Nail Picking Disorder (Onychotillomania)

Nail Picking Disorder

Patients with nail picking disorder repetitively manipulate the nail unit in an uncommon and likely underreported condition. Onychophagia is known among doctors as a nail biting disorder, while onychotillomania is a nail picking disorder. There are a few nonspecific features associated with onychotillomania, including bony fingernails and nails with a bizarre morphology and nail bed and periungual skin damage.

Histopathological changes may also be nonspecific but may be viewed as analogous to prurigo nodularis and lichen simplex chronicus. It is important to analyze the patient’s clinical history in order to identify this diagnosis, because effective treatment may require behavioral therapy and psychiatric medication.

Nails picking constantly indicates anxiety or stress, not even scratching an uneven fingernail or picking at a hangnail.

Picking at nails habitually may be a sign of nervousness or stress, while some may not recognize they are doing it.

Picking and biting children’s nails is a common childhood behavior, but the behavior can also persist into adulthood. You can talk to your doctor about why you pick your nails too often and sometimes he can prescribe medication to help you break the cycle.

Related: Lip Biting Disorder

Nail picking and anxiety

Biting your nails or picking your nails can be a coping mechanism. Sometimes these behaviors are hard to control, resulting from anxiety disorders.

One of the most common is nail biting. Almost 45 percent teens show signs of it at some point in their teens. However, others don’t get better until they’re adults. It’s estimated that 20 to 30 percent of people bite their nails.

Diagnostic and Statistical Manual of Mental Disorders (DSM-5) does not recognize nail picking or nail biting as disorders. However, these behaviors could indicate anxiety disorders. The behaviors may also be considered repetitive behaviors associated with anxiety, which focus on the body.

The following list of signs may suggest an underlying condition if you:

  • Consistently pick your nails with your fingers
  • Even if you suffer an injury, continue picking your nails
  • Avoid showing your habits to others
  • Continue doing these things repeatedly

When you pick your nails or bite your nails excessively you may also be prone to other body-focused repetitive behaviors, such as:

Read: Transient Tic Disorder

Other symptoms of anxiety

There are other symptoms of anxiety besides picking and biting your nails. Severe symptoms of anxiety can include those that interfere with your daily life for 6 months or more, such as:

  • Irritability
  • Inability to fall or stay asleep
  • Unreasonable fears
  • Worry all the time
  • Difficulty concentrating
  • Muscle tension
  • Restlessness
  • Fatigue

Symptoms of obsessive-compulsive disorder (OCD) may also include repetitive body behaviors, such as nail biting and picking. You gain pleasure or relief from engaging in these behaviors, and this cycle continues. Furthermore, studies show nail tics (repetitive movements) may reduce tension.

Anxiety disorders such as OCD usually involve obsessions and compulsions as a way to deal with unwanted thoughts and feelings. You can also have both OCD and generalized anxiety disorder (GAD).

Nail picking is associated with the following mental disorders:

Read: Chronic Motor Tic Disorder

Nail picking treatment

Some people pick their nails as a nervous habit. When you identify your triggers, you can possibly break this habit. Is it common for you to pick your nails when you’re stressed out? Are you always hungry or bored when you do it? If so, you need to focus on those issues instead.

A mental health condition can make this more difficult. You may benefit from behavioral treatments from a mental health professional if you suspect that your nail-picking habit is related to anxiety or OCD.


Cognitive-behavioral therapy (CBT) is a method of treatment for mental disorders, and anxiety disorders are among them. A psychotherapist can assist you in rethinking your thinking patterns and in making behavioral changes. Children may benefit from positive reinforcement and rewards.

Nail tics may also be treated with Habit Reversal Therapy (HRT). Nail picking and biting can be replaced with healthier habits, such as chewing gum or using a stress ball. It is important to bear in mind that HRT will not treat any mental conditions that may be contributing to your nail behaviors.


If you suffer from a mental health disorder that interferes with daily functioning, your physician may prescribe medication to relieve your symptoms. Medications such as these are designed to block the effects of neurotransmitters, such as serotonin, dopamine, and noradrenaline, in the brain.

