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Prevalence of nail biting and its association with mental health in a community sample of children

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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.
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SHOR T REPOR T Open Access
Prevalence of nail biting and its association with
mental health in a community sample of children
Ahmad Ghanizadeh
1,2*
and Hajar Shekoohi
1
Abstract
Background: This study evaluates onychophagia or nail biting (NB) prevalence and association with mental health
of a community sample of children from Shiraz, Iran.
Findings: The parents of 743 primary school children, selected by random sampling, reported NB behavior of their
children and themselves. Childrens 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.
Conclusions: 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.
Findings
Nail biting (NB) or onychophagia is a common but
unresolved medical problem in children [1]. A study on
248 girls aged 15-16 years reported the rate of 25.5%
[2]. Another study on 385 school children aged 12-16
years using a questionnaire reported the rate of 29%[3].
Its incidence in the ages of 4-6 years is more than ear-
lier ages. Its rate increases in adolescence while it
declines in later ages [1]. NB is not gender dependent in
children less than 10 years but its incidence in boys is
more than girls in adolescents [1].
NB may induce complications such as malocclusion of
the anterior teeth [1], teeth root resorption [4], intestinal
parasitic infections [5], change of oral carriage of entero-
bacteriaceae [6], bacterial infection, and alveolar destruc-
tion [1]. Moreover, about one forth of patients with
temporo-mandibular joint pain and dysfunction have
nail biting habit [7].
Given that the treatment of nail biting is not easy.
Many of children with NB and their parents have
already tried to stop it but they were not successful.
Mayparentsmaypunishorridiculeorevenpressure
the children to stop it. But these attempts are not
usually effective in long term. Probably, the studying of
associated factors to NB helps us for planning more
effective managements [8].
At least, in clinical samples, NB reflects underlying emo-
tional disorders [9]. A study on clinical sample of children
showed that boys with NB suffer from at least one of the
psychiatric disorders more than girls that most likely were
attention deficit hyperactivity disorder (ADHD) 0.6%,
oppositional defiant disorder 36%, and separation anxiety
disorder 20.6%. The presence of psychiatric disorders is
not associated with the age of onset, the frequency of NB,
and the existence of physical damage [9]. NB is one of the
most common behavioral problems (228.6%) in children
and adolescents with Tourette syndrome [10]. Its rate in
children with ADHD is about 40.0% [11,12]. 14.3% of
children with alopecia areata suffer from NB [13]. It is sug-
gested that NB as a behavioral sensory processing problem
may help us for a better pharmacological management of
children with ADHD [14].
Moreover, more than half of parents of children with
NB have at least one psychiatric disorder most likely it
is major depression [9]. However, that study mentioned
that their sample was not typical of children with NB in
the general population. It recommended that future stu-
dies including community samples should be conducted.
* Correspondence: ghanizad@sina.tums.ac.ir
1
Research Center for Psychiatry and Behavioral Sciences, Hafez Hospital,
Shiraz, Iran
Full list of author information is available at the end of the article
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© 2011 Ghanizad eh et al; licensee BioMed Ce ntral Ltd. This is an open access article distributed under the terms of the Creati ve
Commons Attri bution License (http://creativecommons.org /licenses/by/2.0), which permits unrestricted use, distribution, and
reproductio n in any medium, provided the original work is properly cited.
The current cross-sectional study aimed to survey pre-
valence of nail biting in school aged children. The inves-
tigation of possible associating of NB with emotional
and behavioral problems is another aim of this study.
Materials and methods
The participants of this study are the parents of one
thousand school children selected by randomized cluster
sampling. 743 completed questionnaires were returned
by the parents. 358(48.2%) were boys and 385 were girls.
The parents reported their childrensnailbitingbeha-
vior and his/her emotional and behavioral problems.
Parents reported the numbers of days per week whereby
the children bite their nail [9]. Parents were also ques-
tioned whether there is anybody else with nail biting
behavior in their family.
Strengths and Difficulties Questionnaire (SDQ)
The Strengths and Difficulties Questionnaire (SDQ) is a
research tool with adequate validity and reliability. It is
consisted of 25 items including five clinical scales:
hyperactivity/inattention, emotional symptoms, conduct
problems, peer relationship problems, and prosocial
behavior. Each of the clinical scales has 5 items.
Response to each item can range from 0 to 2. Zero was
for not true,1forsomewhat true’’,and2for
certainly true. Positive items are reverse coded except
for prosocial scale. So, the score of each clinical scale
can range from 0 to 10. Summing the scores from the
scales of hyperactivity/inattention, emotional symptoms,
conduct problems, and peer relationship problems gen-
erates a total difficulties score. The resultant score can
range from 0 to 40. Therefore, the prosocial scale is not
included for generating of total score. The parent ver-
sion of SDQ was used here. The psychometric proper-
ties of its Farsi version has been studied before [15].
SDQ takes about 5 to 10 minutes to be completed by
parents. Its scoring system is clear and straightforward.
Contrary to the other subscales of SDQ, higher score of
prosocial subscale indicates a better condition. SDQ is a
valuable brief screening instrument for the adjustment
and psychopathology of children [16,17]. The SDQ, its
Farsi language translation, scoring information, and pub-
licationslistcanberetrievedfromtheWebsiteof
http://www.sdqinfo.com.
