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Nail Biting – Using Science To Quit


“Do you have any habits like nail/pen/pencil/cheek/lip biting, resting your head on your hand, or habitual gum chewing?”

Researching and scripting this nail biting article made my eyes go somewhat cross-eyed. Let me right that—A LOT cross-eyed.

In this article, we’re going to take a deep dive to uncover the psychology and nail anatomy behind nail biting to offer you some insights on one of the best methods to beat this painful, damaging and frustrating habit.

This text is damaged down into three elements:

Half 1: The Analysis about Nail Biting

Part 2: The Perform of Habit in Nail Biting

Half Three: Attainable Options for Nail Biting


PART 1: The Analysis About Nail Biting

Since nail biting not discussed in my nail bible—Doug Schoon’s ebook (Nail Construction and Product Chemistry)—I needed to dust off my analysis expertise from highschool and school.

I poured via articles from PubMed, NCBI, Wikipedia, Iranian Journal of Medical Sciences, Brazilian Oral Research, Psychology Research and Conduct Management, Modern Medical Dentistry, Journal of Psychiatry and Neuroscience and lots of others.

The most important takeaway from all this analysis was somewhat little bit of a disappointment.

There simply aren’t sufficient research about nail biting. It’s robust to actually make strong conclusions.

A lot of the hypotheses and analysis studies I read typically contradicted each other.

The articles have been affected by words like “suggested,” “suspected,” “controversies,” “contradictory reports,” “not clear,” and “speculation.”

Now how am I presupposed to make sense out of all that?

What I do know is that our behavioral habits serve a function.

All habits have consequences or results. Whether or not the consequence is sweet or dangerous, it’s up to us to continually determine which end result we would like.

For instance, if you wish to be wholesome, you choose to eat nicely and exercise. The result’s better well being.

If you wish to keep alive while driving your automotive, you select to drive on the right aspect of the street.

These examples may look like easier decisions than stopping nail biting. And this might be true.

A few of our habits we do without even noticing or paying attention.

Nail biting is a type of habits.

So, how do we modify one thing we don’t even understand we’re doing?

In the present day’s article is going to be full of nitty gritty analysis article quotes.

After every quote, I supply a translation into one thing that’s simpler to know when you’re simply on the lookout for the necessary stuff.

This for these of you who just want the gist of the research. Simply look for the sections titled “Ana’s Interpretation” with my photograph.


Onychophagia (AH-nih-koe-FAY-gia), outlined as ordinary nail biting, is a standard dysfunction affecting 20-30% of the population and all age groups. It might result in vital psychosocial issues, have a destructive influence on high quality of life, and cause problems involving both the nail unit and the oral cavity…Since onychophagia is a challenging disorder to treat, a multidisciplinary strategy ought to be taken involving dermatologists, internists, pediatricians, psychiatrists, and dentists. ~PubMed

Ana’s Interpretation

The various causes for nail biting embrace stress, boredom, nervousness, melancholy, loneliness, heredity, imitation of a family member, prior thumb-sucking behavior, inactivity, and poorly manicured nails.

You’ll see in the remainder of this text that most of the unfavourable attempts to assist others don’t work. Punishment, nagging and threats, ridicule, and software of bitter tasting options actually don’t work.

In lots of instances, a majority of these makes an attempt can truly make the problem worse.

Remedy is best when directed on the root reason for the conduct.

For nail biters to vary their conduct, they need to need to make the change.


The operational definition of NB is “putting one or more fingers in the mouth and biting on the nail with teeth”. Three The behavior of NB is usually restricted to fingernails, and a lot of the people with the behavior don’t have any choice for biting any of the fingernails. 4 This behavioral drawback has been reported in youngsters and adults.


Nail biting (NB) just isn’t a pathological condition in all occasions and all shoppers. Nevertheless, it isn’t precisely clear where the border between the wholesome and unhealthy conduct of NB is. Nail biting in healthy youngsters is short-term and does not last very lengthy. The frequency, depth, and period of pathological NB are greater than these in regular people. Uncertainties for the distinction of pathological and nonpathological NB are also reflected in the classification of psychiatric issues. Whereas some behavioral problems corresponding to trichotillomania (hair pulling) are categorized as an impulse management dysfunction in Diagnostic and Statistical Guide of Mental Issues, Fourth Version (DSM-IV), NB isn’t categorised in DSM-IV.6 Nail biting can be categorised as a self-injurious conduct akin to pathological skin-picking or as a stereotypic motion disorder.5 Others consider that NB is part of obsessive compulsive dysfunction spectrum.6

Ana’s Interpretation:

Nail biting isn’t all the time an obsessive or compulsive conduct. Many individuals outgrow it or are capable of stop the habit.

Typically occasions nail biting is a symptom of one thing greater.

Nail biting might fall within the category of Impulse Control Disorder like compulsive hair pulling.

Many of us by now have been recognized with some type psychological dysfunction.

Whereas a number of the mental issues are generally often known as melancholy and nervousness—nail biting could be a symptom of ADHD, OCD, ODD, and a number of other psychological issues.

Is Nail Biting Age Associated?

Nail biting often doesn’t start till the age of three or four years.7 There are contradictory studies concerning the prevalence of NB. The prevalence of NB increases from childhood to adolescence and then decreases in adulthood.7 It isn’t clear what proportion of the youngsters with NB conduct stops it, and won’t endure from it later. Nail biting was not associated to gender, conduct issues, inattentiveness, hyperactivity, and peer issues.

Ana’s Interpretation:

Often, nail biting begins throughout childhood and is outgrown. For some individuals though, the conduct continues into adulthood. It’s actually not understood why.

Nail biting isn’t unique to gender, certain conduct points, lack of consideration, hyperactivity or struggles with different college students or co-workers.

It appears that evidently a lot of the studies have been completed with youngsters. I’m unsure why. Perhaps it’s as a result of it’s easier to collect knowledge from them shortly. It’s also attainable that youngsters don’t have the extra work and relationship stress elements that adults have.

I find it fascinating that nail biting increases throughout adolescence but supposedly isn’t associated to see problems.

Humm… Despite the fact that it’s been over 25 years since I attended highschool, I’m fairly positive that it’s still riddled with cliques and peer issues.

