Is nail-biting a sign of OCD?

If you bite your nails, you’re in good company. Up to 30% of people do it, including as many as 45% of teenagers.

Of course, just because something is common doesn’t mean it’s healthy. Nail biting can harm your teeth, nails and skin—as you’ve likely seen first hand if you’ve ever drawn blood by accident.

Nail biting can be a tough habit to break. People do it for many reasons, like stress and boredom. Sometimes, though, it can be related to a deeper issue like anxiety or obsessive compulsive disorder (OCD). In any case, the habit is treatable, says Tracie Ibrahim, LMFT, CST, Chief Compliance Officer of NOCD, the leading telehealth provider for OCD. Let’s explore why you might have this habit, and what you can do about it.

Why do people bite their nails?

Nail biting typically begins during childhood and carries into adulthood. At any age, it’s often used as a coping mechanism to deal with loneliness, hunger, and nervousness.

Some people also bite their nails without realizing it whenever they’re focused on a task. Others nibble to keep their hands busy when they have nothing better to do. “I’ve treated students who bite their nails in class. That often happens because of boredom,” says Ibrahim. Interestingly, this may be more common for perfectionists, according to research published in the Journal of Behavior Therapy and Experimental Psychiatry..

If you ever noticed a trend of nail biting in your family, that’s not necessarily a coincidence. It may have a genetic element. A study of over 1,000 pairs of twins found that children were much more likely to bite their nails if both of their parents did the same. 

In some cases, nail biting can be a medication side effect. So if a nail biting habit pops up out of the blue and you recently started a new medication, that may be something to discuss with your doctor.

Is nail biting a mental health issue?

By itself, nail biting is a common habit—although not the best habit in the world. But sometimes, it can cross a line and become a mental health issue—more specifically, Body-Focused Repetitive Behavior (BFRB) Disorder. 

As the name suggests, people with this disorder repeatedly perform behaviors involving their bodies, such as nail biting. Often, they do it to relieve feelings of tension and anxiety. The habit can also bring pleasure and gratification. The behavior can come naturally—a person may bite their nails without even thinking about it. 

Signs that your nail biting may be related to BFRB Disorder including if it:

• Causes a lot of distress, or hampers your functioning. It may interfere with hygiene or social situations.  
• Causes damage. For example, you might notice bleeding, swelling, or cracking. Or you might bite your nails down to the quick.
• Is a habit you’ve repeatedly tried to break, or cut back on, but haven’t been able to.

In some cases, nail biting can pop up among people with other disorders. These include attention-deficit/hyperactivity disorder (ADHD), separation anxiety, and tic disorder. BFRB Disorder can also dovetail with OCD.

The relationship between BFRBs and OCD

Obsessive Compulsive Disorder (OCD) involves obsessions and compulsions. Obsessions are intrusive thoughts, images, or urges that cause anxiety or distress. They are often repetitive or persistent. Some examples of obsessions may be unwanted thoughts of harming someone, fear that something may be contaminated, and need for symmetry and order.

Compulsions are behaviors done to try to prevent a feared outcome or relieve the anxiety that comes from obsessions. For example, someone who has an obsession with germs might wash their hands constantly to try to get rid of them. Other people with OCD might repeat words in their head to drive out unwanted thoughts or repeatedly revisit places to make sure nothing is wrong.

People with OCD typically feel compelled to perform compulsions over and over again. This is where BFRB Disorder bears similarities to OCD. People with BFRB Disorder often adopt habits related to their bodies—like nail-biting—to try to relieve tension. The habits can feel compulsive and out of a person’s control. They may struggle to quit even after multiple tries. 

For this reason, the DSM-5 classifies BFRB Disorder as a disorder related to OCD. But while BFRB Disorder is related to OCD, it’s not the same. That’s because BFRB Disorder typically doesn’t involve the obsessions, fears, and intrusive thoughts that often drive people with OCD to perform compulsions.

People with BFRB Disorder often get what’s called a “premonitory urge”—a sudden feeling of tension—and then perform the body-focused habit because it feels good and right. However, this feeling of tension typically isn’t related to a fear or obsession as compulsions often are for people with OCD. For instance, the person generally isn’t biting their nails because they’re afraid that if they don’t, something bad might happen.

