Updated: Nov 20, 2019
How To Find A Psychologist To Drive Away Your Nail Biting
In the past few years, I have noticed that so many people, both children and adults, bite their nails or pick the skin around the nail. As a teenager and during part of my twenties, I also had nail biting issues, and I never paid any particular attention to it. This week, while speaking with my 13-year-old, I noticed that she had some scabs around her nails, but I didn't want to bring attention to it just yet. However, noticing the behavior in my own daughter, combined with seeing so many other kids and adults over the years who have had challenges with nail biting, it made me realize how this is an issue that doesn’t get talked about enough. It can seem harmless -- and sometimes it is -- but it can also be quite serious. In the following blog, I will address the questions that I have gotten from many of my clients, their parents, and readers over the years related to this topic.
What is Nail Picking? Nail Biting?
Nail picking or biting is a problem that plagues a lot of children and adults. When we talk about nail biting, the problem actually encompasses more than just what we typically think of as chewing on nails. Rather, there are several related behaviors, like cuticle picking and even toenail biting. Toenail biting might sound a bit strange, but I have seen several kids do it and heard from numerous parents who are concerned about their children biting their toenails. All of these behaviors are real problems, and having a stigma and shame associated with them does not help anyone stop. Bringing awareness to what is going on and speaking to a professional about ways to help and resolve these issues is extremely important. But first, I think it’s necessary to get a better understanding of what it is and why people engage in these types of behaviors.
With some people, it is obvious that they are nail biters (or pickers, etc.), but others become experts at hiding it. Often people assume that this is something that affects people who are insecure and nervous, but in the many years of working with people who suffer with these issues, I have seen people of all levels of functioning, ages, and professions struggle with these problems. Now, when I write about these behaviors as characterized as a psychological disorder, I want to be clear and state that I am not referring to the kind of little bites of rough nails or cuticles that everyone picks at or chews on from time to time. It’s also not the occasional blemish that you might pick or squeeze. The nail biters/pickers I am talking about will continue to bite their nails past the nail and pick their cuticles until they bleed. These people constantly walk around with red, sore, and sometimes infected fingers.
Is there a psychological term for that?
Many people might not know how to refer to these behaviors or even think of nail biting or skin picking as a psychological disorder. As a psychotherapist, I like to refer to the group of behaviors that include nail biting, hair pulling (also called trichotillomania), and skin picking as pathological grooming. These behaviors become automatic activities that have no relationship to external stimuli at all. Years ago, the DSM, which is the bible of psychology, treated pathological grooming like an afterthought and put it in a catch-all category called “not otherwise specified.” However, the new DSM 5 added a disorder called excoriation (skin-picking) disorder. It is estimated that between 2-4 percent of the population could be diagnosed with this disorder, but I personally think that the percentage is a lot higher.
If you start paying more attention to what people are doing with their hands when you are around them, you might be surprised to find out how many bite their nails, pick their skin, or do other related behaviors that damage their nails in other ways. Those who are clinically and medically affected have results such as infections, skin lesions, scarring, and even physical disfigurement. According to the APA (American Psychological Association), individuals with excoriation disorder must have repeated attempts to decrease or stop the skin picking, which must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. They also add that these symptoms can’t be better explained by another mental disorder.
Nail biting and other related behaviors were categorized into another group of disorders called other specified and unspecified obsessive-compulsive and related disorders. These disorders can include conditions such as body-focused repetitive behavior disorder and obsessional jealousy, or unspecified obsessive-compulsive and related disorder. For the purposes of this article, let's talk about body-focused repetitive behavior disorder. There is also a medical term that is called onychophagia, which involves repetitive biting, chewing, and picking of one’s fingernails and the cuticles around them. What’s important to note is that there are now several accepted terms and classifications because these behaviors have been recognized in the medical and psychological fields as actual disorders.The terminology can get a bit confusing, but it might help to read through the different classifications when determining whether you or your child has formed a bad habit or has a serious problem that requires treatment.
Why Do People Do It?
Different experts have varying opinions about why people might start biting their nails. For Sigmund Freud, known as the founding father of psychoanalysis, or the talking cure, which is a method for treating mental illness as well as a theory that explains human behavior, nail biting is an oral fixation that is a form of stimulation. Many experts believe that nail biting is associated with stress and anxiety and is a way for people to distract themselves from bad thoughts or feelings. The function of the behavior is to manage negative feelings. It is generally benign and learned as a habit, and may work as a way to manage distress.
