ISSN: 2320-5407 Int. J. Adv. Res.

10(12), 403-409

Journal Homepage: -www.journalijar.com

Article DOI:10.21474/IJAR01/15854
DOI URL: http://dx.doi.org/10.21474/IJAR01/15854

RESEARCH ARTICLE
ONYCHOPHAGIA (NAIL-BITING) SIGNS OF PSYCHOLOGICAL DISORDERS OR SIMPLE HABIT

Dr. Suhail Abdalhameed Abdalrasheed Khan1, Dr. Hoda Jehad Abousada2, Dr. Mohammed Musharraf
Alamri3, Dr. Muaath Ahmed Al Ghamdi3, Dr. Ghaidaa Abdulkareem Alfaraj3, Dr. Abdullah Salem
Alghamdi4, Dr. Salihah Ahmed Bajaber5, Dr. Khulud ali Bakri5, Hanadi hamoud alharbi6, Lamia Naiaf
Alotaibi6, Suad saad Almutairi6, Mathal abdulrahman Alanazi6, Jamilh saad Al Rashidi6 and Tahani Yousef
Alatawi6
1. Consultant Psychiatrist, Psychiatry Department, Mental Health Hospital, Jeddah, KSA.
2. Obestetric&Gynecology MRCOG, Master SA, KAMC, KSA.
3. SERVICE DOCTOR, MOH, KSA.
4. Service Pharmacist, KSA.
5. Medical Intern, KSA.
6. Staff Nurse, MOH, KSA.
……………………………………………………………………………………………………....
Manuscript Info Abstract
……………………. ………………………………………………………………
Manuscript History Background:In the fields of psychiatry, psychology, medicine, and
Received: 10 October 2022 dentistry, nail biting (NB) is a prevalent yet unsolved issue. Although
Final Accepted: 14 November 2022 many people assume that NB is a basic habit that can be readily
Published: December 2022 corrected, many children who exhibit NB have previously attempted to
correct the behavior and have failed.The aim of the present research
focused on the reason for onychophagia or nail-biting if it is a
psychological disease or a general habit and recommend some suitable
suggestions.
Methods:An inductive research approach was suitable for the present
research methodology as it involved a survey process. The research
approach helped in collecting information in an effective way. A
stratified random sampling method was considered for the present
research method through the inclusion of participants that are suffering
from the issue of nail-biting belonging to the UK. The sample size for
the research methodology included a total of 350 participants belonging
to the age groups of 18 to 50 years. The primary data collection method
was considered for the present research methodology as it followed the
cross-sectional method. The quantitative data analysis method would be
considered under the primary research method and so a survey would
be done.
Results: Of 380 study participants,more than half of them believe that
nail biting is a psychological disorder (n= 219, 58.1%). Furthermore,
about two thirds of study participants believe that nail biting is a
common disorder among humans (n= 247, 65%). Most of study
participants think that nail biting is curable (n= 296, 77.9%). Daily
exercise is helping in reducing the habit of nail biting as reported by
178 (73.2%). Half of study participants were neutral with regard to the
benefit of psychological treatment to nail biting (n= 184, 48.4%). Vast
majority of study participants believed that exercise is effective for

403
Corresponding Author:- Dr. Hoda Jehad Abousada
Address:- Obestetric&Gynecology MRCOG, Master SA, KAMC, KSA.
ISSN: 2320-5407 Int. J. Adv. Res. 10(12), 403-409

enhancing mental stability (n= 318, 83.7%).Leading a life with a the

disorder or nail biting issue was moderately painful among 165
participants (43.3%). Participants were asked about the cost of
medication for onychophagia, most of participants responded with
affordable cost (n= 270, 71.1%). The most frequent symptom of nail
biting issue as reported by study participants was moderate span of time
(n= 234, 61.6%).
Conclusion: Onychophagia is a psychological disorder from the
perspective of study participants. Furthermore, they recommended
medical treatment and stated that psychological treatment alone is not
enough. Moreover, exercise helps with mental stability as reported by
study participants.

Copy Right, IJAR, 2022,. All rights reserved.

