Article

A Preliminary Survey of Rhinotillexomania in an Adolescent Sample

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Abstract

Rhinotillexomania is a recent term coined to describe compulsive nose picking. There is little world literature on nose-picking behavior in the general population. We studied nose-picking behavior in a sample of 200 adolescents from 4 urban schools. Almost the entire sample admitted to nose picking, with a median frequency of 4 times per day; the frequency was > 20 times per day in 7.6% of the sample. Nearly 17% of subjects considered that they had a serious nose-picking problem. Other somatic habits such as nail biting, scratching in a specific spot, or pulling out of hair were also common; 3 or more such behaviors were simultaneously present in 14.2% of the sample, only in males. Occasional nose bleeds complicating nose picking occurred in 25% of subjects. Several interesting findings in specific categories of nose pickers were identified. Nose picking is common in adolescents. It is often associated with other habitual behaviors. Nose picking may merit closer epidemiologic and nosologic scrutiny.

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... Nose-picking is an almost universal practice in adults with 91% of adult respondents to the Rhinotillexomania Questionnaire acknowledging digitalization of the nares as an active and regular behavior [1][2][3][4]. In addition, the average person picks their nose four times a day [1]. ...
... Nose-picking is an almost universal practice in adults with 91% of adult respondents to the Rhinotillexomania Questionnaire acknowledging digitalization of the nares as an active and regular behavior [1][2][3][4]. In addition, the average person picks their nose four times a day [1]. Picking of the nose is often a required and accepted behavior and, if limited, is without serious sequelae, serving to partially empty the nasal passages of obstructing nasal secretions, inhaled debris, and potentially pathogenic organisms. ...
... While most cases of nose-picking represent a benign habit, when the practice is extreme, as in our patient, it can be a manifestation of an underlying condition. Potential causes may include anxiety, dementia, obsessive-compulsive disorder, empty nose syndrome, allergic or non-allergic rhinitis, and/or anatomical defects [1,10,11]. The goal is to identify and address the underlying etiology whenever possible. ...
Article
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Rhinotillexomania, more commonly known as nose-picking, is a body-focused repetitive behavior that involves compulsive picking of the nares. While nose-picking in general is a common and largely unharmful practice worldwide, severe complications from chronic nose-picking do exist. This case highlights a 66-year-old female with a longstanding history of nose-picking and nose blowing who presented to the emergency department with acute delirium and various bodily complaints. She was subsequently admitted multiple times for recurrent sepsis, meningitis, endocarditis, cystitis, and discitis with each culture positive for methicillin-sensitive Staphylococcus aureus (MSSA) with identical antibiotic sensitivities. Further imaging failed to reveal an underlying greater pathology. Intranasal swab revealed identical culture and sensitivity results as previous blood, CSF, and urine cultures and was thus hypothesized to be the source of infection. This case aims to elucidate the harmful effects of nose-picking as well as the importance of prevention, diagnosis, and management.
... These viruses can even travel down the lacrimal (or tear) duct from the eye into the nose [5]. Considerable research has also supported that the main transmission route of the cold is self-innoculation from individuals' fingertips contaminated with the viruses [6], [7], [8], [9], [10], [11], [12], [5]. Thus, decades of research has shown that handwashing remains the best documented method of preventing infection. ...
... There are generally three ways in which infectious diseases spread: airborne, droplet, and contact transmission. However, details on how colds are transmitted have not been clarified yet, but considerable research has supported the finding that self-innoculation [6] from a healthy individual's own fingertips is the main route of transmission [6], [7], [8], [9], [10], [11], [12], [5]. Usually, a person will contaminate his or her fingers and spread the virus by touching his or her own eyes or nose, which gives the virus access to the nasal mucosa. ...
... In their study, to determine how many times people touch their noses, Mark et al. videotaped 10 students working alone in an office for 3 hours and found that they touched their eyes, nose, and lips an average of 16 times an hour [11]. In a study targeting schools in India, Andrade and Srihari studied 200 adolescents in four urban schools and found that almost the entire sample admitted to nose picking roughly four times a day [12]. Viral particles gain access to the epithelium from eyes via the lacrimal duct [5]. ...