Nail biting is probably because of rampant insecurity and self-loathing that is widespread among youngsters.

Totally different stressors can definitely improve the intensity of a nail biting behavior.

Epidemiological Elements

Epidemiology is the research and evaluation of the patterns, causes, and effects of health and disease circumstances in defined populations. It is the cornerstone of public well being and shapes policy selections and evidence-based apply by figuring out danger elements for disease and targets for preventive well being care. [Source: Wikipedia]

Connection between TMJ Dysfunction and Nail Biting

The rate of finger and nail biting in patients struggling temporomandibular joint pain and dysfunction was about 24.1%.8Therefore, it is strongly recommended to inquire about oral habits comparable to NB in all temporomandibular joint pain and dysfunction. Furthermore, sufferers with temporomandibular joint pain and dysfunction ought to be consulted as a part of their administration.eight

Ana’s Interpretation:

I wore braces twice to right TMJ Dysfunction.

My jaw would lock shut or painfully pop while consuming. I once dated someone who stated I used to be a dainty eater. I had to take small bites because I might barely open my mouth!

My orthodontist informed me to by no means chew gum and to wear my retainers every night time for the remainder of my life!

He stated that the human jaw is just not alleged to be continually chewing.

For this reason grinding tooth at night time can also be a problem. Biting nails can tire the jaw also.

E. Coli and Nail Biting

Oral habits like thumb sucking and nail biting are pernicious habits that act as an adaptive perform in obtaining pleasure and subduing nervousness. These habits may act as carriers of numerous microorganisms into the oral cavity, of which, Enterobacteriaceae members are transient pathogens, which might end in debilitating systemic circumstances.10

The Enterobacteria species remoted in our research have been E. coli, Klebsiella, Proteus, and Enterobacter. Of these, probably the most commonly remoted Enterobacteria among all three teams was E. coli (in 12 subjects), whereas the least remoted Enterobacteria was enterobacter (3 topics). Our results are according to the results of Baydas et al. and Sushma et al.9 who confirmed a higher isolation of E. coli. Other organisms comparable to streptococci, staphylococci, pseudomonas, and candida have been also seen together with Enterobacteria.

Literature revealed that environmental organisms might be inoculated into the oral cavity via paranormal habits like nail biting leading to transmission of infections to different elements of the physique, by contaminated palms or environmental objects, which may be answerable for the cause of morbidity and mortality worldwide.9

This indicates the larger prevalence of E. coli in people amongst totally different population groups. Research by earlier authors reported that E. coli have been probably the most regularly remoted organism among Enterobacteriaceae household in several systemic sicknesses. With these knowledge, it can be prompt that E. coli gets a channel of entry into the oral cavity by means of the continual nail biting and thumb sucking habits and is usually a perpetrator of local and systemic infections.10

Ana’s Interpretation

Though it may well calm nervousness, nail biting has a unclean little secret—you’re consuming bacteria that can make you very sick.

The most typical bacteria discovered is E. coli in analysis studies, however different organisms like strep, staph, pseudomonas, and candida have been additionally discovered.

Unfortunately, bacteria don’t all the time die within the mouth. It could spread to your inner organs. Infections can result in illnesses and even dying.

Nail Biting and E. Coli in Your Mouth

The Analysis Says:

The presence of a nail biting habit indicated a better plaque index, which in turn showed a better carriage of Enterobacteria spps, predominantly Escherichia coli.

Accumulating proof suggests the impression of the dental illnesses on the overall well being of the person, warranting a harmonious relation of the microorganisms with that of the oral tissues, albeit any shift in this balanced ecology would unfold a collection of occasions which may end in a disease status.10

Ana’s Interpretation:

Individuals who chew their nails are likely to have extra plaque on their tooth, which makes a nice surroundings for E. coli to flourish.

Dental illnesses can even mess with the great bacteria in your mouth.

Hand Washing

Listed here are some fascinating statistics about hand washing. They’re fairly surprising.

  • While 62% of girls are washing greater than 10 occasions per day, only 37% of males are doing the same. 41% of males wash their palms 6 occasions a day or less, in comparison with only 17% of girls. On average, American heads of family wash their palms eight.6 occasions per day (up from in 2008).11
  • In a survey of 100,000 individuals, which was the most important ever evaluation into hand-washing, it revealed that 62% of males and 40% of girls admit they don’t hassle washing their palms after using the restroom.12
  • A research by the agency Preliminary Washroom Hygiene discovered that after using the restroom, a person has on average 200m bacteria per square inch on each hand. Individuals can then switch the micro organism to their arms or mouths, as well as onto doors, keyboards, telephones. This implies office staff come into contact with a mean 10 million bacteria a day.13
  • Last yr, US researchers highlighted the importance of hand washing, because it discovered a virus can spread via an workplace within two to four hours. Researchers discovered 40% to 60% of staff as well as guests have been contaminated after touching objects within the building.13

In the photograph to the suitable, the green areas are the micro organism current on a mean office keyboard.

Etiological Elements: The Contributing Causes of Nail Biting

(Etiology: the research of causation, or origination.)

The Research Says:

There are loads of controversies concerning the causes of NB. Whereas some research related NB to behavioral problems,14 and nervousness,15,16 others did not consider so.17,18 Nervousness in youngsters with NB just isn’t a trait; it is a state.19

Though it was steered that NB may scale back nervousness or rigidity,16 current studies do not help the nervousness principle for NB.1,20 Nail biting often occurs because of boredom or engaged on troublesome problems moderately than nervousness. Nail biters don’t chew their nail when they are engaged in social interactions, or when they are reprimanded for the conduct.20 Nail biting happens more typically in boredom or frustration than in contingent or noncontingent consideration in undergraduate college students.20 It is suspected that smoking and gum chewing in adults are substitutes for NB in childhood.7 Extreme and delicate NB seem to have some variations when it comes to the idea of bodily and social penalties, severity, frequency, and physiological mechanisms.21

Ana’s Interpretation:

Keep in mind once I stated that the varied hypotheses and analysis research contradict each other?

Above is an ideal example. Some research say that conduct problems and nervousness trigger nail biting. Others disagree.

I’ve interviewed lots of people who stated that nervousness is likely one of the primary causes causing them to chew their nails.

