Onychotillomania is a type of obsessive-compulsive disorder (OCD) that is characterized by repetitive and compulsive picking, biting, or pulling of one’s own fingernails or toenails. It is a relatively uncommon condition, affecting only a small proportion of the population, but it can have a significant impact on an individual’s quality of life. People with onychotillomania experience intense anxiety or stress that is relieved through the act of nail biting or pulling, but the relief is short-lived, and the behavior is soon repeated.

The exact cause of onychotillomania is not well understood, but it is thought to be related to anxiety, stress, and other psychological factors. Some people with onychotillomania may have a genetic predisposition to the condition, and it is also thought to be related to other mental health conditions, such as depression, anxiety, and obsessive-compulsive disorder (OCD).


While the exact causes of onychotillomania are not fully understood, a number of factors are thought to contribute to its development, including genetic, environmental, and psychological factors. In this article, we will discuss the main causes of onychotillomania in detail.

  1. Genetics: There is some evidence to suggest that onychotillomania may have a genetic component. Studies have found that individuals with a family history of OCD or other related disorders are more likely to develop onychotillomania. This suggests that there may be a genetic predisposition to the condition.
  2. Environmental factors: Environmental factors can also play a role in the development of onychotillomania. For example, individuals who grew up in a stressful or traumatic environment may be more likely to develop the condition as a way of coping with stress. Similarly, individuals who have experienced a traumatic event, such as a natural disaster or a violent crime, may be more likely to develop onychotillomania as a form of self-soothing behavior.
  3. Psychological factors: Psychological factors, such as anxiety and stress, are also thought to contribute to the development of onychotillomania. Individuals with anxiety disorders or who experience high levels of stress may turn to nail biting as a way to cope with their feelings. Additionally, individuals with low self-esteem or a negative body image may also be more likely to develop onychotillomania as a way of self-punishing or expressing frustration with themselves.
  4. Learned behavior: Onychotillomania may also be a learned behavior. For example, an individual may have seen a family member or friend bite their nails and picked up the behavior as a result. Additionally, individuals who have experienced social pressure or criticism for biting their nails may continue the behavior as a form of self-soothing.
  5. Imbalanced brain chemistry: Imbalanced brain chemistry, such as imbalances in neurotransmitters like serotonin and dopamine, can also contribute to the development of onychotillomania. When these neurotransmitters are imbalanced, individuals may experience feelings of anxiety, stress, or compulsions that can lead to nail biting.
  6. Sensory factors: Onychotillomania may also be related to sensory factors, such as the taste, texture, or sensation of biting one’s nails. Individuals with sensory processing disorders, such as autism spectrum disorder, may be more likely to engage in nail biting as a way of seeking sensory input.

It is important to note that these causes are not mutually exclusive and that individuals with onychotillomania may experience a combination of these factors. Additionally, the causes of onychotillomania can vary from person to person, and it is likely that there are other contributing factors that have not yet been identified.


The following are the main symptoms of onychotillomania:

  1. Recurrent and persistent nail biting: The primary symptom of onychotillomania is repetitive and persistent nail biting. This behavior can occur several times a day and can last for several minutes at a time.
  2. Inability to resist the urge to bite nails: People with onychotillomania often feel an irresistible urge to bite their nails, even though they know that it is not a good habit. They may try to resist the urge, but they are unable to do so.
  3. Shortened or damaged nails: Nail biting can result in shortened, misshapen, or damaged nails. This can cause discomfort and embarrassment, and can make it difficult to perform daily tasks, such as typing or playing a musical instrument.
  4. Cuticles and skin damage: In addition to damaging the nails, nail biting can also cause damage to the surrounding skin, including the cuticles. This can result in pain, redness, and infection.
  5. Anxiety and stress: Nail biting is often triggered by anxiety and stress. People with onychotillomania may find that they bite their nails more frequently when they are feeling anxious, nervous, or overwhelmed.
  6. Shame and embarrassment: People with onychotillomania often feel ashamed and embarrassed by their behavior. They may try to hide their hands to avoid drawing attention to their nails, or they may avoid social situations because they are self-conscious about their appearance.
  7. Difficulty concentrating: Nail biting can be a distracting behavior that interferes with daily activities, such as working, studying, or driving. People with onychotillomania may find that they are unable to concentrate or focus on tasks due to their repetitive nail biting.
  8. Chronic or recurrent infections: Biting the nails can introduce bacteria into the mouth and the surrounding skin, which can result in chronic or recurrent infections. This can cause further damage to the nails and skin, and can lead to other health problems.
  9. Disruptive to daily life: Onychotillomania can be disruptive to daily life, as it can interfere with work, school, and social activities. People with this condition may find that they are unable to perform tasks as effectively as they would like, and they may feel limited by their behavior.
  10. Negative impact on self-esteem: Onychotillomania can have a negative impact on self-esteem, as people with this condition may feel embarrassed, ashamed, or self-conscious about their appearance. They may also feel frustrated and discouraged because they are unable to stop the behavior, even though they want to.