Conference Paper
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More than 200 virus strains have been implicated in common colds, thereby thwarting vaccination efforts. However, the most common causes of colds are human rhinoviruses, which infect the epithelial cells of the nasopharynx. Moreover, after decades of research, the best documented method of preventing infection remains to be handwashing. However, stopping people from inadvertently touching or rubbing one’s nose and eyes is difficult, and the effectiveness of preventing such habits has not been validated. Here, we reported the results of a randomized controlled trial (n = 120) performed over 50 days. We examined the effectiveness of using smartwatches equipped with a sensor and a vibration alert, as well as the self-checking of behavior, in preventing subjects from touching their nose or eyes. Participants were randomly assigned to either the smartwatch group or the handwashing group (control). Subjects in the handwashing group were requested to wash their hands after going out, whereas subjects in the smartwatch group were requested to wash their hands and in addition wear a smartwatch that vibrates to remind them not to excessively touch their nose or eyes. The daily frequency of nose and eye touching was also recorded by the smartwatches. The first incidence of an upper respiratory tract infection (URTI) was the primary endpoint. In the smartwatch group, compared with the control group, the incidence of URTIs was significantly lower by 53% (p < 0.05) and was associated with a decrease in the mean frequency of nose or eye touching (p < 0.05).
... Epistaxis secondary to trauma, especially digital trauma, is well established as a common presenting complaint [5]. Compulsive nose picking, termed rhinotillexomania, is a common habit with reported rates of up to 97.5% [6] in adolescents and 91% of adults [7]. Rates of epistaxis secondary to rhinotillexomania in these studies were 25% for adolescents [7] and 18% for adults [6]. ...
... Compulsive nose picking, termed rhinotillexomania, is a common habit with reported rates of up to 97.5% [6] in adolescents and 91% of adults [7]. Rates of epistaxis secondary to rhinotillexomania in these studies were 25% for adolescents [7] and 18% for adults [6]. Jefferson, et al. also reported a coexistence of nail biting, cuticle picking, hair pulling, and scratching of a specific spot in individuals with frequent rhinotillexomania. ...
... Chronic rhinotillexomania is associated with self-mutilation, typically resulting in erosion and/ or perforation of the nasal spectrum, turbinates, ethmoidal sinus, medial orbital wall [8][9][10][11]. The self-reported rate of injuries more serious than a simple bleed ranges from 0.8% to 2% of those with rhinotillexomania [6,7]. ...
... 5 However, it is also suggested that the association between AD and inflammation is bidirectional. 5 Compulsive nose-picking is called "rhinotillexomania". 6 The nasal cavity is lined by mucus which traps dust and foreign particles. When mucus and these particles accumulate and dry, it leads to difficulty breathing and discomfort. ...
... Nose picking is just a response to this discomfort, and this temporary relief of this discomfort leads to unhygienic habits. 6 It is hypothesized that nose picking has a crucial role in accelerating neuroinflammation caused by the entry of bacterial, viral, or fungal pathogens into the brain via the nasal cavity. 4 The olfactory system contains sensory neurons that are projected through the cribriform plate, so the nasal cavity is directly connected to the olfactory bulb present in the anterior cranial fossa. ...
... Digital nasal exploration and hair removal is a benign activity often found at near-universal levels in the general population [1]. Significant portions of the population, primarily adolescents, have been found to engage in this activity up to four times a day [2]. Although taken for granted as an unattractive habit by the common population, it has severe implications, including nasal septum perforation, epistaxis, higher respiratory infection risk, and even underlying anxiety based psychiatric disorders [2][3]. ...
... Significant portions of the population, primarily adolescents, have been found to engage in this activity up to four times a day [2]. Although taken for granted as an unattractive habit by the common population, it has severe implications, including nasal septum perforation, epistaxis, higher respiratory infection risk, and even underlying anxiety based psychiatric disorders [2][3]. When this otherwise benign habit develops to such degrees that it interferes with an individual's social interaction, daily functioning, or physical functions, it is linked to rhinotillexomania, a form of trichotillomania focused on the nasal area [1]. ...
