpersonal communication.
  • Dialectic behaviour therapy (DBT): Patients with personality disorders are treated with this psychotherapy. It is specifically designed to help people overcome detrimental behavioral habits.
  • Cognitive behavioural therapy (CBT): This popular kind of psychotherapy is founded on behavioral, cognitive, and learning theories. When less complicated approaches fail, it helps. It aids patients in realizing that their perception of the behavior may not be accurate. Later on, individuals learn to recognize unpleasant feelings and associated behaviors so that they may be managed more skilfully. It is connected to the opposing reaction. A technique known as "competing response" involves offering someone an alternative to nail-biting, like chewing gum, to sate oral-motivated cravings.
  • Stimulus control: The fundamental idea behind this treatment is to find the stimulus and then get rid of it since it constantly makes you want to bite. This treatment aids in identifying and eliminating the circumstances, surroundings, or feelings that lead to nail biting. This therapy's primary objective is to modify conscious behavior in order to control triggers. Other psychotherapies like self-help groups and acceptance commitment therapy (ACT) are also beneficial.[21]
  • Habit reversal therapy: The goal of the therapy is to break the nail-biting behavior and perhaps replace it with a more useful one. When the automatic reaction is weak, it functions. It is a four-step approach that teaches how to do muscle-response exercises, relax, and breathe and feel grounded. Self-control interventions in this treatment should increase self-esteem and confidence. [39,40] Many components make up this psychotherapy, such as social support, contingency management, relaxation training, bringing the habit into consciousness, awareness training, competent response training, and working in an opposing behavior that makes it physically impossible to bite or pick until the urge passes.[21]
  • Aversion stimulus: By applying an unpleasant stimulus, such a bitter substance, to the nail biter's nail, this method makes him consider before placing his finger in his mouth.[24] This method relies on learning through reinforcement, which consists of a self-terminating reminder.
  • Nail Cosmetics: While waiting for treatment to become effective, it might assist the patient manage their nail dystrophy and improve NB social impacts. The purpose of nail paint or nail plates is to improve the nail's look. [37]
  • Self-help technique: Preliminary studies have indicated that this behavioral approach is effective. The wrist bands are meant to serve as permanent reminders. Recently, wearable technology and smart watch apps that track a user's wherever it is have been produced by tech businesses.[41] There are several steps involved in this self-help or self-control intervention. The nail biter is first instructed that their conduct is problematic and has to be changed. The nail biter is next asked to identify the potential thinking and emotion linked to the action, as well as the cause of NB. Third, self-monitoring is recommended for nail biters, which raises their awareness of the habit. Fourth, students receive instruction on how to modify the automatic behavior using learnt techniques like self-talk and self-reward. Lastly, the nail biter receives training on how to control and modify comparable pathologic habits using the acquired abilities.[42]
  • Interpersonal psychotherapy: Interpersonal problems between an individual and family members are the main focus of this kind of psychotherapy. It focuses on enhancing social support for an individual and fostering better interpersonal communication among family members. Since repeated behavior in NB typically disrupts interpersonal relationships, interpersonal psychotherapy in these cases relies on family members' engagement to comprehend the behavior, offer social support, and show empathy for the victim.[37]

CONCLUSION

Onychophagia, often known as nail biting, is a common yet undertreated disorder marked by abnormal oral behaviour. It has a strong hereditary component and is frequently associated with emotional imbalances, stress, and anxiety. Permanent nail dystrophy, nail fungus, and malocclusion are among the consequences of untreated nail biting. Pharmacotherapy, aversion therapy, habit reversal training, and non-pharmacological treatments including cognitive behavioral therapy and interpersonal psychotherapy are among the available treatment choices. For effective management, a multidisciplinary strategy that incorporates encouragement, emotional support, and instruction is essential. Self-help methods like utilizing smartwatch applications or wearing wristbands can also assist break the habit. For those with onychophagia, early intervention and treating underlying psychological difficulties are crucial to preventing long-term repercussions and improving their quality of life.

