Occasionally picking at an uneven fingernail or a hangnail isn’t usually a cause for concern, but constantly picking at your nails could indicate underlying stress or an anxiety disorder.
Onychotillomania is the medical term for a nail picking disorder, while nail biting disorder is known among the medical community as onychophagia. Some people might pick at their nails when they feel nervous or stressed, while others do so habitually without realizing it.
While nail picking and biting are often associated with children, these behaviors can extend into adulthood. A doctor can help you understand the causes of frequent nail picking and recommend therapies — and sometimes medications — that can help you break this cycle.
Nail picking and biting may occasionally appear as a coping mechanism. In other instances, these common behaviors may be difficult to control and are done habitually in response to anxiety disorders.
Nail biting, in particular, is especially common. It’s thought to start at some point during childhood, with about
Nail picking or biting aren’t individually recognized disorders by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). However, they may be symptoms of an anxiety disorder. Such habits may also be considered a body-focused repetitive behavior, which can coincide with anxiety.
- compulsively pick your nails out of habit
- continue to bite or pick at your nails despite any resulting injuries
- try to hide your habits out of shame
- repetitively continue with these behaviors
If you struggle with chronic nail picking or biting, you may also be at risk for other types of body-focused repetitive behaviors, including:
- cheek biting
- hair pulling, or trichotillomania
- skin picking disorder, or excoriation
- teeth clenching or grinding, or bruxism
Other symptoms of anxiety
- trouble falling and staying asleep
- irrational fears, or phobias
- constant worry
- concentration difficulties
- muscle tension
Body-focused repetitive behaviors like nail biting and picking may also be symptoms of obsessive-compulsive disorder (OCD). When you engage in these behaviors, you gain pleasure or relief, which then continues the cycle.
As a subtype of anxiety, OCD is known for creating a cycle of obsessions and compulsions to help cope with unwanted thoughts and feelings. It’s also possible to have OCD along with generalized anxiety disorder (GAD).
Other related mental health disorders with nail picking behaviors include:
In some cases, nail picking is the result of a nervous habit. You may be able to break this habit once you’ve identified your triggers. For example, do you notice that you pick your nails in times of stress? Or if you’re hungry or bored? It’s important to shift your focus toward those concerns instead.
However, this can be difficult in the case of an underlying mental health condition. If you suspect your nail picking habits are related to anxiety or OCD, then you may benefit from behavioral treatments from a mental health professional.
Cognitive behavioral therapy (CBT) is a form of psychotherapy typically used for mental health conditions, including anxiety disorders. With the help of a psychotherapist, you can help reframe your thinking patterns and make behavioral modifications. In children, positive reinforcements with rewards may help.
Habit reversal therapy (HRT) is another technique that may help with nail tics. The goal is to replace nail picking or biting with a healthier habit, such as using a stress ball or chewing on gum. The caveat to HRT is that it won’t address any underlying mental health disorders that may be contributing to your nail behaviors.
In some cases, your doctor may prescribe medications to help alleviate symptoms of mental health disorders that interfere with your daily life. These prescription drugs target neurotransmitters in the brain, such as serotonin, dopamine, and noradrenaline.
Possible medications that may help chronic nail biting include:
- high-dose selective serotonin reuptake inhibitors (SSRIs) anti-depressants, with fluoxetine (Prozac) being
the most helpfulfor OCD-related nail tics
- tricyclic antidepressants, such as clomipramine (Anafranil)
- lamotrigine, which is also used in the treatment of bipolar disorder and seizures
- olanzapine (Zyprexa), which is also used to treat bipolar disorder and schizophrenia
- naltrexone (Revia, Vivitrol), a medication typically used in the treatment of alcohol and substance use disorders
Whether you pick or bite your nails out of nervousness or anxiety, you may be able to help break this cycle on your own. Consider trying the following methods:
- Keep your nails manicured. Also, a shorter length may help you resist the urge to bite your nails.
- Consider professional manicures. A nail technician will not only keep your nails at a healthy length, but also treat hangnails, cuticles, and calluses that may be tempting to pick. Also, the thought of ruining a good manicure you spent money on is sometimes enough for some people to stop.
- Use bitter nail polish. For some people, the awful taste of this over-the-counter product can help resist the urge to put their fingers in their mouths. Talk to your child’s pediatrician before using such products on children’s nails.
- Place adhesive bandages over your fingers. This can help protect your nails from further picking and biting, while also allowing your nails to heal from any wounds you might have from previous tics.
- Keep your hands busy. Replace nail picking with another habit whenever you’re faced with the urge. Examples include using a stress ball, going for a short walk, or doing something creative such as writing or crocheting.
- Ask your dentist for help. In some cases, they may be able to apply an oral device onto your teeth to make it impossible to bite your nails.
It’s also important to keep in mind that kicking your nail picking or biting habit is a gradual process. Some experts recommend starting with one set of nails at a time. Once you stop picking and biting for several days, you can move on to another set of nails until you’ve stopped on both hands.
If you’ve tried the tips above and still can’t break the cycle of nail picking, it may be time to see your healthcare provider for help. You should also seek help if your habits have led to injuries to your nails and fingers.
Your primary doctor can also refer you to a mental health professional if they suspect your chronic nail behaviors are related to an underlying anxiety disorder, such as GAD or OCD.
Nail picking may indicate an underlying anxiety disorder, but this habit may also have other health consequences if left untreated. These include:
- permanent damage to your nails and cuticles
- fungal infections of the nails
- skin and bone infections
- possible stomach infections from swallowing nails
- dental problems
- injuries to your mouth
You may also consider seeing a dermatologist if your nails and cuticles become infected or deformed. This type of doctor specializes in conditions of the nails, skin, and hair. See your dentist if you develop mouth injuries or tooth deformities.
The American Psychological Association is a good starting point for researching mental health professionals in your area. You can also search for a talk therapist based on your mental health needs.
Your primary doctor may be able to recommend a psychiatrist, a type of mental health professional who can prescribe and advise you on medications.
You can also call your insurance provider for a list of therapists who are in-network. Be sure to ask about any out-of-pocket costs associated with your plan.
Occasionally picking at your nails isn’t usually a cause for concern, but if you find that nail picking or biting has become habitual, you may need help from your doctor.
A mental health professional can help if you suspect nail picking is related to an anxiety disorder. Some signs include compulsive and repetitive nail biting or picking, despite any resulting injuries.