Posted by Veronica Grigore 1437 Days Ago
Millions of adults and children struggle to break through the nail biting habit. These notes take a closer look at the available literature and treatment recommendations. In addition information is provided to parents to support their children in overcoming this unhelpful habit.
When it comes to understanding nail biting, the literature is rather confusing as nail biting receives a variety of labels from a ‘para functional habit’ (which is a habitual exercise of a part of the body in a way that is other than the most common use; not eating, drinking, speaking), to self mutilation (a form of self harm) and addictive behaviour, category that brings it closer to Obsessive Compulsive Disorder (OCD). Also known as onychophagia, nail biting is classified under unspecified compulsive and related disorders in the Diagnostic Statistical Manual of Mental Disorders (DSM-5). As nail biting is experienced as an urge, the treatment does borrow some techniques from OCD treatment such as resisting the urge to bite. What most people do not know is that the more we resist the urge the less of an urge we experience.
But as with hair pulling and skin picking, nail biting is not a disorder unless it is impairing, distressing and severe (interfering with life). The prevalence of nail biting is probably underestimated. In the literature is reported that up to 33% of children aged 7 to 10 years and 45% of adolescents are nail biters. The vast majority of nail biters do not bite their nails severely, however they complain about experiencing pain, about the non aesthetic aspect of their nails and about the risks of contacting colds and mouth infections. At the same time, people experience nail biting as ‘feeling good when you get the nail right’. Nail biters looking to quit find themselves struggling and many failing their attempts. The risk of relapse for the recovered nail biters is high. This needs to be accounted for when people embark on the journey of overcoming nail biting so that it can be accommodated into the journey itself.
Many people find that nail biting occurs during sedentary activities, such as watching TV, reading, driving, or sitting in a meeting. There are times when the nail biter would be engaged in this behaviour with awareness, fully focused, other times people are not even aware they are doing it. Certainly there is a great deal of mental activity going on and people report worrying, problem solving, concentrating, processing information that is important or threatening. The common factor for nail biting is the experience of a tension, whether this is experienced as anxiety, uncomfortability, excitement, concentration or boredom. Normally there is a physical sensation that draws the nail biter towards the nail: skin imperfection, itching, tingling, pain and its associated automatic reactions: searching for an irregularity in order to remove it and biting.
Many nail biters can trace nail biting back to their childhood experiences, either copying one of the parent, sibling, or learning it randomly, through association particularly when a state of tension is experienced and when the person is sensitive to interoceptive stimulation (sensations that originate inside the body). There seem to be some genetic make up, however as with any expression of our genes, it is the environment that places its expression on a continuum (whether expressed or not and at what degree/level).
Let’s look at what nail biting is characterised by:
Each intervention is designed to address the unique sensations that are achieved through nail biting and therefore are to be taken seriously.
When children are experiencing nail biting, we encourage the parents to get involved. Often the parents’ response involves telling children off for biting their nails, which actually generates tension and more of an urge to bite. By this time the children would have started the process of attending to the nail, making it even more irregular and therefore enhancing the urge.
Motivation can be considered an obstacle for children. Parents are invited to use a reward system to help initiate behavioural change. Effective reward system can be challenging and often misunderstood. Reward charts work better if: the children are involved in monitoring, having an agreement in place how parents should respond when a child engages in nail biting, reminders of recognising the urge and associated sensations, talking the children through their sensations, understanding one’s psychological functioning of harming or neglecting a less perfect aspect of themselves and encouraging nurturing and ‘looking after’, offering rewards for successfully abstaining from nail biting and using competing responses.
The moral/key message of these notes is that nail biting requires experiential re-learning, a nurturing approach to nails (looking after the nails ongoing) and at the time when an urge is experienced it requires engaging with competing responses, acknowledging the feeling or the emotion experienced and attending to it differently.