Dear doctor;

Is biting fingernails a form of psychotic disorder? I have failed to bail of the habit and now in my 30s but often find myself embarrassed whenever I peel the cuticles around my fingernails.

Jerome.

Dear Jerome,

Nail-biting is common in children (30 per cent) after three years of age and in 25 per cent of teenagers. In children, it often occurs due to anxiety, fear, attention deficit disorder or simply attention seeking. But one outgrows it and it is rare in adults. When present in an adult, nail biting is categorised among one of the obsessive compulsive disorders. One may bite nails without realising what one is  doing. One might be involved in another activity, such as reading, watching television, or talking on the phone, and bite nails without thinking about it.

Nail-biting includes biting the cuticle and soft tissue surrounding the nail as well as biting the nail itself. It may be associated with other repetitive disorders like hair pulling or skin picking. The habit may be continued from childhood where one gets nervous and starts biting nails or finds stress being released after doing so. It may be part of an obsessive behaviour disorder, where one indulges in nail-biting for no valid explanation. Rarely it may occur due to somebody else in the family having same habit. For example, a child may watch their parent or elder sibling bite  nails, pick the habit and find it difficult to give up.

Whatever the reason, nail-biting is detrimental for health in many ways. Chewing the nails and cuticle repetitively leads to chronic deformity of the nails and nail bed. This can lead to pain and swelling. There can be pain and swelling of the gums also due to this activity. Microbes present under the nails can enter the body through the mouth due to nail biting and cause recurrent stomach and intestinal infections. Moreover, an adult with such a habit feels stressed in company of others because they are conscious of this bad habit and are unable to stop it.

There is no medical management for this condition. Counseling is helpful for individuals where one is told about the ill effects of this habit and motivated to give it up. It is also suggested to put some bitter solution over nails so that one may find it repulsive to bite. When one has the urge to bite nails, diverting the mind by doing something useful with the hands is useful to gradually wean off this habit. If difficult, using gloves or tying hands with bands is helpful to some extent. Keeping nails trimmed and well manicured helps in preventing deformity. Mental relaxation is also beneficial in getting rid of this habit.