……………………………………………………………………………………………………....
Introduction:-
Both psychology and dermatology have had less articles published on nail biting (NB) [1-2]. Unfortunately, NB has
defied attempts at resolution by the medical, psychological, and dental communities [3]. Those who engage in NB
may want to see an end to it, but their attempts to do so have been fruitless. Many parents of children brought into
clinics for the treatment of NB have attempted to assist by doing things like covering their kid's nail plate with
substances that have an unpleasant taste. Nails have been protected with rubber or fabric in the past. Most of the
time, these interventions do not cause the undesirable habit to disappear completely. Many youngsters that exhibit
NB conduct may face consequences from their loved ones. There is some evidence that punishment and threat may
not work to reduce the incidence of NB, and may instead enhance it. Someone exhibiting NB conduct may claim
helplessness or inability to stop the behavior at times. Clinical practitioners treating children with attention deficit
hyperactivity disorder (ADHD) may find NB useful in determining the optimal combination of medications to use
[4].

Body-focused repetitive behavior (BFRB) disorders include onychophagia, or persistent nail biting, and
onychotillomania, or repeated plucking and pulling of the nails [5]. The matrix, nail bed, nail plate, and periungual
skin may all be negatively impacted by these conditions. Although nail biting and picking are common in the
general population, particularly in children and individuals under stress, limited awareness of their clinical
presentations, feelings of shame towards the habit, failure to refer to mental health specialists, and coexisting
psychiatric conditions can all contribute to delayed diagnosis and treatment. Patients seldom appear with nail biting
or nail picking as the primary symptom, thus a correct diagnosis requires a thorough history and physical
examination. Dermatologists, internal medicine doctors, pediatricians, psychiatrists, and dentists all have a role in
the care of onychophagia and onychotillomania [6-10].

In spite of the increasing focus on BFRB disorders, onychophagia and onychotillomania are still under-researched in
the psychiatric and dermatological literature in comparison to other forms of self-inflicted dermatoses such as skin
picking and hair pulling. The result has been diagnostic delays and the use of therapies with questionable efficacy
due to a lack of information on these nail disorders.

Nail biting, or onychophagia, is recognized as a symptom of a number of mental problems. Nail biting may be seen
as either a mental illness or a simple habit, as most individuals pick up the activity innocuously but get used to it
with time [11]. Anxiety, fear, and other emotions may all play a role as key causes of this behavior. Nail biting is a
common coping mechanism for individuals of all ages who are experiencing mental stress, worry, or dread. As a
result, the mental problem situation of a person has been linked to this sickness [12]. The aim of the present
research focused on the reason for onychophagia or nail-biting if it is a psychological disease or a general habit and
recommend some suitable suggestions.

Methods:-
The research methodology considered the implementation of a descriptive research design as the research was done
through a cross-sectional method. The descriptive type of research design was helpful for the present research
proposal as it was fruitful in collecting and analyzing the data that is related to the topic [13].

404
ISSN: 2320-5407 Int. J. Adv. Res. 10(12), 403-409

Research Approach
An inductive research approach was suitable for the present research methodology as it involved a survey process.
The research approach helped in collecting information in an effective way [14].

Research Population
The research involved a study on the habit of nail-biting that is called Onychophagia and thus, the survey was done
targeting the population of the people who suffer from this habit. Therefore, the present study involved people
within the age range of 18 to 50 years belonging to the UK [13].

Research Sample
A stratified random sampling method was considered for the present research method through the inclusion of
participants that are suffering from the issue of nail-biting belonging to the UK. The sample size for the research
methodology included a total of 350 participants belonging to the age groups of 18 to 50 years [14].

Research Tool
The research was done through a survey method and therefore it included a questionnaire incorporating a total of 12
multiple-choice questions. The questionnaire was sent via mail to the participants [13].

Data collection
The primary data collection method was considered for the present research methodology as it followed the cross-
sectional method. The quantitative data analysis method would be considered under the primary research method
and so a survey would be done [14].

Data analysis
The quantitative data analysis technique was considered for the present research as it was justified for the collection
and analysis of the data. The selected data analysis method helped in accessing the information in an authentic
manner [14].