Another difference? “Individuals with OCD often feel powerless to control their compulsions and have no desire to engage in such behaviors,” explains Kimberley Quinlan, LMFT, who specializes in OCD, anxiety, and OCD-related disorders. “Conversely, individuals with BFRBs may not enjoy the outcomes of their picking and pulling behaviors, but they find pleasure in the behaviors themselves.”

For a disorder related to OCD, BFRB Disorder doesn’t overlap with OCD as often as you might expect. A 2014 study of 339 people found that participants who chronically bit their nails weren’t any more likely to have OCD than those who didn’t. But some people do have both OCD and BFRB Disorder. People with both conditions tend to have more persistent symptoms for both, according to a 2015 study.

Is nail biting a symptom of OCD?

Ibrahim notes that, since nail biting is often a coping mechanism for anxiety, some people with OCD may bite their nails when they’re anxious about an obsession. They might also bite their nails when they’re bored or hungry, or for any of the many other reasons people in general bite their nails. But that’s not the same as biting their nails as an OCD compulsion, which Ibrahim says is rather rare.

“You almost never see nail biting under the OCD umbrella,” says Ibrahim. But there are exceptions—and she is one of them. For her, it’s a manifestation of “just right” or perfectionism OCD. 

Before treatment, Ibrahim would have trouble focusing at work and daily life whenever she noticed her nails didn’t look perfectly even. She would become obsessed with the way her nails looked and felt, and she felt compelled to bite them to try to even them out. She wasn’t comfortable unless her nails were completely smooth. 

“It can be quite distressing and distracting,” Ibrahim says. But that’s not the only reason she wanted to stop—there are physical risks to the habit, as well, whether it’s caused by OCD or not.

Risks of chronic nail biting

Nail biting can seem harmless, but if you do it regularly, it poses several risks. First off, it can introduce germs into your mouth. This can increase your chance of catching the common cold, stomach virus, and other diseases. It can also give you bad breath and increase your risk of gum disease. You may also ingest toxic chemicals if you wear nail polish.

When done chronically, biting your nails can cause your teeth to crack or chip. It erodes your teeth, and it can contribute to teeth grinding. This will erode your teeth even further and could lead to headaches, soreness, and TMJ. The force of chronically biting your nails can also move your teeth over time, which may lead to misalignment and crowding. 

Of course, nail biting can also damage your nails and the skin around it. “Sometimes you start biting your nails and the next thing you know, your nails are ripping off,” says Ibrahim.

Nail biting can lead to hangnails, which are torn pieces of skin. Germs can enter the damaged skin and lead to infections. For example, human papillomavirus (HPV) can enter and cause warts that may spread between the fingers and the mouth.

A more common infection is paronychia. This infection can cause pain, swelling, redness, and abscesses (pus-filled pockets). If paronychia is severe and chronic, it can break down your cuticles and eventually cause your nail to become deformed or separate from your skin.

Whether you get an infection or not, chronic nail biting can shorten and thin your nails permanently. It can also damage the cuticles, which can cause your nails to grow abnormally.

In most cases, nail biting doesn’t lead to permanent damage. But the risks of nail biting definitely outweigh the benefits, which makes management and treatment all the more important.

How do I stop nail biting?

Here are some ways to reduce your urge to bite your nails:

• Think about the benefits of not biting your nails: For one of Ibrahim’s young patients, the thought of being able to get her nails done and wear cute sandals was enough to motivate her to quit biting her toenails. “In a short time, we were able to accomplish that goal,” says Ibrahim. “She proudly went to school with her new sandals and polished nails and it was a win for everybody.”
• Trim your nails short: Having shorter nails means there’s less nail to bite. This can make biting your nails less tempting.
• Use bitter-tasting nail polish: You’ll be a lot less likely to bite your nails if you’re met with a disgusting taste every time you do.
• Use barriers: Try covering your nails with stickers, tape, or gloves so that your mouth can’t get to them.
• Do your nails: If your nails look great, you may feel inclined to leave them alone—as was the case for another one of Ibrahim’s patients.
• Identify your triggers: What situations make you more likely to bite your nails? Does it happen when you’re bored, stressed, or see a hangnail? Knowing your triggers can help you avoid them—or at least help you prepare for them.
• Replace nail biting with a better habit: When you get the urge to bite your nails, do something else with your hands instead, like squeezing a stress ball.