Eight primary schools in the different geographic loca-
tions in the city of Shiraz, southern of Iran, were
selected by stratified random sampling method. All of
the principals of the schools agreed for participation in
the study after they were informed. They permitted us
to contact the parents. The questionnaire was delivered
to the parent by the students and then they completed
and returned back. Information about the aim of this
study was provided to the children and their parents.
Participation in this study was voluntary. The Good
Clinical Practice Guidelines, in accordance with the
Declaration of Helsinki, 1975, as revised in 2000 was
considered for conducting of this study. Parental con-
sent was provided by the parents of the children
involved in the study. This study was approved by Ethics
Committee of Shiraz University of Medical Sciences.
Statistical analysis
Statistical analysis was conducted using SPSS statistical
package. The frequency of nail biting by children and
their family members were analyzed for boys and girls.
t-test was used to compare the mean age of boys and
girls. Chi-Square test was used to study the association
of nail biting behavior and gender.
Logistic regression analysis was conducted to examine
association of the predictable factors and nail biting.
Nail biting was considered as a categorical variable. The
response categories of neverand I days per week
was coded as zero and all other categories (i.e. >= 2
days per week) were coded as 1. The variables of age,
parental educational level, rank of birth, prosocial score,
emotional score, hyperactivity/inattention score, conduct
problem score, and peer problem score were considered
as independent factors. The educational levels of parents
were considered as continues variables.
Results
The mean age of the sample was 8.2(SD = 0.8) years
withtheagerangeof7to10years.Themeanageof
boys and girls was not different (t = 1.1, df = 741, P =
0.2). 358(48.25) of the sample were boys. 41.0% of the
children were the first child of their family. 28.4% were
the second child of family. 21.7% of the whole sample
was the only child. 38.4% had at least one brother or
sister.
The rate of nail biting in boys and girls was 20.1%
(95% confidence interval 15.9 to 24.2) and 24.4% (95%
confidence interval 20.1 to 28.7), respectively. The rate
of nail biting was not statistically different between boys
and girls (X2 = 1.98, df = 1, P = 0.1) (Table 1).
577(77.7%) of the parents reported that their children
have not habitually bitted nail in the last three months.
5.0% reported that their child frequently (more than
3 days per week) bitted his/her nail in the last three
months. The rate for children with 2-3 days and 1 day
were 7.1% and 10.2%, respectively. So, 22.3% of the sam-
ple had the habit of nail biting with frequency of at least
a day in week in the last three months. Out of the 166
children with nail biting, 45.8% of them bitted it 1 day
per week. The frequency of nail biting per day is indi-
cated in Table 2.
36.8% (95% CI: 22.3 to 44.2) of the children with nail
biting had at least one family member with nail biting.
Ghanizadeh and Shekoohi BMC Research Notes 2011, 4:116
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22.9% of children with nail biting have at least one
brother or sister with nail biting (Table 3). The parents
of 13.2% of children with nail biting habitually bite their
nail (Table 3). From 93 children with NB who has at
least one sibling, 31(33.3%) had a sibling with NB.
Totally, 53(55.8%) of children with NB who has at least
one sibling, at least one of their siblings or parents bite
his/her nail frequently (Table 4).
Table 5 indicates the mean scores of different domains
of parent reported SDQ for children with NB and those
without NB. It displays that the scores of prosocial
behavior score, emotional score and conduct score are
significantly different between children with and those
without nail biting. Prosocial behavior score in children
with nail biting is less than that those counterparts with-
out nail biting. Emotional problem score and conduct
problem score of children with nail biting are more than
that of those children without nail biting.
Logistic regression analysis indicated that the factors
of age of children and prosocial score have a statistically
significant association with nail biting frequency in chil-
dren. None of the parental educational level, gender,
rank of birth, hyperactivity/inattention score, conduct
problem score, and peer problem score significantly pre-
dicts nail biting frequency in children. There was a
marked trend for the association of emotional problems
and nail biting (Table 6).
Discussion
The most striking findings of our study are that emo-
tional and behavioral problems are more common in
children with nail biting than those without nail biting.
More than one fifth of children have this habit. In addi-
tion, our results added to literature that NB has a family
pattern. There was not a significant association between
nail biting and emotional problems, however, children
with NB have higher rates of emotional problems than
children without NB. In addition, the prosocial behavior
of children with NB is weaker than that of those without
NB. This behavior is age dependent but it is not gender
related.
Nail-biting allows children relieve their anxiety, loneli-
ness, and deprivation of safety feeling and love [18].
However, there is a controversy about the association of
anxiety, stress and NB [19,20]. In the current study, emo-
tional problems are higher in those with NB. It should be
noticed that emotional problems are not equal to anxiety.
In addition, possible cause and effect of anxiety and NB
has not already been reported. Meanwhile, 20% of clinical
sample of children with NB had separation anxiety disor-
der [9]. 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. Social and family pressure for
stopping this behavior may induce or increase emotional
problems of these children. Maybe these children will
experience higher level of emotional problems in later
ages.
