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Annotated Bibliography


The following papers are represent different perspectives on the aetiology of

chronic nail biting. Bohne et al. (2005) argue that pathologic hairpulling, skin

picking, and nailbiting share a common aetiology, as dysfunctional, learnt stress-

coping behaviours. Cavaggioni and Romano (2003) take a psychodynamic

perspective, arguing that like self-mutilation and eating disorders, nail biting is

symptomatic for latent unhealthy sexual and otherwise aggressive struggles.

Teng et al. (2002) and Williams et al. (2006) both take a functional approach,

arguing, like Bohne et al. (2005), that nail biting is rewarding because it reduces

anxiety and/or reduces feelings of boredom.

Bohne, A., Keuthen, N., & Wilhelm, S. (2005). Pathologic hairpulling, skin picking,

and nail biting. Annals of Clinical Psychiatry, 17, 227-232.

Cavaggioni, G., & Romano, F. (2003). Psychodynamics of onychophagia. Eating and

Weight Disorders, 8, 62-67.

Teng, E. J., Woods, D. W., Twohig, M. P., & Marcks, B. A. (2002). Body-focused

repetitive behavior problems: Prevalence in a nonreferred population and

differences in perceived somatic activity. Behavior Modification, 26, 340-360.

Williams, T. I., Rose, R., & Chisholm, S. (2006). What is the function of nail biting:

An analog assessment study. Behaviour Research and Therapy, 45, 989-995.


These two papers demonstrate the negative physical effects of nail biting. Baydas

et al. (2007) discuss their finding that nail biting increases the amount of
potentially harmful bacteria in nail biters’ mouths. Krejci (2000) discusses a case

of gum-related injury caused by nail biting.

Baydas, B., Uslu, H., Yavuz, I., Ceylan, I., Dagsuyu, I. (2007). Effect of a chronic

nail-biting habit on the oral carriage of Enterobacteriaceae. Oral Microbiology

and Immunology, 22, 1-4.

Krejci, C. B. (2000). Self-inflicted gingival injury due to habitual fingernail biting.

Journal of Periodontology, 71, 1029-1031.


The following papers are seminal works in the treatment of nail biting, and other

related health-compromising habits. Allen (1995) compares Azrin and Nunn’s

(1973) habit-reversal technique with a mild aversion treatment (i.e., applying a

bitter substance to fingernails). Bucher (1968) argues for self-administered shock

as an effective aversion therapeutic technique. Odlaug et al. (2007) introduce N-

Acetyl Cysteine as an effective drug for nail biting and related disorders, that is

free of nasty side-effects. Ronon and Rosenbaum (2001) outline a self-help

system for children.

Allen, K. W. (1995). Chronic nailbiting: A controlled comparison of competing

response and mild aversion treatments. Behaviour Research and Therapy, 34,


Azrin, N. H., & Nunn, R. G. (1973). Habit-reversal: A method of eliminating nervous

habits and tics. Behaviour Research and Therapy, 11, 619-628.

Bucher, B. D. (1968). A pocket-portable shock device with application to nailbiting.

Behaviour Research and Therapy, 6, 389-392.

Odlaug, B. L., & Grant, J. E. G. (2007). N-Acetyl Cysteine in the treatment of

grooming disorders. Journal of Clinical Psychopharmacology, 27, 227-229.

Ronon, T., & Rosenbaum, M. (2001). Helping children to help themselves: A case

study of enuresis and nail biting. Research on Social Work Practice, 11, 338-