Onychophagia as a Spectrum of Obsessive-compulsive Disorder

Department of Psychiatry, Wroclaw Medical University, Poland.
Acta Dermato Venereologica (Impact Factor: 3.03). 02/2009; 89(3):278-80. DOI: 10.2340/00015555-0646
Source: PubMed


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.

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    • "Pathological nail-biting is a common impulse control disorder which nonetheless has received little attention in the medical and psychological literature (Pacan et al., 2009). In the present study, we tried DC, an intervention that may be regarded as a hybrid of competitive response treatment (Azrin & Nunn, 1973) and association splitting (Moritz, Jelinek, Klinge, & Naber, 2007). "
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    ABSTRACT: Nail-biting is currently classified as an impulse control disorder not otherwise specified. Although seldom targeted as a primary symptom, nail-biting is often associated with somatic complications and decreased quality of life. The present study assessed the effectiveness of an innovative self-help technique, titled decoupling (DC). DC aims at attenuating pathological nail-biting by performing motor sequences that decouple and rearrange the behavioral elements involved in the habit. A total of 72 participants with excessive nail-biting were recruited via specialized self-help forums and were randomized to either DC or progressive muscle relaxation (PMR) groups after baseline assessment. Four weeks later, participants underwent a similar assessment as before and were asked to rate the effectiveness of the intervention. The primary outcome parameter was the Massachusetts General Hospital Scale (MGH) adapted. Relative to the PMR group, the DC group showed significant progress in withstanding the urge to bite their nails. Furthermore, they appraised the appearance of their nails as considerably less compromised at the end of the treatment relative to participants undergoing PMR. At statistical trend level, the DC group showed a significantly greater decline on the adapted MGH relative to PMR. Despite methodological limitations, the present study asserts that the effectiveness of DC, previously shown for trichotillomania, extends to nail-biting.
    Behavior modification 06/2011; 35(5):468-85. DOI:10.1177/0145445511409395 · 2.23 Impact Factor
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    • "Another study reported that 70% of individuals with hair-pulling habit had other stereotypic behaviors, of which skin-picking and nail-biting were the most common ones.27 Individuals with NB have higher obsessive compulsive behaviors.2,18 Fifty six out of 509 individuals with obsessive compulsive disorder had NB.28 "
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    ABSTRACT: Nail biting (NB) is a common, but unresolved, problem in psychiatry, psychology, medicine and dentistry. While it seems that NB is a simple behavior that can be stopped easily, many of the children with NB have already tried to stop it, but they have not been successful. The frustrations due to failed attempt involve others such as parents and siblings. The present review aims at providing an overview of prevalence, co-morbidities, education and counseling, and management for NB. Overall, the reviewed literatures suggest that co-morbidities of psychiatric disorders and other stereotypic behaviors in clinical sample of children with NB is more than 80%, and more than half of the parents suffer from psychiatric disorders mainly depression. Treatment of NB, however, is not as easy as it seems. The management of NB is much more complicated than just focusing on stopping it. Nail biting cannot be managed without considering its co-morbidities, antecedents and consequences. It might be concluded form the reviewed literature that children with NB, parents, siblings, and teachers should be educated about what to do and what not to do about NB. Punishment is not effective. Moreover, clinical randomized controlled trials are required to make available evidence-based behavioral and pharmacologic treatment protocols.
    Iranian Journal of Medical Sciences 06/2011; 36(2):73-9.
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    • "It is possible that both of them are secondary to a common factor. Moreover, NB is a common co-existing problem in many psychiatric disorders [10,21,22] and these co-morbidities may be an explanation for the higher rate of emotional problems in children with NB. Another possible explanation for the higher rate of emotional problems in children with NB may be due to the consequences of NB. "
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    ABSTRACT: This study evaluates onychophagia or nail biting (NB) prevalence and association with mental health of a community sample of children from Shiraz, Iran. The parents of 743 primary school children, selected by random sampling, reported NB behavior of their children and themselves. Children's mental health problem was assessed using the Strengths and Difficulties Questionnaire (SDQ). 22.3% (95% CI: 19.3 to 25.3) of children had NB behavior in the last three months (girls: 20.1% (95% CI: 15.9 to 24.2). The rate in boys was 24.4% (95% CI: 20.1 to 28.7). 36.8% of the children with NB had at least one family member with nail biting. Older age was associated with a higher prevalence of NB while a higher score on the prosocial score was associated with a lower prevalence of NB. NB is a very common behavior in both genders in children and their family members. Children with NB have less prosocial ability than those without it.
    BMC Research Notes 04/2011; 4:116. DOI:10.1186/1756-0500-4-116
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