Children with NB especially boys had lower score of
prosocial behavior score. This scale indicates social rela-
tionship ability. So, the lower score of prosocial behavior
score is related to lower ability. This lower ability may
be another explanation for higher emotional problems
in children with NB.
The mean score for conduct problem in children
with NB was more than that of those without NB. But
Table 1 Frequency of parent reported nail biting
Frequency Boys Girls Total Significancy
Number Percent Number Percent Number Percent
Always (4 days or more per week) 18 5.0 19 4.9 37 5.0% X
2
= 2.6, df = 3, P = 0.4
sometimes (2-3 days per week) 21 5.9 32 8.3 53 7.1%
Rare (1 day per week) 33 9.2 43 11.2 76 10.2%
Never 286 79.9 291 75.6 577 77.7%
Table 2 The frequency of nail biting per day
Times per day Frequency Percent
1 to 2 97 58.4
3 to 4 34 20.5
5 to 6 8 4.8
More than 6 12 7.2
Total 151 91.0
The discrepancy between total number and the number of children with nail
biting is due to missing data.
Table 3 The frequency of nail biting in the siblings or
parents of children with nail biting
Family member Frequency Percent
Sister 17 10.2
Brother 21 12.7
Father 8 4.8
Mother 14 8.4
Nobody 103 62.0
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after considering the covariant factors, conduct pro-
blems score did not predicted nail biting behavior. The
association of NB and aggression has been reported
before [23]. However, they did not include covariant
factor.
Thepresentstudyassomepreviousstudyhasshown
that the prevalence of parent reported NB is not gender
associated [1]. It is clear that this study is a cross sec-
tional study and it investigates the association of NB
and childrens emotional and behavioral problems.
There are several research and clinical implications for
these findings. The research implication is that the com-
mon behavior of nail biting should be studies more,
although research and evidence on nail biting etiology
and its associations are becoming more available. One of
the clinical implications is that nail biting occurs fre-
quently in other members of family. So, the questioning
about nail biting in children and students can be consid-
ered as a screening question. Positive response may indi-
cate high probability for happening in other members of
family. So, child psychiatric nurses and school nurses
should be very careful about this behavior. They should
evaluate children with nail biting for screening of emo-
tional problems and less developed prosocial behaviors.
Another clinical implication is that the other family
members of children with nail biting should be evaluated
and screened for nail biting. Psychological evaluations
should not be limited on the children. So, it seems that
nail biting should not be considered as a simple habit.
There are many consequences for nail biting that should
be considered. For example, these children may require
to be referred for dentistry assessment. Our finding has
an important clinical implication for management of
these children. Habit reversal which is usually used for
their management is not effective in long term in many
cases. An explanation for this failure can be due to lack
of consideration of co-occurring emotional and beha-
vioral problems.
In conclusion, nail biting is a very common, age
dependent, but not gender related behavior in school
age children. NB is associated with lower prosocial skills
in the community sample of children.
Table 4 The prevalence of nail biting in family members
of children with NB who has at last one sibling (n = 93)
Family member Frequency Percent
Sister 14 14.7
Brother 17 17.9
Father 2 2.1
Mother 7 7.4
Total 53 55.8
Table 5 The comparison of the mean score of different domains of parent reported SDQ between children with nail
biting (> = 1 day per week) and that of those without nail biting
Scale Nail biting Mean Standard Deviation 95% Confidence Interval for Mean
Lower Bound Upper Bound
Prosocial behavior score Without 8.15 1.6 8.0 8.3
With 7.6 2.0 7.2 7.9
Hyperactivity/inattentiveness scale Without 5.5 1.6 5.4 5.7
With 5.8 1.7 5.5 6.0
emotional problem score Without 3.7 1.8 3.5 3.8
With 4.3 2.1 4.0 4.6
Conduct problem Score Without 2.9 1.4 2.8 3.0
With 3.2 1.4 3.0 3.4
Peer problem score Without 4.9 1.5 4.8 5.1
With 5.1 1.6 4.8 5.4
Total score Without 15.9 4.7 15.4 16.4
With 17.3 4.6 16.5 18.1
Table 6 Logistic regression analysis for the predictors of
parent-reported frequency of nail biting in children
Odds
ratio
95% C.I. Significance
Lower Upper
Age 1.5 1.12 2.07 .006
Gender 1.4 .81 2.44 .22
Rank of birth .8 .65 1.17 .36
Mothers educational level 1.0 .90 1.13 .77
Fathers educational level 1.0 .99 1.19 .07
Prosocial behavior score .8 .75 .99 .044
Hyperactivity/inattention
scale
.9 .83 1.15 .81
emotional problem score 1.1 .98 1.32 .07
Conduct problem Score 1.1 .95 1.39 .14
Peer problem score 1.0 .85 1.20 .87
Ghanizadeh and Shekoohi BMC Research Notes 2011, 4:116
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Acknowledgements
This study was supported in part by Vice Chancellor for Research of Shiraz
University of Medical Science. There is no conflict of interest or financial or
other funding sources from each author to be declared.
Author details
1
Research Center for Psychiatry and Behavioral Sciences, Hafez Hospital,
Shiraz, Iran.
