Onychophagia as a Spectrum of Obsessive-compulsive Disorder

Department of Psychiatry, Wroclaw Medical University, Poland.
Acta Dermato Venereologica (Impact Factor: 4.24). 02/2009; 89(3):278-80. DOI: 10.2340/00015555-0646
Source: PubMed

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.


Available from: Adam Reich, Jun 02, 2015
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    ABSTRACT: Onychophagia is defined as a chronic nail biting behaviour affecting about 20-30% of the general population. However, nail biting seems to be an ignored problem in a daily clinical practice. We have analysed the influence of onychophagia on quality of life (QoL) and stigmatisation level among 339 medical students with and without nail biting. Those with onychophagia demonstrated significantly higher QoL impairment compared to the controls (p < 0.001). Subjects who had been unable to stop nail biting behaviour in the past (p < 0.01) had visible nail abnormalities (p = 0.03), spent more time on nail biting (p = 0.02) and with a higher number of involved fingernails (p = 0.03), demonstrated further impaired QoL. Furthermore, tension before or when trying to resist nail biting (β = 12.5; p < 0.001), suffering due to nail biting (β =12.6; p = 0.001) and nail eating behaviour (β = -7.5; p < 0.01) were independent variables influencing QoL. Patients with onychophagia also demonstrated higher level of stigmatisation (0.6 ± 1.2 vs. 0.2 ± 0.6 points, p < 0.01), although in both groups the stigmatisation level was low.
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