Some experts recommend cutting back on your nail biting gradually. For example, you might stop biting your thumb nails first, before you stop biting your pinky nails. This can help you build confidence as you start biting fewer of your nails, until you eventually stop completely.

The above strategies help many people kick their nail biting habit to the curb. But for some people, these tools are not enough. If this is true for you, you may need the support of a healthcare provider. 

When should I go to a healthcare provider for nail biting?

Sometimes, people need to see a healthcare provider to address the physical effects of nail biting. It may be a good idea to see a doctor if you develop symptoms of infection (like swelling, pain, and bleeding) or have recurring problems with your nails, such as:

• Discoloration 
• Ingrown nails
• Nails separating from your skin

There are also cases in which nail biters may benefit from consulting a mental health professional. This can help you find and address the root cause of why you’re biting your nails. Here are some signs you may want to consider seeing a mental health professional:

• You can’t help but bite your nails after repeatedly trying to quit.
• The habit interferes with your life or brings severe distress.

Professional treatment for nail biting

Severe cases of chronic nail biting may be treated with medication such as SSRIs. More often, though, chronic nail biting is treated with cognitive behavioral therapy (CBT), which aims to change your thoughts and behaviors.

One form of CBT is Acceptance and Commitment Therapy (ACT) which teaches you to accept and observe your urges. While you don’t act on them, you don’t try to avoid the urges, either. ACT might boost the effectiveness of other treatments for chronic nail biting.   

When nail biting is a compulsion caused by OCD, it’s typically treated with a form of CBT called Exposure and Response Prevention (ERP). ERP involves gradually facing your fears and obsessions, and resisting the temptation to do compulsions. Over time, this makes the urge less powerful.

For Ibrahim, ERP has involved purposely trimming her nails to make them uneven and resisting the urge to bite them. She’s still not entirely comfortable when her nails are uneven, but her urges have become quieter the less she listens to them. This has allowed her to regain time and focus in her everyday life, no longer distracted by constant urges to bite her nails. And she no longer has to deal with the physical damage that the habit brings. 

However, chronic nail biting is only rarely the result of OCD. More often, it is a sign of BFRB Disorder. If you believe you have BFRB Disorder, you should get in touch with a specialist who knows how to treat BFRBs.

The typical treatment for this disorder is Habit Reversal Training (HRT) which is made up of three components. HRT puts into motion some of the tips we’ve already gone over—all with the support of a mental health professional: 

Awareness training: This involves developing a greater awareness of your behavior: what the experience is like, how often you do it, and the warning signs. For example, you might notice you always bite your nails when you’re sitting and scrolling on your phone, or laying in bed at night before falling asleep. Or you might rate your emotions before or during episodes, and realize you tend to bite your nails when you’re stressed. 

Competing response training: This involves replacing your habit with a less harmful one. So if you get an urge, “you have a competing response to shut it down,” explains Ibrahim. For example, you might clasp your hands every time you feel the urge to bite your nails, and continue until the urge passes. Other ideas include:

• Fiddling with an object with a unique texture (like a pen or nail file)
• Squeezing a stress ball
• Knitting
• Sitting on your hands

Some people purposely place themselves in situations where they may feel tempted to bite their nails, and perform their new habit instead. This may help ingrain the new habit.

Another common strategy is overcorrection. When people catch themselves biting their nails, they estimate how long they were doing it, and perform their new habit for twice as long. This can help reinforce the new habit as the dominant one.

Social support: This enlists the support of loved ones and others to help the patient remain accountable. For instance, a child with a nail biting BFRB may use a parent for social support, working together to stay on track.

The parent may root for them when they avoid biting their nails. And when the child does bite their nails, the parent will gently remind them to perform their new habit instead. A social support person does not police behavior, but offers accountability and support in a loving, positive way. 

If you’re trying to find treatment for chronic nail biting, you may be pleased to learn that NOCD offers treatment for not only OCD, but disorders related to OCD, as well. This includes BFRB Disorders. Of course, NOCD therapists are also trained in ERP, the gold standard treatment for OCD, which can benefit people whose nail biting is an OCD compulsion. We encourage you to learn about NOCD’s accessible, evidence-based approach to treatment if you think you may have OCD or a related disorder like BFRB.