2
Department of Psychiatry, Shiraz University of Medical Sciences,
Hafez Hospital, Shiraz, Iran.
Authorscontributions
AG: Research project conception and organization. Statistical analysis design,
execution, review and critique. Writing the first draft and review and critique
of the manuscript. HS: Research project organization and execution.
Statistical analysis execution. Writing the first draft and review and critique of
the manuscript. All authors read and approved the final manuscript.
Competing interests
The authors declare that they have no competing interests.
Received: 28 February 2011 Accepted: 11 April 2011
Published: 11 April 2011
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doi:10.1186/1756-0500-4-116
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... 10,14,19 However, a lower mean age of 9.4 ± 3.3 was reported among Iranian nail biters. 20 In the our study it was found that the nail biting habit was more among boys than girls which is in accordance with other Indian studies. 14,21 This is contrary to Ghanizadeh and Shekoohi who found that nail biting habit was more among girls. ...
... 14,21 This is contrary to Ghanizadeh and Shekoohi who found that nail biting habit was more among girls. 20 The present study reported the highest mean score in distress (2.44 ± 1.6), followed by attempt to resist nail biting (2.08 ± 1.6), and control over nail biting (2.06 ± 1.2), with an overall mean score of 13.5 ± 7.3 obtained from a questionnaire (MGH-NBQ) evaluating nail biting habits. Previous studies discovered similar nail-biting behaviours. ...
... Presence of Enterobacteriaceae among school going nail-biting students Similar to this study, discovered that prosocial behaviour was significantly weak. 20 Other studies have linked aggression to the nail biting. 3,11,24 These and other studies have found that children who bite their nails are stressed, lonely, and lack affection, and that this behaviour may be indicative of underlying psychopathology. ...
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Background: Onychophagia, commonly known as nail biting, is considered a compulsive behavioral disorder primarily observed in children and adolescents. Nail biting behavior leads to an increased presence of various opportunistic microorganisms in the oral cavity. This study aimed to investigate the association between nail biting and mental health in children aged 10 to 16 years. It further compares the load of Enterobacteriaceae in nail-biters and non-nail biters. Methods: A case control study was conducted on 50 nail biters (cases) and 50 non-nail biters (controls). Data were collected by using convenient sampling technique from school going students aged 10 to 16 years, using pre-designed and self-administered questionnaires, the Massachusetts General Hospital-Nail Biting Questionnaire (MGH-NBQ) and the Strengths and Difficulties Questionnaire (SDQ) as well as saliva samples taken and tested for bacterial growth. All ethical issues were taken into consideration. SPSS v23 was used to analyze the data using descriptive statistics to calculate the mean and standard deviation. The independent t test was used to compare mean SDQ scores between nail biters and non-nail biters. P-values<0.05 were considered statistically significant. Results: Among the 50 cases, 44 (88.0%) of the students had positive Enterobacteriaceae growth, while 13 (26.0%) of the controls did not. Nail biters had considerably higher mean scores for emotional symptoms, conduct problems, hyperactivity, and peer problems than non-nail biters (P value<0.001). All of the SDQ domains and nail biting were found to have a statistically significant (P=0.05) association. Conclusion: The study highlights the persistent and burdensome nature of nail biting, which poses risks in terms of disease transmission. Additionally, nail biting has been associated with various behavioural and emotional disorders. Awareness of the harmful consequences of nail biting, along with appropriate preventive and treatment approaches, can assist young individuals in discontinuing this habit.
... Several studies investigating onychophagia have shown an association with other coexisting psychiatric conditions [6,[8][9][10]. In a study of 63 nail biters, ages 5 to 18 years, who were referred to a child and adolescent mental health clinic, attention deficit hyperactive disorder (74.6%), oppositional defiant disorder (36%), separation anxiety disorder (20.6%), enuresis (15.6%), tic disorder (12.7%), and OCD (11.1%) were the most common conditions associated with onychophagia [6]. ...
... A total of 166 (22.3%) nail biters were identified and their scores were compared to those of non-biters. Nail biters, on average, had significantly higher emotional symptom (4.3) and conduct problem scores (3.2) and lower prosocial behavior scores (7.6) compared to those of non-biters (3.7, 2.9, and 8.15, respectively) [8]. ...
... One survey-based study of 281 participants at an outpatient pediatric clinic, ages 3 to 21, reported that a majority (63%) of nail-biting patients had at least one family member with onychophagia [9]. Similarly, the previously mentioned survey-based study analyzing mental health and nail-biting habits in 743 children reported that 55.8% of nail biters with one or more siblings had at least one sibling or parent who bit their nails frequently [8]. ...
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Onychophagia (nail biting) and onychotillomania (nail picking) are chronic nail conditions categorized as body-focused repetitive behavior (BFRB) disorders. Due to a limited awareness of their clinical presentations, embarrassment on the part of patients, and/or comorbid psychiatric conditions, these conditions are frequently underrecognized and misdiagnosed. This article reviews the prevalence, etiology, diagnostic criteria, historical and physical exam findings, and treatment options for these conditions. The PubMed/MEDLINE database was searched for relevant articles. Onychophagia and onychotillomania are complex disorders necessitating a detailed patient history and physical examination and a multidisciplinary treatment approach for successful diagnosis and management. Due to the dearth of clinical trials for treatment of nail biting and nail picking, large clinical trials are necessary to establish standardized therapies.