It is important to note that the symptoms of onychotillomania can vary from person to person. Some people may experience only a few of the symptoms listed above, while others may experience many of them. In addition, the severity of symptoms can also vary, with some people experiencing mild symptoms and others experiencing more severe symptoms.


Here is a list of some of the most commonly used diagnostic tests for onychotillomania:

  1. Clinical Assessment: A clinical assessment involves a comprehensive evaluation of the individual’s symptoms and behavior by a mental health professional. This may include a thorough examination of the nails and surrounding skin, as well as a discussion of the individual’s history of nail biting. The clinician may also ask about any stressors, triggers, or underlying psychological issues that may be contributing to the behavior.
  2. Psychiatric Interview: A psychiatric interview is a structured conversation between the individual and a mental health professional. During this interview, the clinician will ask questions about the individual’s symptoms, behavior, and overall mental health. This is an important step in the diagnostic process as it helps to rule out any underlying psychiatric conditions that may be contributing to the nail biting behavior.
  3. Psychological Testing: Psychological testing is a set of standardized procedures used to assess mental health and behavior. This may include self-report questionnaires, projective tests, or cognitive tests. These tests can provide valuable information about the individual’s emotional and psychological functioning, which can help to guide treatment decisions.
  4. Laboratory Tests: Laboratory tests can help to rule out any underlying medical conditions that may be contributing to the nail biting behavior. This may include blood tests, skin scrapings, or nail clippings to test for infections or other underlying health issues.
  5. Behavioral Observations: Behavioral observations involve observing the individual in their natural environment, such as at home or at work. This can provide valuable information about the frequency, intensity, and context of the nail biting behavior. This information can be used to develop a more comprehensive understanding of the individual’s behavior and to develop targeted treatment strategies.
  6. Nail Biting Severity Index (NBSI): The Nail Biting Severity Index is a standardized tool used to assess the severity of onychotillomania. This index is based on a self-report questionnaire that asks the individual to rate the frequency and intensity of their nail biting behavior, as well as the impact it has on their daily life.
  7. Clinical Global Impression Scale (CGI): The Clinical Global Impression Scale is a widely used tool for evaluating the severity of psychiatric symptoms. This scale is based on a clinician’s assessment of the individual’s symptoms and behavior and provides a rating of the individual’s overall level of functioning.


Treatments for onychotillomania can be divided into three main categories: behavioral therapies, pharmacological interventions, and complementary and alternative therapies. The choice of treatment will depend on the severity of symptoms, the presence of co-occurring mental health conditions, and individual preferences.

Behavioral Therapies:

  1. Cognitive-behavioral therapy (CBT): This is the most widely used form of therapy for onychotillomania. CBT focuses on changing negative thought patterns and behaviors associated with nail biting. A therapist may use techniques such as exposure and response prevention, habit reversal training, and mindfulness-based interventions to help individuals overcome their nail biting habit.
  2. Habit reversal training (HRT): This is a type of CBT that aims to replace the nail biting habit with a competing response, such as squeezing a stress ball or tapping one’s fingers. The goal of HRT is to increase awareness of the nail biting behavior and to create a new, more positive habit in its place.
  3. Mindfulness-based interventions: This type of therapy emphasizes the importance of being present in the moment and paying attention to one’s thoughts, feelings, and physical sensations. By practicing mindfulness, individuals can learn to become more aware of their nail biting habit and to resist the urge to engage in this behavior.

Pharmacological Interventions:

  1. Antidepressants: Selective serotonin reuptake inhibitors (SSRIs) have been shown to be effective in reducing nail biting in some individuals. SSRIs work by increasing levels of serotonin in the brain, which is thought to help regulate mood and reduce the urge to engage in compulsive behaviors.
  2. N-acetylcysteine (NAC): NAC is a dietary supplement that has been shown to be effective in reducing symptoms of obsessive-compulsive disorder (OCD), including nail biting. NAC is thought to work by increasing levels of the neurotransmitter glutamate in the brain, which is involved in regulating mood and behavior.

Complementary and Alternative Therapies:

  1. Acupuncture: Acupuncture is a form of traditional Chinese medicine that involves the insertion of fine needles into specific points on the body to promote healing and balance. Acupuncture has been shown to be effective in reducing symptoms of anxiety and stress, which can contribute to nail biting.
  2. Aromatherapy: Aromatherapy involves the use of essential oils to promote relaxation and reduce stress. Certain essential oils, such as lavender and chamomile, have been shown to have a calming effect on the body and mind, which can help reduce the urge to engage in nail biting.
  3. Hypnotherapy: Hypnotherapy is a form of therapy that uses hypnosis to help individuals overcome negative behaviors and thought patterns. During hypnotherapy, the individual is guided into a state of deep relaxation and is then given positive suggestions and affirmations to help change their behavior.

In conclusion, onychotillomania is a common compulsive behavior that can cause significant distress and have negative impacts on physical and mental health. While there is no single “cure” for this disorder, a combination of behavioral therapies, pharmacological interventions, and complementary and alternative therapies