I don’t agree with the assertion that boredom or engaged on troublesome issues is the rationale for biting over nervousness.

It’s thought that smoking and gum chewing in adults is changing a childhood nail biting behavior.

The research I reviewed indicated that people who have been childhood biters who picked up smoking or continual gum chewing have been much less more likely to continue with nail biting.

Comorbidities or Underlying Circumstances: What Else is Going On?

Definition of comorbidity: In drugs, comorbidity is the presence of one or more further illnesses or issues occurring with (that is, concomitant or concurrent with) a main illness or disorder; in the countable sense of the term, a comorbidity (plural comorbidities) is every further dysfunction or disease. [Source: Wikipedia]

The Analysis Says:

There are restricted studies about co-morbidity of NB with psychiatric issues.2 Three commonest co-occurring psychiatric issues in medical sample youngsters with NB are attention deficit hyperactivity dysfunction (74.6%), oppositional defiant disorder (36%), and separation nervousness disorder (20.6%).2

All the boys and 81% of the women of the medical sample of youngsters with NB endure from at the least one psychiatric disorder.2

The most typical co-occurring stereotypic behaviors have been lip biting (33.Three%) and head banging (12.7%).2Another research reported that 70% of people with hair-pulling habit had different stereotypic behaviors, of which skin-picking and nail-biting have been the most typical ones.22

Ana’s Interpretation:

There haven’t been many studies concerning the correlation between nail biting and psychological issues.

Attention deficit hyperactivity dysfunction (ADHD), oppositional defiant dysfunction (ODD), and separation nervousness dysfunction do appear to contribute to nail biting urges.

Apparently, in a single medical pattern, all the boys and 81% of the women with a mental disorder chew their nails.

The most typical behaviors in addition to nail biting have been lip biting, head banging, hair pulling and pores and skin choosing.

Family Matters: Psychiatric Issues of Mother and father of Youngsters with Nail Biting

The Analysis Says:

The one research that investigated the mother and father of youngsters with NB reported that about 56.8% of mothers and 45.9% of fathers suffered from a psychiatric dysfunction, which most frequently was a serious depressive disorder.2 The speed of main depressive dysfunction in mothers was 46.6% and in fathers was 35.1%. A research on youngsters of mothers with psychiatric issues reported that the speed of NB in youngsters of mothers with schizophrenia was greater than that in youngsters of moms with bipolar dysfunction. Additionally, the rate of NB in youngsters of mothers with schizophrenia or bipolar dysfunction was greater than that within the control group.23

General, the reviewed literatures recommend that co-morbidities of psychiatric issues and other stereotypic behaviors in a medical pattern of youngsters with NB is more than 80%, and greater than half of the mother and father endure from psychiatric issues mainly melancholy.32

Ana’s Interpretation:

Just one research seemed at the mother and father of nail biting youngsters. Roughly 50% of moms and dads suffered from a psychological dysfunction. Melancholy was most often reported.

One other research showed that the kind of psychological dysfunction in the mothers made a difference too. More youngsters chew their nails if their mother has schizophrenia compared mothers who have bipolar disorder.

Over 80% of the youngsters in a single medical pattern additionally had a psychological disorder.

Nail Biting is a Household Problem

The Analysis Says:

Nail biting consequences will not be limited to the stricken individuals, and often, have an effect on members of the family. Typically, the mother and father or different relations really feel disgrace from the conduct of their youngsters or siblings. The youngsters or adults with NB may be laughed at or stigmatized by others. Nail biting might cause a restriction in social behaviors or behaviors that must be accomplished within the presence of others using palms similar to writing, drawing, or enjoying.32

Youngsters with NB are regularly attacked by others. Youngsters with NB are often informed that they’re able to control or stop NB, but they don’t wish to stop it. Assaults not solely don’t enhance NB conduct but in addition can add extra to the stress, frustration, helplessness, hopelessness, and nervousness of the youngsters. In addition, nail biting has effects on the oral carriage of Enterobacteriaceae.32

The rate of Enterobacteriaceae is extra in the oral cavities of youngsters with NB habit than these with out it.24 The drive of biting nails may be transferred to the basis of tooth and result in apical root resorption,25 alveolar destruction,7  malocclusions,26 temporomandibular issues,27 and gum accidents.28 Moreover, nail biting might injury the tissue across the nail and lead to an infection and tooth root injury.29 Moreover, in severe instances, NB might injury the nail beds and trigger the disappearing of nails.30 The growth of nails may be increased by NB.31 The result of NB isn’t just limited to medical consequences. Nail biting also causes some unfavorable social and psychological penalties for the sufferers and their mother and father.32

Ana’s Interpretation:

Nail biting can have a big influence on the rest of the family. Shame, ridicule, and isolation are quite common.

Youngsters are sometimes attacked by others and informed they will cease biting simply. This results in more stress, frustration, helplessness, hopelessness, and nervousness.

In fact, as talked about earlier on this article, the rate of germs and bacteria considerably will increase with nail biting. It may cause tooth, gum, and joint accidents too.

Though damaging the nails by biting can truly velocity nail progress, it’s inconsequential because the biter is causing extra injury to the nail plate and nail mattress.

Management and Remedy of Nail Biting

The Research Says:

Nail biting is a habit that can’t be managed with out considering some related elements akin to comorbidities, precedent, and consequences of the conduct.

Any remedy must be accompanied by educating the stricken youngsters as well as their mother and father, siblings, and academics. They need to be taught about what to do and what to not do about it. For example, they should know that punishment, menace or snicker on the youngsters with NB can improve this conduct, as a result of they try to catch others’ consideration by NB. Typically, the mother and father feel responsible for his or her youngsters NB habits. These emotions ought to be detected and managed. Siblings might feel shame for to their brothers’ or sisters’ NB conduct. So, they must be included and educated within the means of administration as properly. Coating nails with unpleasant materials or masking them are tried by many mother and father, however it is often ineffective. Others shouldn’t blame youngsters with NB behavior and improve their disappointments, as an alternative, they should encourage them, and provides them help and confidence. The administration and remedy of a child with NB conduct won’t happen in a number of periods, it is a long course of. All of such medical findings point out that the management of NB is far more difficult than simply focusing on its stoppage. Remedy isn’t as straightforward as it seems. As a result of NB can injury tooth and alveolar structure, the bothered youngsters must be referred for the assessment and administration of potential damages.