... It is a crucial tool for completing clinical examinations when evaluating a number of nail diseases, including nail pigmentations and infectious, inflammatory, and 1 2 1 1 1 1 traumatic nail disorders. A video dermoscope, which provides magnifications of up to 200 times, or a portable dermoscope can be used for dermoscopic examination [5,6]. ...
... Although there are several studies investigating the nail findings with the naked eye or histopathologically in children with nail disorders, studies with dermoscopy are limited [5,7]. Besides, visualizing nail findings using a dermatoscope that improves the clinicians' diagnostic accuracy significantly enhances results in comparison to examination with the naked eye. ...
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Introduction The majority of nail diseases in children are comparable to those in adults, while there are some physiological changes that start to happen around this age and go away over a few years. These conditions could be symptoms of infections and systemic illnesses. Pediatric nail disorders are typically easy to diagnose clinically, although there are occasionally conditions that masquerade as juvenile nail problems. Dermoscopy has grown in favour as a rapid, easy, non-invasive clinical procedure for examining nail diseases. This study aims to assess dermoscopic findings of child nail diseases. Methods A prospective analysis was conducted for seven months between January and July, 2022, at PNS Shifa Hospital, Karachi, Pakistan. A total of 180 patients who presented in the outpatient department with any dermatological complaint underwent thorough history and examination. Special emphasis was given to clinical and dermoscopic examinations of nails. Data analysis enclosed descriptive and inferential statistics. The quantitative data was presented with help of mean and standard deviation, while the qualitative data was presented with help of frequency and percentage tables. Chi-square test was applied to compare nail findings diagnosed on clinical examination and dermoscopic examination. Results The mean age of study subjects was 9.4±3.2 years and ranged between five years and 18 years. The most common nail changes were hand eczema (n=41, 23%) followed by nail changes due to nutritional disorders (n=38, 21%), anaemia (n=34, 19%) and habit tic deformity (n=31, 17.2%). Conclusions Clinical evaluation is crucial for nail disease diagnosis. Dermoscopy of nails can help with the final diagnosis of nail disease and confirm clinical diagnoses. Also, it aids in the management of nail illnesses by providing a clearer picture of pathology and nail structure.
... In addition, NB has major social conundrums. For example, nail-biters are usually recognized as anxious people lacking social skills, and children with NB are usually bullied by other children [1,13]. ...
Article
Nail‐biting (NB) or onychophagia is a compulsive disorder that affects millions of people in both children and adults. It has several health complications and negative social effects. Treatments include surgical interventions, pharmacological medications, or additionally, it can be treated using behavioral modification therapies that utilize positive reinforcement and periodical reminders. Although it is the least invasive, such therapies still depend on manual monitoring and tracking which limits their success. In this work, we propose a novel approach for automatic real‐time NB detection and alert on a smartwatch that does not require surgical intervention, medications, or manual habit monitoring. It addresses two key challenges: First, NB actions generate subtle motion patterns at the wrist that lead to a high false‐positives (FP) rate even when the hand is not on the face. Second, is the challenge to run power‐intensive applications on a power‐constrained edge device like a smartwatch. To overcome these challenges, our proposed approach implements a pipeline of three convolutional neural networks (CNN) models instead of a single model. The first two models are small and efficient, designed to detect face‐touch (FT) actions and hand movement away (MA) from the face. The third model is a larger and deeper CNN model dedicated to classifying hand actions on the face and detecting NB actions. This separation of tasks addresses the key challenges: decreasing FPs by ensuring NB model is activated only when the hand on the face, and optimizing power usage by ensuring the larger NB model runs only for short periods while the efficient FT model runs most of the time. In addition, this separation of tasks gives more freedom to design, configure, and optimize the three models based on each model task. Lastly, for training the main NB model, this work presents further optimizations including developing NB dataset from start through a dedicated data collection application, applying data augmentation, and utilizing several CNN optimization techniques during training. Results show that the model pipeline approach minimizes FPs significantly compared with the single model for NB detection while improving the overall efficiency.
... Считается, что онихофагия является гетерогенным заболеванием, в развитии которого играют роль как генетические, так и факторы окружающей среды. В ряде исследований отмечен четкий семейный анамнез по онихофагии, что касалось как братьев, сестер, так и родителей пациентов [4,10]. Также в исследовании S. Ooki показано, что привычка грызть ногти была генетически связана и присутствовала у 50% пар близнецов [11]. ...
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Onychophagia is a psychiatric disorder manifested by compulsive, repetitive biting of nail plates. To date, the etiopathogenesis of the disease remains incompletely understood. The leading role in the development of this condition is attributed to concomitant mental disorders. Nevertheless, onychophagy today is a complex interdisciplinary problem that requires the involvement of doctors of various specialties. Dermatologists are no exception. Clinical evaluation of nails in onychophagia by a dermatologist is important both in terms of diagnosis and possible ways of correcting pathologic changes in nail plates. This article provides up-to-date information on onychophagia with an emphasis on the dermatologic aspect of the disorder.