Why Should You Want To Stop Doing it?
If you are one of those people who practices pathological grooming, then you might not be aware of how it looks from the outside. I suggest that you either record yourself doing it and then watch it, or watch a YouTube of someone who does it in public. Sometimes people don’t recognize it as a problem until they view it from a different lens. From clients and from personal experience of biting my nails and picking skin, I remember being very aware of how insecure or stressed I might seem to others while doing it (and I was under a lot of stress at the time!) but for some reason I couldn’t stop. It seemed like the act of doing it actually served as a form of self-soothing and stress reduction that was out of my control. Or so I thought at the time. When I realized that there were actually proven ways to help individuals stop nail biting or skin picking, I was excited to share this with others and help in any way I could.
These compulsive behaviors can also have a significant negative impact on your emotional and physical well-being. Emotionally, self-mutilation behaviors can produce feelings of shame and low self-esteem. You might also feel guilty for being engaged in behaviors that are compulsive that you know are not within the normal range of behaviors. Also, in some serious cases, the physical injuries can take their toll in the form of lesions, infections, and scarring that may also carry risks of life-threatening complications. So while I’ve seen people be quick to dismiss the problem, I strongly suggest learning more about the behavior and looking for a solution to the underlying issues. It might seem like a fairly low-impact way to manage stress, but there are much healthier options out there, and getting to the root of the stress or other stimulus is important for overall well-being.
How Do I Treat It? (Best Treatments)
The most effective type of treatment for compulsive self mutilation behaviors is cognitive behavior therapy (CBT). You will probably read about CBT in many of my blogs as I am a strong advocate of this type of therapy. Sure, sometimes you will need to include other types of therapeutic methods or modalities, but CBT is one of the most effective and evidence-based techniques. Understanding and practicing it helped change my life. I will write more about it in other blogs, but for now I want to briefly explain what it is and how It can help you stop biting your nails.
The goal of CBT is to help you identify unhealthy and irrational thought patterns and “re-wire” your thinking. By doing so, you will learn to replace self-harming behaviors (like nail biting or skin picking) with healthy ways to cope with your anxiety, emotional pain, or other triggers that cause you to do the behaviors you wish to stop. Research has found that CBT is more effective than only using medication. In one study from Johns Hopkins, CBT was found to be more effective -- and have longer lasting implications with fewer side effects -- than traditional antidepressants when used to treat social anxiety disorders in adults.
This doesn’t mean that I think all medication is bad. Of course, in some severe cases, clients might need medication to help with reducing or eliminating symptoms. Antidepressant Fluoxetine, for example, may help reduce compulsive skin picking. People who struggle with nail biting or skin picking often have other psychological issues, though, so it's important to have a full assessment in order to get the best diagnosis and treat with the appropriate methods. Since self mutilation behaviors can lead to physical symptoms, it is important to also work closely with a medical doctor who can help and treat the physical symptoms. Besides working with professionals who can help reduce and eliminate the symptoms, there are some self-help strategies that you can employ as a starting point.
Stress has been found to be one of the most common factors that leads to these behaviors, so stress management is key in treatment. Try turning to activities like yoga, meditation, and breathing exercises to help lower stress. Even things like volunteering or spending time on a hobby can provide your brain with some physical and emotional relief that will help with the urge to perform the destructive behaviors. Another great place to start is learning to express your emotions. Talking to a professional can definitely help, but also talking to a friend or family member whom you trust to start learning to identify what feelings cause you to pick or nail bite can be really useful. I’ve personally always found that journaling helps me manage stress. It’s a way to express myself emotionally. It also involves using your hands so it can serve as a form of physical and emotional release. That brings me to another important thing to try: Keep your hands busy! Look for other ways to keep your hands stimulated and release stress or tension. Things like a fidget spinner or a stress ball will keep your hands busy and redirect your focus.
I want to reiterate that just because someone is ashamed of their behavior or embarrassed by how their hands look, it’s usually not enough to get them to stop. Awareness is definitely a necessary first step, and often these actions are done without really thinking about them, but simply knowing it’s abnormal or destructive won’t fix the problem. Be careful when talking to your children about it, as you don’t want to make them feel shame. If you have more questions about how to approach your child or the best ways you can help someone in this situation, we at Bespoke Wellness Partners would love to help. If you have found something that has worked for you or someone you know, we’d also love to hear about it, so leave a comment or send us an email.
If you would like me to connect you with one of our expert therapists, please contact me. I look forward to hearing from you!