REFERENCES

  1. Bohne A, Keuthen N, Wilhelm S. Pathologic hairpulling, skin picking, and nail biting. Ann Clin Psychiatry 2005;17(4):227-32.
  2. Massler M, Malone AJ. Nailbiting. A review. J Pediatr 1950; 36:523-31.
  3. Pearson GHJ. The psychology of finger sucking, tongue sucking, and other oral habits. Am J Orthod 1948; 34:589-98.
  4. Pennington LA. Incidence of nail biting among adults. Am J Psychiatr 1945; 102:241-4.
  5. Pacan P, Grzesiak M, Reich A, Szepietowski JC. Onychophagia as a spectrum of obsessive-compulsive disorder. Acta Derm Venereol. 2009;89 (3):278-80.
  6. Halteh P, Scher RK, Lipner SR. Onychophagia: a nail-biting conundrum for physicians. J Dermatol Treat 2017; 28: 166, 172.
  7. Siddiqui, J. 2020. Onychophagia (Nail Biting): an overview. Indian Journal of Mental Health. 7: 97 to 98
  8. Ghanizadeh A. Can behavioral sensory processing problems guide us to a better pharmacological management of children with attention deficit hyperactivity disorder? a case report. Psychiatry (Edgmont) 2009; 6: 40-43.
  9. Avesh Sachan, TP Chaturvedi. Onychophagia (Nail biting), anxiety, and malocclusion. on Wednesday, February 20, 2013, IP: 117.199.176.175] :68
  10. Winebrake, J.P.; Grover, K.; Halteh, P.; Lipner, S.R. Pediatric Onychophagia: A Survey-Based Study of Prevalence, Etiologies, and Co-Morbidities. Am. J. Clin. Dermatol. 2018, 19, 887–891. [CrossRef]
  11. Ghanizadeh, A.; Shekoohi, H. Prevalence of nail biting and its association with mental health in a community sample of children. BMCRes. Notes 2011, 4, 116.
  12. Erdogan, H.K.; Arslantas, D.; Atay, E.; Eyuboglu, D.; Unsal, A.; Dagtekin, G.; Kilinc, A. Prevalence of onychophagia and its relation to stress and quality of life. Acta Derm. Alp. Pannonica Adriat. 2021, 30, 15–19
  13. Siddiqui, J. 2020. Onychophagia (Nail Biting): an overview. Indian Journal of Mental Health. 7: 97.
  14. Mohsen Baghchechi BS, Janice L. Pelletier MD FAAP, Sharon E. JacobMD, FAAD, FAAP, Art of Prevention: The importance of tackling the nail-biting habit International JournalofWomen’sDermatology7(2021)309–313: 311
  15. Orlando Motohiro Tanaka, Robert Willer Farinazzo Vitral, Giulia Yuriko Tanaka, Ariana Pulido Guerrero, and Elisa Souza Camargo; Nailbiting, or onychophagia: A special habit, American Journal of Orthodontics and Dentofacial Orthopedics August 2008; 306
  16. Avesh Sachan, TP Chaturvedi, Onychophagia (Nail biting), anxiety, and malocclusion, Indian Journal of Dental Research, 23(5), 2012; 680-681.
  17. Leung AKC, Robson LM. Nailbiting. Clin Pediatr 1990;29: 690-2.
  18. Baran, R. Nail biting and picking as a possible cause of longitudinal melanonychia. A study of 6 cases. Dermatologica 1990, 181, 126–128.
  19. Halteh, P.; Scher, R.K.; Lipner, S.R. Onychotillomania: Diagnosis and Management. Am. J. Clin. Dermatol. 2017, 18, 763–770.
  20. Rieder, E.A.; Tosti, A. Onychotillomania: An underrecognized disorder. J. Am. Acad. Dermatol. 2016, 75, 1245–1250.
  21. Javed Ather Siddiqui and Shazia Farheen Qureshi, Onychophagia (Nail Biting): an overview, Indian Journal of Mental Health 2020;7(2); 100-103
  22. Twohig, M.P.; Woods, D.W.; Marcks, B.A.; Teng, E.J. Evaluating the efficacy of habit reversal: Comparison with a placebo control. J. Clin. Psychiatry 2003, 64, 40–48.
