ψ PsychoBabble

Special Edition: Nail Biting
Nail biting is one of those “bad habits” that many people have, most people find disgusting, but few people really know anything about. Sure, everyone has opinions about why people bite their nails, and how to get them to stop, but familiarity with the research on the area is rare, even among clinicians. For this month’s edition of the PsychoBabble Newsletter, I decided to read as many research articles on nail biting as humanly possible, to enlighten the masses about the causes and effects of, and treatments for this nasty habit.

August 2007

This month’s PsychoBabble newsletter reviews the research on the causes, effects, and potential cures for chronic nail biting.
non-nail biters, this does not mean that all nail biters have depression or obsessive-compulsive disorder, or whatever. Most nail biters are otherwise healthy, well-adjusted individuals who just happened to pick up a nasty habit. The general consensus - though there are many disagreements on the details - is that nail biting is (for some, perhaps evolutionary reason associated with self-grooming) a relaxing, stress-reducing behaviour to most. Some individuals discover - via imitation or by sheer accident - that nail biting is psychologically rewarding. The behaviour is thus reinforced over a long period of time, to the extent that it becomes a chronic habit.

Is nail biting bad? Many people associate
nail biting with endoparasites, parasitic “worms” that can infiltrate people’s digestive systems. Naturally then, nausea, diarrhoea and other related health problems are often blamed on nail biting. While the belief that nail biting increases the risk of having these parasitic worms invade one’s stomach has yet to be empirically justified, there is evidence that nail biters carry more and nastier bacteria in their mouths than non-nail biters. Perhaps our folk theories about nail biting causing nausea and diarrhoea are not so far-fetched after all. Furthermore, nail biting has long been known to cause infections of the gums and fingers. While these infections are
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What causes nail biting?
Most people think stress or anxiety is causally related to nail biting. And indeed, psychologists have found that nail biting is often used as an anxietyreduction strategy. Perhaps more unexpectedly, nail biting has also been found to be a boredom-reduction strategy. Nail biters bite their nails, not only when they feel stressed and nervous, but also when they’re bored! Now, many people will interpret these findings to mean that nail biters are chronically nervous, anxious, or bored people. Nail biting is therefore understood as a symptom for underlying anxiety disorders. However, while it is true that more nail biters do suffer from such disorders than do

not fatal, they can be painful, inconvenient, and expensive to treat. At a social level, nail biting can be the cause of embarrassment and social difficulties. Given that most people find bitten fingernails unattractive, this habit might even decrease one’s reproductive fitness! Far from being an innocuous habit, nail biting might well be a evolutionarily maladaptive self-grooming technique.

replace the maladaptive nail biting behaviour with a more adaptive or neutral behaviour. Nail biters are taught to do other things - e.g., give themselves manicures, chew gum, clench on a stress ball whenever they feel the urge to bite their nails.

How to stop nail biting? Everyone
who has tried to stop biting their nails has at least considered the “paint a bitter substance to your nails” approach to the matter, reasoning that (a) the bitter substance will make them more aware of their behaviour, and that (b) the bitterness will act as punishment for the behaviour, thereby reducing it. This, and other forms of aversion therapy (selfadministered electric shocks, anyone?) have been shown to be effective in the short term, and in highly motivated individuals. However, drop-out rates for this sort of therapy are understandably high. More common nowadays, cognitive-behavioural package programmes are used to treat chronic nail biters. As the name suggests, these programmes usually include cognitive (i.e., educational or informational) components and behavioural (i.e., operant learning) components. The aim of the cognitive component is often to inform nail biters about the negative side effects associated with nail biting, and the positive effects of having neat, unbitten nails, in order to motivate nail biters to kick the habit. They might also included courses on self-grooming and manicuring. The most wellestablished behavioural technique is the habitreversal treatment, the main point of which is to
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Furthermore, research on cognitive-behavioural treatments of nail biting strongly affirm the importance of social support. Any sort of behaviour modification is difficult to do alone, and nail biting is no exception. Finally, there have recently been some advances in pharmacological treatments of nail biting. However, these are difficult to obtain, and tend to have nasty side effects. Furthermore, these drugs do not work on everybody, and only work if the drugs are continually taken. Two of the more established drugs are Clomipramine and NAcetyl Cysteine (NAC). Clomipramine is more commonly used to treat obsessive-compulsive disorder, but in this context is administered at much smaller dosages. Still, the side effects - drowsiness, nausea, and diarrhoea among the milder ones - are formidable. The research on NAC much more promising: It’s effective on 60% of chronic nail biters and people with other similar habits, and has no known side effects, except possible increased flatulence. That’s right: Flatulence. However, these drugs have not yet been approved by the US Food and Drug Administration as a treatment for nail biting, and are therefore difficult to obtain. The best bet then, it seems, is cognitive-behavioural therapy (CBT) or socially-supported, self-help programmes based on CBT principles. For more information on nail biting, visit our weblog at psychobabbleblog.blogspot.com. As always, if there are any psychological phenomena you wish the PsychoBabble team to investigate, send an e-mail to our Editor-in-Chief, Jonathan Jong, at jonathan@psy.otago.ac.nz.