There are some strategies instructed for controlling of NB similar to chewing gum or sporting a rubber piece on the wrist. Nevertheless, these approaches must be studied in management trials for his or her efficacy. Also, the efficacy of partaking fingers with substitute activities similar to writing, drawing, holding small balls, or musical instrument ought to be investigated.32

Ana’s Interpretation:

Earlier than the nail biting habit may be managed, it’s essential to take a look at why you do it.

  • Is it a life long difficulty?
  • Are mental health points contributing?
  • And finally, how does the conduct make you are feeling?

Remedies have to be accompanied with compassion. Punishment and ridicule usually tend to improve biting somewhat than resolve it.

Mother and father, siblings, and academics have to be educated in methods to help the nail biter to switch the biting conduct with a extra constructive conduct.

Coating nails with bitter merchandise often doesn’t work and studying to manage the conduct takes time.

Remedy isn’t as straightforward because it might sound.

As of this writing in 2017, conclusive studies don’t exist.

There have been options for controlling nail biting by taking a look at using chewing gum, sporting a rubber band across the wrist, or protecting arms occupied with one thing.


The definition of psychotherapy is the remedy of psychological disorder by psychological quite than medical means.

The Analysis Says:

There are limited controlled medical research on behavioral or psychotherapeutic approaches to the remedy of NB. There are some cognitive behavioral methods for the management of youngsters’s behaviors. These methods have many similarities and are based mostly on cognitive and behavioral rules corresponding to learning rules. All of them train some expertise to the youngsters to have the ability to management NB behaviors. Sufferers with NB habit may be educated for several types of relaxations reminiscent of self-statements of rest, visual creativeness, muscle rest, and deep respiration.32

Ana’s Interpretation:

There are very few managed research that take a look at behavioral remedy for nail biting.

Adults might be extra profitable learning several types of rest methods.

Whereas, it’s far more troublesome for youngsters to embrace the brain training required to stop an unconscious conduct.

My boys, Mr. D and Mr. B, have ADHD and ADD respectively.

They will’t stand going to the psychiatrist for their medical checkups—and those are only 15 minutes!

Most youngsters would relatively be driving their bikes, enjoying video games, or different enjoyable actions.

They don’t need to sit on a sofa talking to a therapist about why they chew their nails.

Practical Evaluation Analysis

Nail biting is usually a discovered conduct based on a cognitive mannequin. In this model, constructive, destructive, or automated reinforcement maintains our habits. So, our habits have features.32

Ana’s Interpretation:

It’s essential to note that it’s pretty much unattainable to “break” a nasty habit (somewhat more research about this later).

So in the event you’re making an attempt to give up a habit like biting your nails, smoking, or reaching for a pint of Ben and Jerry’s if you’re harassed, quitting chilly turkey just isn’t going to set you up for fulfillment.

Nicely which means individuals and medical professionals will inform you that you simply simply have to develop more “willpower”. They assume that willpower will probably be robust sufficient to beat a nasty behavior.

And when you lack robust enough willpower, that deficiency is usually seen as a character flaw. Sadly, this makes you are feeling like a nasty individual.

Nicely, that’s not how the mind works.

Right here’s a look behind the scenes of what makes a habit so arduous to interrupt.

Why We Have Habits

Habits are as much part of our every day survival as oxygen.

We now have a lot info coming at us all day, day by day, it’s unattainable for our brains to course of all the new sensory input whereas we go about all our regular day by day actions.

Habits are what permit our brains to place sure necessary routines on “autopilot” so we will cope with the subsequent thing that comes our means.

Some examples of those useful “autopilot” habits would come with:

  • Your morning routine of getting up, getting dressed, brushing your tooth, and so forth.
  • With the ability to drive to work without really taking note of your route.
  • Driving a motorcycle or touch typing on your pc without wanting on the keys.

Taking the Freeway or Surface Streets?

When you’ve developed these routines/autopilot habits, they create a strong set of neural pathways in your brain.

This may look like a weird exercise, but think about your neural pathways like a huge 6-lane freeway.

The 6-lane freeway is the straightforward solution to get where you’re going. Your mind is all the time on the lookout for the simplest option to get issues executed.

If you attempt to go “cold turkey” to break a behavior, it’s a bit like taking surface streets and making an attempt to fake the 6-lane highway doesn’t exist anymore.

Even should you don’t use the highway for years, it’s nonetheless there.

Your brains’ neural pathways have created a well-beaten path that gained’t ever really go away.

It’s all the time straightforward to get back on that dangerous habit neural pathway.  This is the reason it’s really easy to relapse in your habit-breaking quests.

An example of this alcoholics or others who wrestle with addictions.

It’s so easy to relapse and not using a good help system and plans in place for different routines when these individuals expertise triggers that they used to affiliate with consuming.

So, when you can’t break a habit, what do you do with it?

The higher answer is to switch the routine or action you’re taking once you’re triggered to chew your nails.

The Elements of a Behavior

In response to Charles Duhigg, writer of The Power of Habit, there are three elements of a behavior:

  1. The set off
  2. The action or routine
  3. The reward

These are the key elements of how your brain is ready to use these “autopilot habits.”

For example, your morning routine is triggered by your alarm clock going off (this is an external environmental set off). Your mind has discovered to affiliate the alarm clock with all the steps you’re taking to get out the door (the routine).

Your brain will get a nice brain increase of chemical compounds that offer you a sense of accomplishment once you full the action of the habit. This is the reward.

This autopilot behavior course of works the identical for good habits and dangerous habits. Let’s take a look at the way it works in a nail biting state of affairs.

  1. The TRIGGER: Could be inner (stress, boredom, and so forth.) or exterior (tough skin, peeling or jagged nails, and so on.).
  2. The ACTION or routine: Biting or choosing at your nails.
  3. The REWARD: Sense of completion from performing your chew/decide habit, even when it’s the sting of nails bitten to brief or pores and skin picked at till uncooked and bleeding.