Article
Full-text available
Compulsive nose picking (rhinotillexomania) is a commonly known condition to general practitioners and pediatricians and is often advised against. This case highlights a 29-year-old individual with a prolonged history of intermittent rhinotillexomania who presented with repetitive viral upper respiratory infections. Physical examinations showed an enlarged nasal turbinate unilaterally with an otherwise normal nasal architecture. Further imaging and investigations showed no abnormalities or evidence of greater pathology. It was hypothesized that the patient's rhinotillexomania induced repetitive inflammation and subsequent hyperplasia of the nasal tissue, narrowing the circumference of an external nare. This case highlights the risks of a common but potentially dangerous habit along with its management.
... The act of picking one's nose (i.e. the act of extracting nasal mucus, generally with a finger or an object, by oneself or someone else) or rhinotillexis remains poorly understood and only a few scientific studies have attempted to elucidate the origin and potential relevance of this behaviour. The handful of studies that investigated this behaviour mainly concern survey-based data in psychology showing that people regularly pick their nose (Andrade & Srihari, 2001;Jefferson & Thompson, 1995;Portalatin, 2009;Wertheim et al., 2006). Interestingly, although the studies were conducted in a handful of countries in Western and Indian populations and show that majority of humans in these populations pick their nose rather often, they are often ashamed to admit it (Jefferson & Thompson, 1995). ...
Article
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Nose picking (rhinotillexis) is a common behaviour in humans which remains, however, poorly studied. Several species of primates are known to pick their nose and ingest the nasal mucus suggesting that this behaviour may actually be beneficial and showing it is not restricted to humans. Here, we review relevant literature and online sources, and document the species of primates observed to pick their nose. We also present the first occurrence of this behaviour in a species of strepsirrhine primate (lemurs and relatives) with a unique video showing an aye‐aye picking its nose. While doing so this animal inserts the entire length of its extra‐long, skinny and highly mobile middle finger into the nasal passages and then licks the nasal mucus collected. We further investigate the internal anatomy of the nasal cavity of the aye‐aye in order to understand how it can introduce its entire finger in its nasal cavity and discover that the finger likely descends into the pharynx. We show that this behaviour is present in at least 12 species of primates, most of them also showing great manipulative/tool use skills and may have some associated benefits that need to be further investigated. Further comparative studies examining nose picking and mucophagy in other primate species and vertebrates in general may shed additional light on its evolution and possible functional role.
... Only three studies (Grzesiak et al., 2017;King et al., 1995;Taman, 2017) performed interviews with eyes-on clinician observation, but their findings were either based on convenient samples of college/medical students or used more restrictive DSM-III-R criteria. Some studies adopted random sampling procedures, or alternatively invited the entire population (e.g., the entire student body), (Andrade and Srihari, 2001;Christenson et al., 1991c;Schreiber et al., 2013;Taman, 2017), but the results from those studies were also limited by relatively poor response rates, non-representative populations and/or the use of self-reported answers to questionnaires to determine the presence/absence of TTM. Of note, three substantially larger sized studies (Bezerra et al., 2021;Grant et al., 2020;Maraz et al., 2017), two of which contributed over half of the individuals to the TTM meta-analysis, were based on online surveys, which may be prone to bias. ...
Article
Epidemiological studies have provided varying prevalence estimates of trichotillomania (TTM) and other hair-pulling behaviors. We performed a systematic review and meta-analysis to provide data-driven prevalence estimates of TTM and hair-pulling. PubMed, PsycInfo and Embase were searched on June 2020 (updated in November 2021). Studies reporting the frequency of TTM defined by Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria or hair-pulling behaviors were included. Prevalence data was extracted for both genders, and female-to-male odds ratios (OR) were computed for TTM and any hair-pulling behaviors. Data were pooled through random-effects meta-analyses. Of the 713 records identified through database searches, 30 studies involving 38,526 participants were included. Meta-analyses indicated TTM had a prevalence of 1.14% (95% CI 0.66%, 1.96%), while any hair-pulling behavior had a prevalence of 8.84% (95% CI 6.33%, 12.20%). Meta-analyses demonstrated females were at an increased risk of any hair-pulling when noticeable hair loss was required (OR = 2.23, 95% CI 1.60, 3.10, p < 0.0001), but not of any hair-pulling when noticeable hair loss was not required (OR = 0.90, 95% CI 0.72, 1.64, p = 0.33). Meta-analyses did not indicate female preponderance in TTM (k = 10; N = 22,775; OR = 1.29; 95% CI 0.91, 1.83; I² = 28%, p = 0.15), although there was considerable heterogeneity across studies. This study demonstrates that TTM impacts ∼1% of the population, while general hair-pulling behaviors affects ∼8%, highlighting the significant public health impact of this understudied condition. Additional research should clarify the gender distribution of TTM in epidemiological samples.