... Therefore, NB can impair oral health and the intraoral microbiome; it has been stated that patients with NB have a higher oral bacterial count, and their oral microbiome is typically colonised by Escherichia coli and Enterobacteriaceae [10], which can cause local and systemic disease due to ingestion of enteric bacteria. [11] Enteric bacteria can induce other intraoral diseases of the oral mucosae, such as abscesses, erosive tooth wear and gingival injuries [4,12]. ...
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Nail biting (NB) is a repetitive and uncontrolled parafunctional activity that can affect oral health by altering tooth shape and intraoral position. Nowadays, there is not enough scientific evidence about the impact of NB on teeth; therefore, this study aimed to evaluate the effects of NB on the length, width and inclination of upper central incisors. This retrospective study involved 76 patients, 40 males and 36 females, with a mean age of 10.6 ± 0.3 years. Digital scans of the maxillary arch of each patient were recorded. Next, the length, width and inclination of upper central incisors used and not used for NB were measured. Finally, data were analysed with a paired t-test. Statistical analysis showed statistically significant differences in the length and inclination of upper central incisors used for NB compared with those of upper central incisors not used for NB, while the width did not show a significant difference. There were relevant changes in upper central incisors subjected to NB, demonstrating that NB impairs the shape, morphology and inclination of teeth. Therefore, because of the potentially negative consequences of NB, it is recommended that NB not be underestimated.
... Patients seldom appear with nail biting or nail picking as the primary symptom, thus a correct diagnosis requires a thorough history and physical examination. Dermatologists, internal medicine doctors, pediatricians, psychiatrists, and dentists all have a role in the care of onychophagia and onychotillomania [6][7][8][9][10]. ...
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Background:In the fields of psychiatry, psychology, medicine, and dentistry, nail biting (NB) is a prevalent yet unsolved issue. Although many people assume that NB is a basic habit that can be readily corrected, many children who exhibit NB have previously attempted to correct the behavior and have failed.The aim of the present research focused on the reason for onychophagia or nail-biting if it is a psychological disease or a general habit and recommend some suitable suggestions. Methods:An inductive research approach was suitable for the present research methodology as it involved a survey process. The research approach helped in collecting information in an effective way. A stratified random sampling method was considered for the present research method through the inclusion of participants that are suffering from the issue of nail-biting belonging to the UK. The sample size for the research methodology included a total of 350 participants belonging to the age groups of 18 to 50 years. The primary data collection method was considered for the present research methodology as it followed the cross-sectional method. The quantitative data analysis method would be considered under the primary research method and so a survey would be done. Results: Of 380 study participants,more than half of them believe that nail biting is a psychological disorder (n= 219, 58.1%). Furthermore, about two thirds of study participants believe that nail biting is a common disorder among humans (n= 247, 65%). Most of study participants think that nail biting is curable (n= 296, 77.9%). Daily exercise is helping in reducing the habit of nail biting as reported by 178 (73.2%). Half of study participants were neutral with regard to the benefit of psychological treatment to nail biting (n= 184, 48.4%). Vast majority of study participants believed that exercise is effective for enhancing mental stability (n= 318, 83.7%).Leading a life with a the disorder or nail biting issue was moderately painful among 165 participants (43.3%). Participants were asked about the cost of medication for onychophagia, most of participants responded with affordable cost (n= 270, 71.1%). The most frequent symptom of nail biting issue as reported by study participants was moderate span of time (n= 234, 61.6%). Conclusion: Onychophagia is a psychological disorder from the perspective of study participants. Furthermore, they recommended medical treatment and stated that psychological treatment alone is not enough. Moreover, exercise helps with mental stability as reported by study participants.
... Moreover, they asked the children about their oral habits. In many studies, questionnaires about oral habits have been administered to parents or teachers [4,[26][27][28][29]. ...
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(1) This study aimed to investigate the association between child abuse and oral habits in adolescents in Mongolia. (2) A cross-sectional survey was conducted with children and their caregivers in Ulaanbaatar, Mongolia. Parents of 770 children enrolled in two public schools in Ulaanbaatar, Mongolia, completed questionnaires regarding the physical and psychological abuse that their children were subjected to and the presence of poor oral habits (biting nails/lips/pens and bruxism). Multivariable Poisson regression models were fitted with adjustment for age, gender, age of the mother, parental education, family income level, birth order, and living status with grandparents. (3) Biting nails/lips/pens and bruxism were reported by 39.0% and 17.5% of the respondents, respectively. Biting nails/lips/pens was significantly associated with physical abuse but was not significantly associated with psychological abuse (prevalence ratio, PR [95% confidence interval, CI]: 1.44 [1.07–1.95] and 1.34 [0.98–1.83], respectively). However, bruxism was not associated with physical or psychological abuse (PR [95% CI]: 1.16 [0.77–1.77] and 1.04 [0.68–1.61], respectively). (4) Child abuse was associated with biting habits among Mongolian adolescents.
... In addition, another study on hair pulling explored how tic disorders and hair pulling were rated among peers. The study results showed that pronounced and frequent tics and hairpulling behaviors prevented students from integrating with their peers and made them more likely to be kept away and discriminated against [21,22]. ...