Writer Marshall Goldsmith adds to Duhigg’s Three-part habit loop in his guide Triggers, by breaking down step the process into four steps, including a step between the trigger and the routine: IMPULSE.

The impulse is the place your mind mechanically analyzes your set off and does its greatest to “help” you get to your reward.

Your brain plugs in a routine that it’s conversant in and associates with a reward. This affiliation is constructed via doing the identical routine time and again.

Whenever you’re capable of assist your brain turn out to be acutely aware of your trigger and the next impulse, you’re capable of consciously change the routine you’re taking to get the reward. This helps you get the results you want.

Let’s look a bit of deeper into what analysis says about habits…

Habit Reversal

The Analysis Says:

Some authors consider that NB is a discovered habit, quite than an emotional situation.29 Behavior reversal is a form of behavioral remedy, which uses an analogous or dissimilar competing response.32

Ana’s Interpretation:

Like I mentioned earlier than, habits can’t be damaged.

Habits have to be replaced with another conduct that’s incompatible with the primary conduct (keep in mind the 6-lane highway analogy above?).

This course of known as aggressive response coaching. That is the flamboyant label for “exchange the dangerous conduct with an excellent conduct.


The Analysis Says:

The recording of NB frequency, videotaping of NB conduct and describing its frequencies improve awareness. Its frequency ought to be recorded on a card. It’ll assist youngsters to watch their behavioral modifications. State of affairs consciousness is the type of awareness that youngsters with NB habit determine the situations or places by which NB is best or worse.32

Ana’s Interpretation:

It’s a pain within the “you know what”, but it’s a good exercise to write down down the occasions you catch your self biting. Perhaps you would use the notepad software on your telephone.

Document what you’re feeling in the meanwhile and where you’re. In the event you’re serving to a toddler, with permission they could be open to you videotaping the conduct.

The Research Says:

For aggressive response training, a behavioral sample that’s incompatible with NB is introduced. Competing responses ought to be contingent with NB. There are several types of contingency administration. Mother and father can touch upon improvement of the conduct, and provide some reward for the improved youngster. For example, the child can go to some places or take pleasure in activities that he/she has been prevented before. Competing responses ought to be practiced daily. Mother and father ought to encourage youngsters with NB habit using competing response. Behavioral modifications are lengthy processes, and fogeys and their youngsters must be knowledgeable that they won’t happen over a couple of days or perhaps weeks. This is essential because mother and father or youngsters often hand over soon.32

Ana’s Interpretation:

Let’s take a look at the definition of contingency. It is the relationship between two occasions, one being “contingent on” or a consequence of the opposite event.

Here’s a actual life instance of contingency. My son, Mr. D, needed to stop biting his nails. My settlement with him was to buy a coveted Lego® set if he went for Three weeks with out biting.

He held out till he earned the reward and then relapsed.

A few week later he stated, “Mom if I go without biting my nails for 3 weeks again, can I get another Lego®set?” Ah, the creativity of youngsters!

The analysis means that competing response ought to be practiced day-after-day. That leads us to the subsequent part. Does doing something else at the time of biting assist in any respect?

Habit Reversal Versus Object Manipulation

Professional Behavior Reversal

The Research Says:

The current research investigates the efficacy of habit reversal coaching (HRT) and compares its effect with object manipulation coaching (OMT) contemplating the restrictions of the current literature.

There was three teams of Habit Reversal Remedy group (HR) (n = 30), Object manipulation group (n = 30), and wait-list or control group (n = 31) on this research. All of the three teams have been assessed at baseline. Nevertheless, each HR and Object manipulation groups acquired intervention while the wait-list group did not obtain any intervention.33

Behavior Reversal (HR)

HR remedy was carried out based on a protocol offered by Woods.35 On this protocol, the attainable features of nail biting as well as the emotions skilled before, throughout and after nail biting have been identified. Based on this protocol, behavior reversal consists of awareness coaching, competing response training, and social help coaching. These trainings have been carried out in a 30-minute session. In reality, the subsequent periods have been booster periods to watch the progress and develop solutions to issues which occurred in the course of the implementation of the intervention. In awareness coaching, youngsters have been educated to acknowledge their nail biting conduct and its warning signs. For competing response, youngsters have been educated to exhibit a conduct which was incompatible with nail biting immediately after the prevalence of nail biting or one among its warning signs. They have been requested to carry a pencil or a toy with their arms. Finally, a person was recognized to help youngsters to increase their remedy compliance, and remind their competing response, and reward them for their compliance.33

Ana’s Interpretation:

Some authors consider that nail biting isn’t associated to an emotional condition, but somewhat a discovered behavior.

Habit reversal is a form of conduct therapy, which uses a dissimilar or comparable competing response.

For the habit reversal research group, coaching included:

  1. Consciousness Coaching: the best way to acknowledge the biting conduct and warning signs.
  2. Competing Response: choose a conduct which was incompatible with nail biting, like holding a pencil or toy.
  3. Social Help Training: one other baby within the research was assigned to hopefully assist improve success.

Let’s take a look at totally different attainable solutions to help exchange the nail biting habit.

Object Manipulation (OM)

The Analysis Says:

[The object manipulation] group of youngsters was educated for all the gadgets reported for HR training. They have been educated to play with something (akin to a toy, pencil) as an alternative of biting their nail. Actually, nail biting was replaced by enjoying with one thing. All other elements including consciousness training and social help have been just like habit reversal remedy group. In truth, the thing manipulation condition and HR situation have been similar. Nevertheless, youngsters in object manipulation condition manipulated an object as an alternative of doing a competing response.33

Ana’s Interpretation:

The thing manipulation group was educated the three methods just like the HR coaching group. The only distinction was that the competing response was to play or “fidget” with something relatively than simply maintain it.

The Analysis Says:

General, the current outcomes confirmed that HR significantly increases the imply length of nails more than the opposite two teams in long run. This confirms that HR is an effective remedy for the management of nail biting for the group sample -of youngsters and adolescents. Furthermore, nail length elevated in the course of the trial in both groups of intervention whereas the imply length of nails within the wait-list group decreased in the course of the trial. It is in keeping with and helps the outcomes of Woods et al.’s research.34 Nevertheless, there’s lots of covariate elements thought-about within the current research that weren’t thought-about in the research by Woods et al. (1999). Furthermore, the research by Woods et al. (1999) was carried out on youngsters with thumb sucking. Only some of their members had nail biting drawback. In addition, we did not find any research on the effect of object manipulation on nail biting conduct. Subsequently, the current research seems to be distinctive.