Ethical consideration
The present research considered all the ethical considerations aspects while conducting the survey methods. The
research was done following an authentic and valid process of data collection. The participants were well aware of
the topic of the survey and the questions were only topic-related [13]. Moreover, no data or information would be
breached.

Results:-
The number of participants included in the current study is 380. Study participants were asked about onychophagia
as a sign of psychological disorders through a set of questions. Their answers are presented in table 1. It is noticed
from the table that more than half of study participants believe that nail biting is a psychological disorder (n= 219,
58.1%). Furthermore, about two thirds of study participants believe that nail biting is a common disorder among
humans (n= 247, 65%). Most of study participants think that nail biting is curable (n= 296, 77.9%). Daily exercise is
helping in reducing the habit of nail biting as reported by 178 (73.2%). Half of study participants were neutral with
regard to the benefit of psychological treatment to nail biting (n= 184, 48.4%). Vast majority of study participants
believed that exercise is effective for enhancing mental stability (n= 318, 83.7%).

Table 1:- Participants responses to the survey questions.

Item Yes No Neutral
1) Do you feel nail-biting is a psychological disorder? 219 81 87
58.1% 21.3% 20.6%
2) Do you think that taking medicines will help in addressing the issue of 76 225 79
nail-biting? 20% 59.2% 20.8%
3) Is the issue of nail-biting a common disorder in human beings? 247 78 55
65% 20.5% 14.5%
5) Are nail-biting diseases completely curable? 296 19 65
77.9% 5% 17.1%
6) Do you consider that practicing daily exercise will assist in 278 36 66

405
ISSN: 2320-5407 Int. J. Adv. Res. 10(12), 403-409

diminishing the syndrome of nail biting? 73.2% 9.5% 17.4%

9) Do you consider that exercise for Onychophagia is a necessity? 252 64 64
66.4% 16.8% 16.8%
10) Do you feel any recovery or improvement after psychological 162 34 184
treatment for nail-biting issue? 42.6% 8.9% 48.4%
11) Do you think that Exercise will be effective to enhance mental 318 18 44
stability? 83.7% 4.7% 11.6%
12) Do you feel mental stabilization is the only solution for reducing the 232 74 74
issue of nail-biting? 61.1% 19.5% 19.5%

Leading a life with a the disorder or nail biting issue was moderately painful among 165 participants (43.3%). The
degree of pain is showed in figure 1.
180

160 165

140 147

120

100

80

60 68

40

20

0
VERY PAINFUL MODERATED PAINFUL MINIMAL PAIN

Figure 1:- Degree of pain to lead a life with nail biting issue.

Participants were asked about the cost of medication for onychophagia, most of participants responded with
affordable cost (n= 270, 71.1%) (Figure 2).

406
ISSN: 2320-5407 Int. J. Adv. Res. 10(12), 403-409

AFFORDABLE COST 270

MODERATE COST 90

VERY COSTLY 20

0 50 100 150 200 250 300

Figure 2:- Cost of medication treatment for nail biting.

The most frequent symptom of nail biting issue as reported by study participants was moderate span of time (n=
234, 61.6%). The frequent of nail biting issue is presented in figure 3.

15%
24%

Long span of time

Moderate span of time
Minimal span of time
61%

Figure 3:- Frequent symptoms of phobia.

407
ISSN: 2320-5407 Int. J. Adv. Res. 10(12), 403-409

Discussion:-
Typically, children don't start chewing their nails until they're about three or four. The prevalence of NB has been
reported differently 3, and these accounts often conflict with one another. In children and teenagers, NB is more
common than it is in adults [15]. It is not known how many children who display NB behavior are able to break the
cycle and avoid the negative consequences of their condition.Rates of NB have been estimated to be between 20 and
33 percent in children aged 7 to 10 and between 45 and 55 percent in adolescents [16].