  23. Azrin, N.H.; Nunn, R.G.; Frantz, S.E. Habit reversal vs. negative practice treatment of nailbiting. Behav. Res. Ther. 1980, 18, 281–285.
  24. Silber, K.P.; Haynes, C.E. Treating nailbiting: A comparative analysis of mild aversion and competing response therapies. Behav. Res. Ther. 1992, 30, 15–22.
  25. Ghanizadeh, A.; Derakhshan, N.; Berk, M. N-acetylcysteine versus placebo for treating nail biting, a double-blind randomized placebo controlled clinical trial. Antiinflamm. Antiallergy Agents Med. Chem. 2013, 12, 223–228.
  26. Leonard, H.L.; Lenane, M.C.; Swedo, S.E.; Rettew, D.C.; Rapoport, J.L. A double-blind comparison of clomipramine and desipramine treatment of severe onychophagia (nail biting). Arch. Gen. Psychiatry 1991, 48, 821–827.
  27. Magid, M.; Mennella, C.; Kuhn, H.; Stamu-O’Brien, C.; Kroumpouzos, G. Onychophagia and onychotillomania can be effectively managed. J. Am. Acad. Dermatol. 2017, 77, e143–e144.
  28. Baghchechi, M.; Pelletier, J.L.; Jacob, S.E. Art of Prevention: The importance of tackling the nail-biting habit. Int. J. Womens Dermatol. 2020, 7, 309–313.
  29. Tanaka, O.M.; Vitral, R.W.; Tanaka, G.Y.; Guerrero, A.P.; Camargo, E.S. Nailbiting, or onychophagia: A special habit. Am. J. Orthod. Dentofac. Orthop. 2008, 134, 305–308.
  30. Koritzky, G.; Yechiam, E. On the value of nonremovable reminders for behavior modification: An application to nail biting (onychophagia). Behav. Modif. 2011, 35, 511–530.
  31. Azrin, N.H.; Nunn, R.G. Habit-reversal: A method of eliminating nervous habits and tics. Behav. Res. Ther. 1973, 11, 619–628.
  32. Skurya, J.; Jafferany, M.; Everett, G.J. Habit reversal therapy in the management of body focused repetitive behavior disorders. Dermatol. Ther. 2020, 33, e13811.
  33. Coleman JC, McCalley JE. Nail-biting among college students. J Abnorm Soc Psychol 1948; 43:517-25.
  34. Schneider PE, Peterson J. Oral habits: Considerations in management. Pediatr Clin North Am 1982; 29:523-46.
  35. Tanaka OM, Vitral RW, Tanaka GY, Guerrero AP, Camargo ES. Nailbiting, or onychophagia: A special habit. Am J Orthod Dentofacial Orthop 2008;134:305-8.
  36. Sharma V, Sommerdyk C. Lithium treatment of chronic nail biting. Prim Care Comp CNS Disord 2014;16(3).
  37. Javed Ather Siddiqui, Shazia Farheen Qureshi, Indian Journal of ISSN 0971-9962 Volume 38 | Issue 3 | July-September 2022 Social Psychiatry, Onychophagia: A Synopsis of Nail Biting and Its Management; 223
  38. Ravindran AV, da Silva TL, Ravindran LN, Richter MA, Rector NA. Obsessive-compulsive spectrum disorders: a review of the evidence-based treatments. Can J Psychiatry 2009;54(5):331-43.
  39. Bate KS, Malouff JM, Thorsteinsson ET, Bhullar N. The efficacy of habit reversal therapy for tics, habit disorders, and stuttering: a meta-analytic review. Clin Psychol Rev 2011;31(5):865-71.
  40. Ghanizadeh A, Bazrafshan A, Firoozabadi A, Dehbozorgi G. Habit reversal versus object manipulation training for treating nail biting: A randomized controlled clinical trial. Iran J Psychiatry 2013;8(2):61-8.
  41. Moritz S, Treszl A, Rufer M. A randomized controlled trial of a novel self help technique for impulse control disorders: A study on nail biting. Behav Modif 2011; 35:468 85.
  42. Ronen T, Rosenbaum M. Helping children to help themselves: A case study of enuresis and nail biting. Res Soc Work Pract 2001; 11:338 56.