Relating to our second goal, the obtained results confirmed that object manipulation was simpler than wait-list briefly time period. Furthermore, object manipulation significantly decreased nail biting in long term. Nevertheless, the variety of youngsters who utterly stopped nail biting was very shut to one another. Subsequently, additional research with longer period are advisable.

Our third goal was to match the effectiveness of object manipulation training and behavior reversal coaching. The results showed that, in long term, both object manipulation coaching and behavior reversal training are considerably efficient for treating nail biting conduct. Nevertheless, behavior reversal coaching is simpler than object manipulation coaching.

Regarding our purpose to know the acceptability of object manipulation coaching and habit reversal training, the current results confirmed no vital difference between the two groups relating to their acceptability.

Nevertheless, the drop-out fee was larger within the object manipulation group than the behavior reversal group.

In conclusion, behavior reversal greater than object manipulation will increase the mean size of nails in long term.33

Ana’s Interpretation:

Apparently, the act of holding an object—versus twiddling with it—was more successful this research—in growing the imply length of nails.

Also, the drop-out fee was larger with the item manipulation group.

Isn’t that fascinating?

Maybe the individuals have been beginning to really feel that it wasn’t working properly sufficient.

Competing Response

The Research Says:

On this behavioral technique, the subject performs a competing response every time he/she has the urge to chew or finds his/hers biting nails. For example, a conduct to stop or keep away from shifting upper limbs in the direction of face or lips, or a conduct to cease or inhibit getting into fingers into the mouth is employed. This technique has been shown to be simpler than not utilizing it.29 Competing response sort just isn’t essential for the suppression of goal conduct, and it doesn’t in all probability perform as an incompatible conduct.35

Ana’s Interpretation:

Like talked about before, competing response means to do a conduct that makes it troublesome to chew.

A superb example of this is to stay your palms in your pockets when tempted to chew.  Studies have proven that this system works higher than not utilizing it.

The only drawback is that we will’t hold our arms in our pockets all the time.

And finally, the competing response doesn’t stop the will to chew.

Aversive Stimulus

The Research Says:

An aversive stimulus is effective for treating NB and is often finished by means of the painting of an aversive stimulus or a bitter substance on the individual nails. Aversive stimulus remedy improves NB, though its effect isn’t as much because the competing response technique.29

Ana’s Interpretation:

Aversive stimulus means to apply some type of unfavourable reinforcement. The basic answer is to paint a bitter answer on the nails.

Unfortunately, this works for a very brief time and could go the opposite course if the individual truly becomes accustomed to the bitter answer painted on their nails.

Punishment or ridicule also falls on this class. It’s been confirmed in lots of studies to not work, and may even improve the conduct.

Self-Control Intervention

The Research Says:

Contemplating that human conduct is goal-directed and affected by various factors, self- management intervention is proposed as a way for the management of NB.36 On this technique, some specific self-control expertise are discovered and applied by the themes. The tactic is carried out in various steps. First, the youngsters are taught that the focused conduct is an issue, they usually can change it. Second, the youngsters are advised to try to find the potential explanation for NB as well as the thought and emotions which are associated with the conduct. Third, the youngsters are instructed to do self-monitoring, as it may well improve their consciousness from the conduct. Fourth, youngsters are educated to make use of some discovered expertise akin to self-talk and self-reward to vary the automated conduct. Fifth, youngsters are educated to use the discovered expertise to handle and alter different comparable pathologic behaviors.36

Ana’s Interpretation:

Human conduct is affected by many various things and is objective directed. If we would like one thing, then we would like it.

In a single research, youngsters have been taught to comprehend that biting is an issue that they will change, and discover the trigger and emotions associated to biting.

The youngsters have been requested to do self-observation, then use discovered expertise like self-talk and self-reward which might assist them handle and change their conduct.

These educated behaviors are onerous sufficient for adults to make use of, let alone youngsters.

“Self-control” is something to me that’s stated by somebody who doesn’t actually understand the new research of how conduct works.

That’s like saying “don’t have that piece of cake because the sugar will make you feel horrible and can contribute to weight gain.”

Who cares? If we would like cake, then we get an IMMEDIATE reward.

If we would like cake, then we get an IMMEDIATE reward.

Or how about this one? “The solution is easy. Just stop biting your nails.” Besides that for many people who find themselves nail biters is that they don’t even know they’re doing it.

Nail biting has moved past a selected conduct to at least one that is unconscious.


As most of my readers know, I try to avoid medical and pharmaceutical discussions as a lot as potential.

There’s a lot misinformation on the web which is completely false and downright scary.

I also haven’t any right making any medical claims or recommendation. That is something reserved in your doctor.

With that being stated, I feel I might be remiss in not together with studies which have included utilizing drugs and various pharmacological remedies to assist with nail biting.

These are undoubtedly things it would be best to talk about together with your docs. Be happy to print or e-mail this text to take to your doctor.


There are several pharmaceutical medicine which have had some success with nail biting.

There’s also the issue that each one of our bodies are totally different and react in another way to varied drugs and various cures.

In truth, some drugs like selective serotonin reuptake inhibitors (SSRI’s) might make nail biting worse.

There seems to be an fascinating correlation by which medicine work higher with individuals with obsessive compulsive dysfunction (OCD). Some researchers really feel that nail biting, hair pulling, and OCD all have comparable causes.