... Awake bruxism also seems to be related more to emotional stress and may even be associated with high stress jobs. 19 The prevalence of bruxism is not very well known, as there is not great public awareness of the topic. 20 ...
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Conditions once considered bad habits are now recognized as psychiatric disorders (trichotillomania, onychopagia). We hypothesized that nose picking is another such "habit," a common benign practice in most adults but a time-consuming, socially compromising, or physically harmful condition (rhinotillexomania) in some. We developed the Rhinotillexomania Questionnaire, mailed it to 1000 randomly selected adult residents of Dane County, Wisconsin, and requested anonymous responses. The returned questionnaires were analyzed according to age, sex, marital status, living arrangement, and educational level. Nose picking was characterized according to time involved, level of distress, location, attitudes toward self and others regarding the practice, technique, methods of disposal, reasons, complications, and associated habits and psychiatric disorders. Two hundred fifty-four subjects responded. Ninety-one percent were current nose pickers although only 75% felt "almost everyone does it"; 1.2% picked at least every hour. For 2 subjects (0.8%), nose picking caused moderate to marked interferences with daily functioning. Two subjects spent between 15 and 30 minutes and 1 over 2 hours a day picking their nose. For 2 others, perforation of the nasal septum was a complication. Associated "habits" included picking cuticles (25%), picking at skin (20%), biting fingernails (18%), and pulling out hair (6%). This first population survey of nose picking suggests that it is an almost universal practice in adults but one that should not be considered pathologic for most. For some, however, the condition may meet criteria for a disorder-rhinotillexomania.
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This study explored the incidence of three personal habits and their correlates with popular tensional outlets. The 108 men and 202 women college students estimated how often they bit their fingernails, picked their noses, chewed on pencils or other objects, used specific tobacco products, used specific caffeine products, chewed gum, and exercised. Also, they rated their happiness on a seven-point scale in Likert format. The fingernail-biting incidence observed here was higher than was reported in previous samples of young adults, and more men than women were nail-biters. More men than women admitted to nose-picking; and about 61% of persons of either sex reported being occasional object-chewers. Men were more likely to exercise, use tobacco products, or consume iced tea than were women but were less likely to chew gum. The intercorrelations among the habits were not significant, and they were unrelated to lower self-reports of happiness. Both men and women who were object-chewers reported drinking greater amounts of cola beverages; otherwise, the relationships between these habits and product uses were not significant.
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The quality of life and pharmaco-economic aspects of obsessive-compulsive disorder (OCD) have received relatively little research attention to date. We aimed to gather preliminary data on these in a South African patient sample. A survey of members of the Obsessive-Compulsive Disorder Association of South Africa was undertaken by means of a detailed self-report questionnaire. Results of the survey suggest that OCD causes significant morbidity, leading to clear distress and Interference with academic, occupational, social and family function. Unfortunately, correct diagnosis and appropriate treatment have been delayed in many patients, and the financial costs of such incorrect management are likely to be considerable. Much further work needs to be done by the medical profession and by interested consumers to raise awareness about OCD and to provide information about its management. In South Africa, it is particularly Important to undertake such psycho-education at a primary health care level and to impact on patients of low socio-economic status.
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A 53-year-old woman with a long history of compulsive nose picking (rhinotillexomania) presented with a large, self-inflicted nasal septal perforation and right-sided penetration of the ethmoidal sinus, or "ethmoidectomy."
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Until the 1980s, obsessive-compulsive disorders (OCD) were considered rare and almost impossible to treat, but it is now recognized that they are frequently encountered and can respond to treatment. Many OCD involve the skin and are therefore observed by dermatologists: we call them dermo-OCD (DOCD). However, despite this, there are few reports in the dermatological literature and the majority are by American authors. The aim of this paper is to offer a critical rediscussion of the diagnostic picture of this pathology on the basis of a review of the literature and the clinical observations of the authors. The main difficulties that dermatologists may encounter are described and some therapeutic guidelines are given. A large number of OCD are frequently observed by dermatologists, but not all of them are recognized as DOCD.
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