Reference

  1. Bohne A, Keuthen N, Wilhelm S. Pathologic hairpulling, skin picking, and nail biting. Ann Clin Psychiatry 2005;17(4):227-32.
  2. Massler M, Malone AJ. Nailbiting. A review. J Pediatr 1950; 36:523-31.
  3. Pearson GHJ. The psychology of finger sucking, tongue sucking, and other oral habits. Am J Orthod 1948; 34:589-98.
  4. Pennington LA. Incidence of nail biting among adults. Am J Psychiatr 1945; 102:241-4.
  5. Pacan P, Grzesiak M, Reich A, Szepietowski JC. Onychophagia as a spectrum of obsessive-compulsive disorder. Acta Derm Venereol. 2009;89 (3):278-80.
  6. Halteh P, Scher RK, Lipner SR. Onychophagia: a nail-biting conundrum for physicians. J Dermatol Treat 2017; 28: 166, 172.
  7. Siddiqui, J. 2020. Onychophagia (Nail Biting): an overview. Indian Journal of Mental Health. 7: 97 to 98
  8. Ghanizadeh A. Can behavioral sensory processing problems guide us to a better pharmacological management of children with attention deficit hyperactivity disorder? a case report. Psychiatry (Edgmont) 2009; 6: 40-43.
  9. Avesh Sachan, TP Chaturvedi. Onychophagia (Nail biting), anxiety, and malocclusion. on Wednesday, February 20, 2013, IP: 117.199.176.175] :68
  10. Winebrake, J.P.; Grover, K.; Halteh, P.; Lipner, S.R. Pediatric Onychophagia: A Survey-Based Study of Prevalence, Etiologies, and Co-Morbidities. Am. J. Clin. Dermatol. 2018, 19, 887–891. [CrossRef]
  11. Ghanizadeh, A.; Shekoohi, H. Prevalence of nail biting and its association with mental health in a community sample of children. BMCRes. Notes 2011, 4, 116.
  12. Erdogan, H.K.; Arslantas, D.; Atay, E.; Eyuboglu, D.; Unsal, A.; Dagtekin, G.; Kilinc, A. Prevalence of onychophagia and its relation to stress and quality of life. Acta Derm. Alp. Pannonica Adriat. 2021, 30, 15–19
  13. Siddiqui, J. 2020. Onychophagia (Nail Biting): an overview. Indian Journal of Mental Health. 7: 97.
  14. Mohsen Baghchechi BS, Janice L. Pelletier MD FAAP, Sharon E. JacobMD, FAAD, FAAP, Art of Prevention: The importance of tackling the nail-biting habit International JournalofWomen’sDermatology7(2021)309–313: 311
  15. Orlando Motohiro Tanaka, Robert Willer Farinazzo Vitral, Giulia Yuriko Tanaka, Ariana Pulido Guerrero, and Elisa Souza Camargo; Nailbiting, or onychophagia: A special habit, American Journal of Orthodontics and Dentofacial Orthopedics August 2008; 306
  16. Avesh Sachan, TP Chaturvedi, Onychophagia (Nail biting), anxiety, and malocclusion, Indian Journal of Dental Research, 23(5), 2012; 680-681.
  17. Leung AKC, Robson LM. Nailbiting. Clin Pediatr 1990;29: 690-2.
  18. Baran, R. Nail biting and picking as a possible cause of longitudinal melanonychia. A study of 6 cases. Dermatologica 1990, 181, 126–128.
  19. Halteh, P.; Scher, R.K.; Lipner, S.R. Onychotillomania: Diagnosis and Management. Am. J. Clin. Dermatol. 2017, 18, 763–770.
  20. Rieder, E.A.; Tosti, A. Onychotillomania: An underrecognized disorder. J. Am. Acad. Dermatol. 2016, 75, 1245–1250.
  21. Javed Ather Siddiqui and Shazia Farheen Qureshi, Onychophagia (Nail Biting): an overview, Indian Journal of Mental Health 2020;7(2); 100-103
  22. Twohig, M.P.; Woods, D.W.; Marcks, B.A.; Teng, E.J. Evaluating the efficacy of habit reversal: Comparison with a placebo control. J. Clin. Psychiatry 2003, 64, 40–48.
  23. Azrin, N.H.; Nunn, R.G.; Frantz, S.E. Habit reversal vs. negative practice treatment of nailbiting. Behav. Res. Ther. 1980, 18, 281–285.
  24. Silber, K.P.; Haynes, C.E. Treating nailbiting: A comparative analysis of mild aversion and competing response therapies. Behav. Res. Ther. 1992, 30, 15–22.