The Analysis Says:

It is supposed that NB, trichotillomania, and obsessive-compulsive disorder have an identical biologic etiology.37

Since NB is an impulse dysfunction, selective serotonin reuptake inhibitors (SSRIs) might exacerbate it. This suggestion is predicated on the assumption that impulsivity is exacerbated in some impulse-prone sufferers by SSRIs.38

As of 2011, and to the most effective of the writer’s information, there isn’t any double-blind, placebo-controlled trial investigating the efficacy of medicine similar to fluoxetine and fluvoxamine for the remedy of NB. There are only a number of case stories concerning the association of NB with other comparable behaviors resembling skin choosing. Fluoxetine has been reported to be effective for the remedy of chewing of digits.39 A double-blind comparability of clomipramine and desipramine results in individuals with NB habit, who did not have obsessive compulsive dysfunction, indicated that clomipramine was simpler than desipramine.37

Fluoxetine (floo OX e teen)

Model Names: PROzac, PROzac Weekly, Sarafem, Rapiflux, Selfemra, PROzac Pulvules. Fluoxetine is a selective serotonin reuptake inhibitors (SSRI) antidepressant. Fluoxetine impacts chemical compounds within the brain that could be unbalanced in individuals with melancholy, panic, nervousness, or obsessive-compulsive symptoms, bulimia nervosa (an eating disorder), obsessive-compulsive dysfunction, panic disorder, and premenstrual dysphoric dysfunction (PMDD). [Source:]

Fluvoxamine (floo-VOX-a-meen)

Model Names: Faverin, Fevarin, Floxyfral, Dumyrox and Luvox. Fluvoxamine is a medicine which features as a selective serotonin reuptake inhibitor (SSRI) and receptor-agonist. Fluvoxamine is used primarily for the remedy of obsessive–compulsive disorder (OCD), and can also be used to treat main depressive dysfunction and nervousness issues comparable to panic dysfunction and post-traumatic stress dysfunction. Fluvoxamine CR (controlled release) is authorised to treat social nervousness disorder. [Source:]

Clomipramine (Clo-mi-pram-mine)
Model Identify: Anafranil. Clomipramine is a tricyclic antidepressant (TCA).[2] It’s used for the remedy of obsessive compulsive dysfunction, panic disorder, main depressive dysfunction, and persistent pain. [Source:]

Desipramine (also called desmethyl-imipramine)
Brand Names: Norpramin, and Pertofrane. Desipramine is a tricyclic antidepressant (TCA). It inhibits the reuptake of norepinephrine and to a minor extent serotonin. It’s used to treat melancholy, but not thought-about a first line remedy because the introduction of SSRI antidepressants. [Source:]

Various Pharmacological Remedies

Two medicine options which may show promise are Glutamate and N-acetylcysteine.

For those of you who need to keep away from pharmaceutical drugs, these are value discussing together with your doctor or psychiatrist.

The Analysis Says:


Glutamate, an excitatory central nervous system neurotransmitter, is emerging as a possible various pharmacological remedy when compared to gamma-aminobutyric acid (GABA)-, dopamine-, and serotonin-modulating remedies for neuropsychiatric circumstances. The pathophysiology, animal models, and medical trials of glutamate modulation are explored in issues with underlying inhibitory deficits (cognitive, motor, behavioral) together with obsessive–compulsive dysfunction, attention deficit hyperactivity disorder, Tourette syndrome, trichotillomania, excoriation dysfunction, and nail biting. Obsessive–compulsive dysfunction, consideration deficit hyperactivity disorder, and grooming issues (trichotillomania and excoriation dysfunction) have emerging constructive knowledge, though only scarce managed trials can be found.40  CNS homeostasis of inhibition–disinhibition signaling finally is dependent upon a well-regulated glutamate–GABA stability, along side different neurotransmitter techniques that influence on this remaining effector pathway, which extremely impacts neuronal well being.41

Future drug design approaches will profit from a better understanding of these pathways (which also influence on different biologic techniques, including immune and developmental networks) in OCD and associated issues, tics and ADHD, to be able to provide a paradigmatic framework to raised understand the imbalance in inhibition–disinhibition from the molecular degree (glutamate–GABA) to the macro-behavioral degree (obsessions, compulsions, tics, hyperactivity, and grooming behaviors). The heuristic value of contemplating these cross-disorder medical manifestations in toto in relation to glutamate awaits future drug discovery to deal with these disinhibitory phenomena. In summary, medicine that impression the glutamatergic stability within the CNS are emerging as a therapeutic various for neuropsychiatric issues, which implicate irregular inhibitory control in cognitive, motor, behavioral, and grooming domains. OCD has probably the most help at current for using glutamate modulators, with ADHD and grooming issues additionally displaying promise.40


N-acetylcysteine (NAC) is emerging as a useful agent in the remedy of psychiatric issues.

Quotes from the next article revealed within the Journal of Psychiatry and Neuroscience was advisable to me by my youngsters’s psychiatrist.

The fascinating factor to me is that he is a nail biter!

Once I asked him what his triggers have been, his response was “being caught in heavy traffic, watching movies and idleness”.

The Analysis Says:

Our evaluation outlines the current literature relating to using N-acetylcysteine (NAC) in issues including habit, compulsive and grooming issues, schizophrenia and bipolar disorder. N-acetylcysteine has shown promising leads to populations with these issues, including those in whom remedy efficacy has previously been restricted. The therapeutic potential of this acetylated amino acid is starting to emerge in the area of psychiatric analysis.42

In addition to TTM (hair pulling), promising preliminary results recommend the necessity for controlled research in other grooming issues, together with nail biting and pores and skin choosing.43,44 A case report was revealed relating to a person with both TTM and nail biting behaviours, in whom nail biting ceased following 9 weeks of NAC remedy.43 The participant relapsed after a hiatus in remedy, however recommencement of NAC resulted in a remission of symptoms.43

A serendipitous finding of the good thing about NAC remedy in the discount of nail biting in a research primarily investigating NAC (2000 mg/d) in the remedy of mood issues has been reported.44

Three individuals taking NAC reported vital reductions in nail biting in the course of the 6-month course of remedy. All 3 individuals have been still abstinent from nail biting 1 month after the discontinuation of NAC.42

Ana’s Interpretation

N-acetylcysteine (NAC) has shown promising leads to populations with habit, compulsive and grooming issues, schizophrenia and bipolar dysfunction. It has been useful for individuals who have tried other drugs with no success.

The healing means of this acetylated amino acid is starting to emerge in the subject of psychiatric analysis. We’d like more controlled studies to see if NAC works higher than a placebo.

One research using NAC to treat temper issues happened to disclose a aspect effect of lowered nail biting.