The prevalence of NB in Iranian school-aged boys was found to be 20.1% (95% CI: 15.9 to 24.2) and in Iranian
school-aged girls to be 24.4% (95% CI: 20.1 to 28.7), according to a research conducted on a community sample of
Iranian school-aged children. Biting one's nails has been shown to have no correlation with either gender, behavioral
issues, ADD/ADHD, or issues with friends or peers. In addition, 36.8% (95% CI: 22.3 to 44.2) of children with NB
had NB in at least one family member. In another study of American preschoolers aged 3 to 6, researchers found
that NB affected 23% of the population [17]. Nail biting is inversely proportional to age, with less and fewer people
engaging in the behavior as they become older [17]. One in twelve school-aged children in Mangalore, India, have
NB, and it's more common in females than males. In children under the age of 12, 28% of male twins and 26% of
female twins were diagnosed with NB. One in four boys (17.7%) and one in six (15.7%) of girls were found to have
this condition together with finger sucking. 13 Nail biting affects around one-quarter of adult men [18].

Thumb sucking was found to be prevalent at 25.5% and lip biting at 3.0% among 5554 Delhi children aged 5-13
[19].Although there was no correlation between gender and oral habit 15, females were more likely to be thumb
suckers than boys [20].When looking at individuals with temporomandibular joint discomfort and dysfunction, the
prevalence of finger and NB was around 24.1% among those in their 15s.

Because of this, it is advised that anybody experiencing discomfort or problems in their temporomandibular joints be
questioned about their oral habits, including NB. In addition, individuals experiencing discomfort or dysfunction in
the temporomandibular joint (TMJ) should be consulted as part of their treatment plan [21].

The origins of NB remain a contentious topic. Some research has shown a link between NB and behavioral issues
[22] and anxiety [23-24]; however, some researchers disagree. Having anxiety is not a character flaw but a symptom
of the disease in children with NB (20,21) [22]. Verbal aggressiveness is a characteristic shared by those who have
NB. 22 In children who are over the preschool age, oral habits like NB pose a threat to the development of
malocclusion because of their environmental origins [25]. A rise in NB is thought to result from insufficient motor
activity. Recent findings do not support the anxiety hypothesis for NB [25], however it was previously hypothesized
that NB would relieve anxiety or tension. When people bite their nails, it's typically because they're bored or trying
to solve a tough issue. If a nail biter is talking to someone or being punished for their habit, they will stop biting
their nails [26]. Adult smoking and gum chewing are thought to be stand-ins for NB used by children [15].
Differentiating between severe and moderate NB in terms of the foundation for physical and social repercussions,
the severity, the frequency, and the physiological processes seems to be warranted [27].

Conclusion:-
Under recognition of onychophagia as a body-focused repetitive behavior, is common in clinical practice. Nail
biting and picking are not usually the predominant complaints of patients, which makes diagnosing these nail
diseases difficult. Due to the possibility of comorbidity with other psychological illnesses, the diagnosis and
treatment of these nail diseases need a team effort including specialists in other fields. Biters and pickers of nails are
at risk for serious psychological and social problems as a result of their behaviors. There are currently no accepted
therapies for onychophagia. To find successful treatments for either disease, larger clinical studies are required.

References:-
1. Halteh P., Scher R.K., Lipner S.R. Onychophagia: A nail-biting conundrum for physicians. J. Dermatol.
Treat. 2017;28:166–172.
2. Pacan P., Grzesiak M., Reich A., Kantorska-Janiec M., Szepietowski J.C. Onychophagia and onychotillomania:
Prevalence, clinical picture and comorbidities. Acta Derm. Venereol. 2014;94:67–71.
3. Lipner S.R., Scher R.K. Comment on “Psychocutaneous disease: Clinical perspectives” J. Am. Acad.
Dermatol. 2017;77:e141–e142.
4. Gupta M.A., Gupta A.K. Self-induced dermatoses: A great imitator. Clin. Dermatol. 2019;37:268–277.