Here are some possible medications to consider:

  • SSRI anti-depressants, especially fluoxetine (Prozac), are often the most effective treatment for nail tics associated with OCD
  • Clomipramine (Anafranil) and other tricyclic antidepressants
  • Lamotrigine can also be used to treat seizures and bipolar disorder
  • Zyprexa (olanzapine), also used to treat schizophrenia and bipolar disorder
  • The medication naltrexone (Revia, Vivitrol) is typically used to treat alcoholism and substance use disorder

Read: How to Stop Trichotillomania

How to manage in daily life

It may be possible for you to break this cycle on your own if you pick or bite your nails out of nervousness or anxiety. Here are some suggestions:

  • Keep your nails manicured. You may also be able to resist biting your nails with a shorter length.
  • Get a professional manicure. You can also get your hangnails, cuticles, and calluses treated by a nail technician if you want to avoid picking at them. People may also be deterred from getting a manicure if they are afraid of ruining a nice manicure they had spent money on.
  • Try using bitter nail polish. This over-the-counter product tastes bad to many people, but for others, it can keep them from putting their fingers in their mouths. If you intend to use such products on your child’s nails, consult your pediatrician.
  • Cover your fingers with adhesive bandages. As well as allowing your nails to heal, this can stop you from picking or biting your nails in the future and save your nails from further damage.
  • Engage your hands. When you feel the urge to pick at your nails, replace it with another habit. Stress balls, a short walk, or creative activities like writing or crocheting are some suggestions.
  • Speak with your dentist for more information. You may be able to get an oral device applied to your teeth to prevent you from biting your nails in some cases.

Remember that kicking your nail picking or biting habit takes time. It is recommended that you start with one set at a time. You can begin each hand by picking and biting one nail for a few days and then move on to the other.

Read: Facial Tics Disorder

Nail biting and young people

There is a high prevalence of nail biting among children and adolescents. Children are affected in 20-33% of cases, while teenagers are affected in nearly half – 45% (Siddiqui et al., 2020). However, some people are still affected by this problem even after reaching adulthood.

One in three US adults can be diagnosed with at least one pathological grooming behavior, according to research.

Is nail biting caused by any specific reasons? Several common reasons have been found for the behavior:

  • Nervousness: Resulting from anxiety and stress. The calming effect nail biting has on the nervous system makes it temporarily appealing
  • Emotions: It is our emotional make-up that contributes to our tendency to bite our nails. Even highly traumatic life events like divorce or death can have an effect on people who are shy or low self-esteem.
  • Perfectionism: These individuals are prone to nail-biting to relieve boredom and frustration.
  • Boredom: Because of inactivity/lack of better activities
  • Imitation: A child mimicking the behavior of an adult
  • Psychosomatic: Families with aggressive members are more likely to display this behavior

A common mental health condition and personality trait associated with nail-biting can be found in this list of factors.

When to consult a doctor

Even after trying the tips above, you may need to seek help from your healthcare provider if you can’t break the cycle of picking your nails. Additionally, if you have injured your nails or fingers due to your habits, you should seek help.

You may also be referred to a mental health professional by your physician if he suspects that your chronic nail behaviors are connected to anxiety disorders, such as generalized anxiety disorder or obsessive-compulsive disorder.

When left untreated, nail picking can also cause other health problems, such as tension headaches and migraines. Examples include:

  • Long-term damage to your cuticles and nails
  • Nails infected with fungi
  • Infections of the skin and bones
  • Swallowing nails may lead to stomach infections
  • Dental problems
  • Mouth injuries

Your nails and cuticles may also suffer from infection or deformity if you see a dermatologist. Doctors in this category specialize in wound care, skin conditions, and hair problems. If your mouth is injured or your teeth are deformed, visit your dentist.

Related: Mental Health Help

Where to find help

You can start your search for mental health professionals in your area by visiting the American Psychological Association. Based on your mental health needs, you can also find a talk therapist.

Psychiatrists are mental health professionals who can prescribe medications and provide medication advice. Your primary physician can recommend one to you.

Your insurance provider can also provide you with a list of the therapists who are in-network. Check to see whether your plan includes any out-of-pocket expenses.

Bottom line

The act of occasionally nail picking or nail biting usually isn’t a big deal, but if you’re aware that it has become habitual, consult your doctor.

If you think nail picking may be caused by anxiety, contact a mental health professional for help. Despite any injuries, people with this disorder may engage in compulsive picking or biting of nails.

2 thoughts on “Nail Picking Disorder (Onychotillomania)

  1. I love your blog.. very nice colors & theme. Did you create this website yourself? Plz reply back as I’m looking to create my own blog and would like to know wheere u got this from. thanks

Comments are closed.