Chapter
Psychological stress can lead to various skin disorders, and dermatological conditions can induce psychological symptoms. There are several disorders which can be defined as “compulsive skin disorders” that include several dermatological diseases having the characteristics of compulsiveness and obsessive thoughts. Patients with these compulsive skin disorders cannot prevent themselves from performing a certain action in a repetitive and purposeless way. Considering that patients with compulsive skin disorders usually have a diagnosis and go into psychiatric follow-up and treatment only 8–10 years after the onset of initial signs and symptoms, it is very important to early recognize these disorders. In this chapter, the principal compulsive skin disorders are described and discussed (prurigo nodularis, lichen simplex, acne excoriée, trichotillomania, trichotemnomania, trichoteiromania, onychophagia, onychotillomania, factitious cheilitis, morsicatio buccarum, and pseudo-knuckle pads). Each disorder is characterized, its diagnosis outlined, and management strategies discussed, emphasizing the need for a multidisciplinary approach involving dermatology and psychiatry. In all these conditions, the diagnostic process involves ruling out medical causes and considering the patient’s psychological history and treatment focuses on addressing underlying psychiatric conditions and managing pruritus.
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Sensory processing problems in children with attention deficit hyperactivity disorder have been the focus of many studies in recent years. It is obvious that different aspects of sensory problems such as with tactile sensory are involved in attention deficit hyperactivity disorder. However, whether the sensory information process problems can be factors in decision making regarding pharmacological management of children with attention deficit hyperactivity disorder has not been researched. This case report presents two children with attention deficit hyperactivity disorder. The mother of the first patient reported that her child's ability for detecting, identifying, and discriminating smells was very high and more than the other children at this age. As she reported, the child also liked to touch everything and everybody. He experienced nail biting after taking 20mg methylphenidate in single dosage. By decreasing of the dosage, nail biting disappeared in the three trials. The other patient started lip biting about half an hour after taking the first dosage of the medication. It continued for four hours. This report suggests that there is an association between methylphenidate and tactile sensory problems in children with attention deficit hyperactivity disorder. It is possible that methylphenidate induces or exacerbates tactile hyposensitivity. If this assumption is supported in controlled clinical trials, then tactile sensory assessment might help to make decisions for the pharmacological management of children with attention deficit hyperactivity disorder. Further studies should investigate whether attention deficit hyperactivity disorder with sensory processing problems is a phenotype with an overlap between autistic disorders and attention deficit hyperactivity disorder in which stimulants may exacerbate some sensory processing problems. Also, if this is the case, the diagnosis of attention deficit hyperactivity disorder as an exclusionary criterion for pervasive developmental disorder needs to be revised.
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This study was conducted to determine the prevalence of oral and parafunctional habits in Nigerian patients suffering temporomandibular joint pain and dysfunction. It consisted of patients that were referred for treatment at the oral and maxillofacial surgery clinic of the University of Benin Teaching Hospital, Benin City, Nigeria. A pre-designed data form was used to collect information on age, gender, reasons for attendance, joint pain, side of pain, clicking, oral habits known to patient, parafunctional habits, occlusion and dietary habits. A total of 29 patients comprising 48.3% male and 51.7% female in a male to female ratio of 1:1.1 were studied. Their age ranged from 17 to 70 years. Eighty two per cent of them complained of joint pain on presentation while 17.1% complained of muscle pain. The joint pain was mainly unilateral in 62.1% and bilateral in 20.7%. Twenty six (89.7%) patients indulged in oral and parafunctional habits such as unilateral mastication 65.5%, hand-on-chin posture 58.6%, clenching 17.2%, tooth grinding 13.8%, chewing gum 37.9%, and finger and nail biting 24.1%. In all, 31.0% of males and 34.5% of females had clicking joints. Reciprocal click was detected in 52.6% of the study sample. There was a prevalence of 89.7% of oral and parafunctional habits in Nigerian patients suffering temporomandibular joint pain and dysfunction.
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A cross-sectional study was carried out in 200 children aged 5-15 years, to examine the presence of intestinal parasitic infections (IPIs) and to assess the risk factors and clinical features associated with them in children in San Juan y Martinez (SIM), Cuba. Three fresh faecal samples were collected from each child and were examined by direct wet mount, brine flotation, formalin-ether and Kato-Katz techniques. Data relating to demography, source of drinking water, personal hygiene habits and clinical features were also collected Living in the rural area was significantly associated with the highest infection rates (p < 0.01). According to clinical features and laboratory examinations, children with abdominal pain were about four times more likely to have IPIs (OR 4.05, CI, 1.11, 13.18) especially soil-transmitted helminths (STH). We suggest that IPIs, especially STH, in SJM should be strongly suspected in children with abdominal pain from rural areas. Targeted and frequent interventions to control these infections are needed in this municipality.