  25. Ghanizadeh, A.; Derakhshan, N.; Berk, M. N-acetylcysteine versus placebo for treating nail biting, a double-blind randomized placebo controlled clinical trial. Antiinflamm. Antiallergy Agents Med. Chem. 2013, 12, 223–228.
  26. Leonard, H.L.; Lenane, M.C.; Swedo, S.E.; Rettew, D.C.; Rapoport, J.L. A double-blind comparison of clomipramine and desipramine treatment of severe onychophagia (nail biting). Arch. Gen. Psychiatry 1991, 48, 821–827.
  27. Magid, M.; Mennella, C.; Kuhn, H.; Stamu-O’Brien, C.; Kroumpouzos, G. Onychophagia and onychotillomania can be effectively managed. J. Am. Acad. Dermatol. 2017, 77, e143–e144.
  28. Baghchechi, M.; Pelletier, J.L.; Jacob, S.E. Art of Prevention: The importance of tackling the nail-biting habit. Int. J. Womens Dermatol. 2020, 7, 309–313.
  29. Tanaka, O.M.; Vitral, R.W.; Tanaka, G.Y.; Guerrero, A.P.; Camargo, E.S. Nailbiting, or onychophagia: A special habit. Am. J. Orthod. Dentofac. Orthop. 2008, 134, 305–308.
  30. Koritzky, G.; Yechiam, E. On the value of nonremovable reminders for behavior modification: An application to nail biting (onychophagia). Behav. Modif. 2011, 35, 511–530.
  31. Azrin, N.H.; Nunn, R.G. Habit-reversal: A method of eliminating nervous habits and tics. Behav. Res. Ther. 1973, 11, 619–628.
  32. Skurya, J.; Jafferany, M.; Everett, G.J. Habit reversal therapy in the management of body focused repetitive behavior disorders. Dermatol. Ther. 2020, 33, e13811.
  33. Coleman JC, McCalley JE. Nail-biting among college students. J Abnorm Soc Psychol 1948; 43:517-25.
  34. Schneider PE, Peterson J. Oral habits: Considerations in management. Pediatr Clin North Am 1982; 29:523-46.
  35. Tanaka OM, Vitral RW, Tanaka GY, Guerrero AP, Camargo ES. Nailbiting, or onychophagia: A special habit. Am J Orthod Dentofacial Orthop 2008;134:305-8.
  36. Sharma V, Sommerdyk C. Lithium treatment of chronic nail biting. Prim Care Comp CNS Disord 2014;16(3).
  37. Javed Ather Siddiqui, Shazia Farheen Qureshi, Indian Journal of ISSN 0971-9962 Volume 38 | Issue 3 | July-September 2022 Social Psychiatry, Onychophagia: A Synopsis of Nail Biting and Its Management; 223
  38. Ravindran AV, da Silva TL, Ravindran LN, Richter MA, Rector NA. Obsessive-compulsive spectrum disorders: a review of the evidence-based treatments. Can J Psychiatry 2009;54(5):331-43.
  39. Bate KS, Malouff JM, Thorsteinsson ET, Bhullar N. The efficacy of habit reversal therapy for tics, habit disorders, and stuttering: a meta-analytic review. Clin Psychol Rev 2011;31(5):865-71.
  40. Ghanizadeh A, Bazrafshan A, Firoozabadi A, Dehbozorgi G. Habit reversal versus object manipulation training for treating nail biting: A randomized controlled clinical trial. Iran J Psychiatry 2013;8(2):61-8.
  41. Moritz S, Treszl A, Rufer M. A randomized controlled trial of a novel self help technique for impulse control disorders: A study on nail biting. Behav Modif 2011; 35:468 85.
  42. Ronen T, Rosenbaum M. Helping children to help themselves: A case study of enuresis and nail biting. Res Soc Work Pract 2001; 11:338 56.

Photo
Neha N. Kadam
Corresponding author

Pravara Rural Education Society College Of Pharmacy For Women, Chincholi, Nashik

Photo
Rutuja Shinde
Co-author

Pravara Rural Education Society College Of Pharmacy For Women, Chincholi, Nashik

Rutuja Shinde, Neha Kadam*, Onychophagia (Nail Biting): An in Depth Look of Problems, Risk Factors, Various Treatments and Management Strategies, Int. J. of Pharm. Sci., 2024, Vol 2, Issue 11, 1199-1210. https://doi.org/10.5281/zenodo.14211757

Download PDF
More related articles
View more

Copyright © 2025 IJPS. All rights reserved