408
ISSN: 2320-5407 Int. J. Adv. Res. 10(12), 403-409

5. Foster L.G. Nervous habits and stereotyped behaviors in preschool children. J. Am. Acad. Child Adolesc.
Psychiatry. 1998;37:711–717.
6. Ghanizadeh A. Association of nail biting and psychiatric disorders in children and their parents in a
psychiatrically referred sample of children. Child Adolesc. Psychiatry Ment. Health. 2008;2:13.
7. American Psychiatric Association DSM-5 Task Force. Diagnostic and Statistical Manual of Mental Disorders:
DSM-5. 2013. [(accessed on 27October 2022)]. Available
online: http://dsm.psychiatryonline.org/book.aspx?bookid=556
8. Ghanizadeh A., Shekoohi H. Prevalence of nail biting and its association with mental health in a community
sample of children. BMC Res. Notes. 2011;4:116.
9. Winebrake J.P., Grover K., Halteh P., Lipner S.R. Pediatric Onychophagia: A Survey-Based Study of Prevalence,
Etiologies, and Co-Morbidities. Am. J. Clin. Dermatol. 2018;19:887–891.
10. Erdogan H.K., Arslantas D., Atay E., Eyuboglu D., Unsal A., Dagtekin G., Kilinc A. Prevalence of
onychophagia and its relation to stress and quality of life. Acta Derm. Alp. PannonicaAdriat. 2021;30:15–19.
11. Drumond CL, Ramos‐Jorge J, Vieira‐Andrade RG, Paiva SM, Serra‐Negra JM, Ramos‐Jorge ML. Prevalence of
probable sleep bruxism and associated factors in Brazilian schoolchildren. International journal of paediatric
dentistry. 2019 Mar;29(2):221-7.
12. Bano Z, Warraich IA, Naz I, Shahzadi A. Socioeconomic Status, Dependent Personality and Nail Biting
Behavior Among Adults: Evaluation of Structural Relationship. Review of Economics and Development Studies.
2019;5(2):387-96.
13. Ørngreen R, Levinsen K. Workshops as a Research Methodology. Electronic Journal of E-learning.
2017;15(1):70-81.
14. Bairagi V, Munot MV, editors. Research methodology: A practical and scientific approach. CRC Press; 2019 Jan
30.
15. Tanaka OM, Vitral RW, Tanaka GY, et al. Nailbiting, or onychophagia: a special habit. Am J Orthod
Dentofacial Orthop. 2008 Aug;134:305–8.
16. Leme M., Barbosa T., Castelo P., Gavião M.B. Associations between psychological factors and the presence of
deleterious oral habits in children and adolescents. J. Clin. Pediatr. Dent. 2014;38:313–317.
17. Ooki S. Genetic and environmental influences on finger-sucking and nail-biting in Japanese twin children. Twin
Res. Hum. Genet. 2005;8:320–327.
18. Pacan P., Reich A., Grzesiak M., Szepietowski J.C. Onychophagia is associated with impairment of quality of
life. Acta Derm. Venereol. 2014;94:703–706.
19. Williams T.I., Rose R., Chisholm S. What is the function of nail biting: An analog assessment study. Behav.
Res. Ther. 2007;45:989–995.
20. Stewart C., Lipner S.R. Insights into recurrent body-focused repetitive behaviors: Evidenced by New York
Times commenters. Arch. Dermatol. Res. 2020;312:629–634.
21. Shin J.O., Roh D., Son J.H., Shin K., Kim H.S., Ko H.C., Kim B.S., Kim M.B. Onychophagia: Detailed clinical
characteristics. Int. J. Dermatol. 2021;61:331–336.
22. Anolik R.B., Shah K., Rubin A.I. Onychophagia-induced longitudinal melanonychia. Pediatr.
Dermatol. 2012;29:488–489.
23. Baydaş B., Uslu H., Yavuz I., Ceylan I., Dağsuyu I.M. Effect of a chronic nail-biting habit on the oral carriage
of Enterobacteriaceae. Oral Microbiol. Immunol. 2007;22:1–4.
24. Waldman B.A., Frieden I.J. Osteomyelitis caused by nail biting. Pediatr. Dermatol. 1990;7:189–190.
25. Tosti A., Peluso A.M., Bardazzi F., Morelli R., Bassi F. Phalangeal osteomyelitis due to nail biting. Acta Derm.
Venereol. 1994;74:206–207.
26. Szinnai G., Schaad U.B., Heininger U. Multiple herpetic whitlow lesions in a 4-year-old girl: Case report and
review of the literature. Eur. J. Pediatr. 2001;160:528–533.
27. Tosti A., Piraccini B.M. Warts of the nail unit: Surgical and nonsurgical approaches. Dermatol.
Surg. 2001;27:235–239.

409