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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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Objective: To compare parental psychopathology and psychiatric disorders in ADHD children with and those without enuresis. Method: The participants of the clinical sample interviewed according to DSM-IV diagnostic criteria were 35 children with ADHD and enuresis, 153 ADHD children without enuresis, 115 fathers, and 172 mothers. Results: Only ODD comorbidity was the predictor of enuresis. Conduct disorder, tic disorder, major depressive disorder, separation anxiety disorder, bruxism, generalized anxiety disorder, obsessive compulsive disorder, and nail biting were not statistically more frequent in ADHD children with enuresis than in the ADHD children without enuresis. The only parental psychiatric disorder that was related to the groups was father’s major depressive disorder. Conclusion: Enuresis in ADHD has a relationship with ODD. Physicians who treat patients with ADHD and enuresis should routinely inquire about the presence of major depression in the fathers. (J. of Att. Dis. 2010; 13(5) 464-467)
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Background Child psychiatric disorders are common and treatable, but often go undetected and therefore remain untreated. Aims To assess the Strengths and Difficulties Questionnaire (SDQ) as a potential means for improving the detection of child psychiatric disorders in the community. Method SDQ predictions and independent psychiatric diagnoses were compared in a community sample of 7984 5- to 15-year-olds from the 1999 British Child Mental Health Survey. Results Multi-informant (parents, teachers, older children) SDQs identified individuals with a psychiatric diagnosis with a specificity of 94.6% (95% Cl 94.1-95.1%) and a sensitivity of 63.3% (59.7-66.9%). The questionnaires identified over 70% of individuals with conduct, hyperactivity, depressive and some anxiety disorders, but under 50% of individuals with specific phobias, separation anxiety and eating disorders. Sensitivity was substantially poorer with single-informant rather than multi-informant SDQs. Conclusions Community screening programmes based on multi-informant SDQs could potentially increase the detection of child psychiatric disorders, thereby improving access to effective treatments.
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Objective: Many previous studies have surveyed associations between Tourette syndrome (TS) and co-morbid psychiatric disorders, but they usually did not include oppositional defiant disorder (ODD), conduct disorder (CD), separation anxiety disorder (SAD), and post-traumatic stress disorder (PTSD). Method: The subjects were children and adolescents with TS who visited a child and adolescent psychiatric clinic, and who were interviewed using DSM-IV diagnostic criteria. Characteristics of their tics were examined by the Yale-Global Tic Severity Scale (Y-GTSS). Behavioral problems were surveyed by the Child Behavior Checklist (CBCL) filled in by the parents. Results: About 87.9% of the subjects were boys. The mean age of the subjects was 11.8 years. The most common psychiatric disorders were attention deficit hyperactivity disorder (ADHD), ODD, nail biting, and obsessive compulsive disorder (OCD). Only one subject was affected by TS without co-morbidities. Among TS patients with co-morbidities, those with disruptive behavioral disorders (DBD) have significantly higher mean scores than patients without DBD on the Externalizing scale, Social problems, Attention problems, Delinquent and Aggression scales. Co-morbidity of anxiety disorders was not related to the CBCL scores. Conclusion: Many of our results were similar to those reported in studies conducted in other parts of the world. TS is more common in boys and nearly all of them had at least one co-morbid disorder. The most common co-morbidity was ADHD. Behavioral problems in TS are related to the co-morbidity with the DBD, and possibly not to the anxiety disorders.
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This study reports the comorbidity of lifetime psychiatric disorders in children and adolescents with alopecia areata (AA) in a child and adolescent psychiatry clinical sample. Fourteen patients with AA were interviewed using the Diagnostic and Statistical Manual of Mental Disorders-Fourth edition (DSM-IV) criteria and the Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime-Farsi Version (KSADS-PL-Farsi Version). The rate of at least one psychiatric disorder was 78%. The rate of major depressive disorder was 50%, and the most common anxiety disorder was obsessive-compulsive disorder (OCD) (35.7%). There is a very high rate of psychiatric disorders in children and adolescents with AA. This high rate of OCD has not been reported previously. There seems to be a clinical association between OCD and AA in children and adolescents.
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Little is known about whether the clinical correlates of hoarding behavior are different in men and women with obsessive-compulsive disorder (OCD). In the current study, we evaluated the association of hoarding with categories of obsessions and compulsions, psychiatric disorders, personality dimensions, and other clinical characteristics separately in 151 men and 358 women with OCD who were examined during the OCD Collaborative Genetics Study. We found that, among men but not women, hoarding was associated with aggressive, sexual, and religious obsessions and checking compulsions. In men, hoarding was associated with generalized anxiety disorder and tics whereas, among women, hoarding was associated with social phobia, post-traumatic stress disorder, body dysmorphic disorder, nail biting, and skin picking. In women but not men, hoarding was associated with schizotypal and dependent personality disorder dimensions, and with low conscientiousness. These findings indicate that specific clinical correlates of hoarding in OCD are different in men and women and may reflect sex-specific differences in the course, expression, and/or etiology of hoarding behavior in OCD.
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Onychophagia, or nailbiting, is a common oral habit, observed in both children and adults. The etiologies suggested for nailbiting include anxiety, stress, loneliness, imitation of other family member, heredity, inactivity, transference from a thumb-sucking habit, and poorly manicured nails. Treatment should be directed at the causes; punishment, ridicule, nagging and threats, and application of bitter-tasting commercial preparations on the nail are a variety of reminders, but are not appropriate approaches to treatment. The key to success is the nailbiter's consent and cooperation.