Index > Vol. 89/2009 > Iss. 3/May > pp. 278-280 > Abstract

Onychophagia as a Spectrum of Obsessive-compulsive Disorder

doi: 10.2340/00015555-0646

Abstract:

Onychophagia can be explained as a kind of a compulsion that may cause destruction of the nails. Habitual nail biting is a common behaviour among children and young adults. By the age of 18 years the frequency of this behaviour decreases, but it may persist in some adults. Nail biting is an under-recognized problem, which may occur on a continuum ranging from mild to severe. Nail biting has received little attention in the psychiatric and dermatological literature. Its position in widely accepted classifications of psychiatric disorders (ICD-10 and DSM-IV) remains unclear. This disorder seems to be related to obsessive-compulsive spectrum disorder. Here, we present three case reports of onychophagia and co-occurring psychopathological symptoms and discuss
the close relationship of onychophagia to obsessive- compulsive spectrum disorder and possible treatment modalities. Psychiatric evaluation of co-occurring psycho pathological symptoms in patients with onychophagia, especially those with chronic, severe or complicated nail biting, may be helpful in making a choice of individual therapy. Serotonin re-uptake inhibitors seem to be the treatment of choice in severe onychophagia.

Authors:

Przemysław Pacan, Magdalena Grzesiak, Adam Reich and Jacek C. Szepietowski

Key words:

onychophagia; nail biting; obsessive-compulsive spectrum disorder.

References

  1. Leung AK, Robson WL. Nailbiting. Clin Pediatr (Phila) 1990; 29: 690–692. Link to article
  2. Gregory LH. Stereotypic movement disorder and disorder of infancy, childhood, or adolescence NOS. in: Kaplan HI, Sadock BJ, editors. Comprehensive textbook of psychiatry. 6th edition. Baltimore: Williams & Wilkins; 1995: p. 2360–2362.
  3. Heaton KW, Mountford RA. Nail-biting in the population and its relationship to irritable bowel syndrome. J R Soc Med 1992; 85: 457.
  4. Lee DY. Chronic nail biting and irreversible shortening of the fingernails. J Eur Acad Dermatol Venereol 2009; 23: 185. Link to article
  5. Baydas B, Uslu H, Yavuz I, Ceylan I, Dagsuyu IM. Effect of a chronic nail-biting habit on the oral carriage of Enterobacteraceae. Oral Microbiol Immunol 2007; 22: 1–4. Link to article
  6. Williams TI, Rose R, Chisholm S. What is the function of nail biting: an analog assessment study. Behav Res Ther 2006; 45: 989–995.
  7. Tosti A, Peluso AM, Bardazzi F, Morelli R, Bassi F. Phalangeal osteomyelitis due to nail biting. Acta Derm Venereol 1994; 74: 206–207.
  8. Bohne A, Keuthen N, Wilhelm S. Pathologic hairpulling, skin picking and nail biting. Ann Clin Psychiatry 2005; 17: 227–232. Link to article
  9. Pu‰ºy‰Ñski S, Wiˆ„rka J. Klasyfikacja zaburze‰Ñ psychicznych i zaburze‰Ñ zachowania w ICD-10. Opisy kliniczne i wskazˆ„wki diagnostyczne. [The ICD-10 Classification of mental and behavioural disorders: Clinical description and diagnostic guidelines.] 1997; 234–238 (in Polish).
  10. American Psychiatry Association. Diagnostic and Statistical Manual of Mental Disorders. 4th edition. Washington DC: American Psychiatric Association Publishing; 1994, p. 118–121.
  11. Penzel F. Skin picking and nail biting: related habits. Western Suffolk Psychological Service, [cited 2008 May 11]. Available from: URL: http://westsuffolkpsych.homestead.com/SkinPicking.html
  12. Hollander E, Benzaquen SD. The obsessive-compulsive spectrum disorder. In: Boer JA, Westenberg HG, editors. Focus on obsessive-compulsive spectrum disorders. Amsterdam: Syn-Thesis Publishers; 1997, p. 33–36.
  13. Koo JY, Smith LL. Obsessive-compulsive disorders in the pediatric dermatology practice. Pediatr Dermatol 1991; 8: 107–113. Link to article
  14. Stein DJ, Hollander E. Dermatology and conditions related to obsessive-compulsive disorder. J Am Acad Dermatol 1992; 26: 237–242.
  15. Joubert CE. Relationship of self-esteem, manifest anxiety, and obsessive-compulsiveness to personal habits. Psychol Rep 1993; 73: 579–583.
  16. Grant JE, Christenson GA. Examination of gender in pathologic grooming behaviors. Psychiatr Q 2007; 78: 259–267. Link to article
  17. Leonard HL, Lenane MC, Swedo SE, Rettew DC, Rapoport JL. A double-blind comparison of clomipramine and desipramine treatment of severe onychophagia (nail biting). Arch Gen Psychiatry 1991; 48: 821–827.
  18. Bloch MH, Landeros-Weisenberger A, Dombrowski P, Kelmendi B, Wegner R, Nudel J, et al. Systematic review: pharmacological and behavioral treatment for trichotillomania. Biol Psychiatry 2007; 62: 839–846. Link to article
  19. Phillips KA, Albertini RS, Siniscalchi JM, Khan A, Robinson M. Effectiveness of pharmacotherapy for body dysmorphic disorder: a chart-review study. J Clin Psychiatry 2001; 62: 721–727.
  20. Arnowitz B. Psychotherapies for compulsive self-injurious behavior. In: Hollander E, Simeon D, editors. Self-injurious behaviours: assessment and treatment. Washington DC, London: American Psychiatric Pub 2001; 97–112.