Three members reported this during their 6-month remedy and after another month of stopping the NAC, they nonetheless weren’t biting. That is promising news!

Aspect Benefits?

Typically occasions a drug that’s formulated for one situation can truly have other aspect benefits—that make it promote even better than the unique intent.

Listed here are a few examples of what I imply.

Propecia, that ubiquitous drug used to deal with male-pattern baldness, was originally marketed as Proscar, a drug to treat the benign enlargement of the prostate. After five years available on the market in the 1990s, it turned clear that one of the uncomfortable side effects of Proscar was – you possibly can practically see the cash indicators flashing within the pharmaceutical entrepreneurs’ eyes – hair progress on bald males. Cha-ching!45

Listerine was invented 133 years in the past, first as a surgical antiseptic, but in addition as a remedy for gonorrhea (don’t attempt that at residence). An article from 1888 recommends Listerine “for sweaty feet, and soft corns developing between the toes.” Over the course of the subsequent century, it was marketed as a refreshing additive to cigarettes, a remedy for the widespread cold, and as a dandruff remedy. However it was in the 1920s that the highly effective, germ-killing liquid lastly landed on its most lucrative use as a magical remedy for dangerous breath.45

Medical Advancements

The world of science and mental issues is regularly altering and making discoveries that may change our life for the better.

Think about how little we knew concerning the human physique just 100 plus years in the past. Listed here are a number of the advancements we’ve got made;

  • 1901 Blood typing was established
  • 1921 Discovery that the absence of vitamin D causes Rickets
  • 1907 Blood transfusions began
  • 1922 Insulin was first used to treat diabetes
  • 1928 Discovery of penicillin
  • 1930 Discovery of vitamins
  • 1935 Invention of the Heart-Lung machine
  • 1953 Heart-Lung machine used for the first time in surgical procedure
  • 1953 The DNA molecule was discovered
  • 1967 The first human coronary heart transplant was performed
  • 1978 The first check tube baby was born
  • 1996 Dolly the sheep turned the first cloned mammal and lived for 7 years.48

Different advancements that have been life altering have been the creation of vaccines starting in  1923 to the current, and their potential to stop illnesses like diphtheria, pertussis (whooping cough), tuberculosis, tetanus, influenza, polio, measles, mumps, and so forth. The listing goes on and on. The discovery of anesthetics, clean water, and sanitation practices, and the creation of the birth control capsule have been also essential.46

Mental Health Advancements

Although individuals have been dwelling with psychological well being issues because the starting of the human race, the Psychological Health America (MHA) wasn’t based until 1909.

Across the turn of the 20 th century, Clifford W. Beers, a current graduate of Yale School and a newly-minted Wall Road financier, suffered his first episode of bipolar disorder (manic depressive illness) following the illness and demise of his brother. In the throes of his illness, Beers tried to take his personal life by leaping out a third story window.  Significantly injured however nonetheless alive, Beers ended up in private and non-private hospitals in Connecticut for the subsequent three years.

While in these establishments, Beers discovered firsthand of the deficiencies in care in addition to the cruel and inhumane remedy individuals with psychological sicknesses acquired. He witnessed and experienced horrific abuse by the hands of his caretakers. At one point throughout his institutionalization, he was placed in a straight jacket for 21 consecutive nights.

Upon his launch, Beers was resolved to show the maltreatment of people with mental sicknesses and to reform care. In 1908, he revealed his autobiography, A Thoughts That Found Itself, which roused the nation to the plight of people with psychological sicknesses and set a reform movement into movement. Within the ebook, Beers declared, As I penetrated and conquered the mysteries of that darkish aspect of my life, it not held any terror for me. I’ve determined to stand on my past and look the longer term in the face.48

Ana’s Interpretation:

We have now made vital progress during the last 100 years to determine and help individuals dwelling with psychological sicknesses, nevertheless it’s nonetheless surprising how mental well being continues to be such a taboo subject to speak about, even on the time of this writing in 2017.

This shame and worry make individuals feel very remoted and extra inclined to resort to nail biting, skin choosing, and hair pulling as a solution to calm their nervousness.

Does that mean that everyone who bites their nails has a psychological well being disorder?

No, however it positive makes one assume.

What if individuals are battling biting because it’s a symptom of something greater?

There are so many working elements within the mind that rely upon the setting, genetics, food regimen, personal historical past, current life situations, stressors, help methods and more.

Two totally different individuals could possibly be scuffling with biting and choosing for utterly totally different reasons.

It’s inconceivable to offer a blanket conclusion that solves everyone’s issues because of these a number of layers of complexity.

Among the best ways to utilize all that we now have discovered up to now 100 years about psychological health and physical well being and totally different issues is to begin to pay attention to YOU.

  • What works for you?
  • What doesn’t be just right for you?
  • What are your triggers?
  • What helps you overcome them?

For those who don’t have the tools to beat your triggers and different contributing points, then you might find it useful to enlist the assistance of a professional physician, counselor, or other help groups.

I’ve began a Bliss Kiss™ help group on Fb for individuals who wrestle with biting and choosing. [ ]

Wherever you search help, it’s essential to seek out what works for you.

Find somebody who understands you and may help you work via your unique state of affairs.


As you possibly can tell by now, a lot more studies must be completed to know easy methods to assist someone stop biting their nails.

We’d like extra randomized controlled medical trials to make treatment tips which might be based mostly on good proof for the remedy of nail biting conduct.

Nail biting shouldn’t be an remoted symptom.

Research with youngsters have shown that sporting nail coatings, repeated promptings to cease biting, and lots of conduct modification methods don’t work because of the shortage of consideration that nail biting could be a symptom for more difficult circumstances.

Analysis research turn into even more troublesome when nail biting is a symptom of many various psychological issues.

It can be even more durable to manage when somebody has multiple disorder.

The good factor is that science retains making developments.

Society members around the globe are using social media as a approach to assist scale back the stigma of mental well being issues.

On-line help teams have gotten very fashionable and out there to anybody on the planet.

This is an thrilling time in historical past for individuals from everywhere in the world to help one another with our personal challenges.

We get hold of an enormous sense of connection and aid once we find other people who find themselves battling the same difficulty. There are individuals out there who understand and help us. We not really feel alone.

This can be a excellent factor.


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