Self Induced Nail Disorders
Onychophagia and onychotillomania are self-induced nail disorders. Onychophagia involves compulsive biting of the nail past the nail bed leading to nail deformity, textural changes, bleeding cuticles, and risk for infection. Onychotillomania involves tugging, picking, pulling, and manicuring of the nail causing damage and deformity of the nail and surrounding tissue. Diagnostic criteria and management strategies are discussed.
In humans, concerns regarding nail appearance and integrity are common throughout life. Perceptions about an individual’s health, beauty, style, attitude, and sexuality can all be influenced by the appearance and adornments of the nails. Dystrophic nails elicit a range of negative appraisals and anxieties from others. They can indicate circumstances such as poor hygiene, poor diet, illness, infection, or psychiatric illness. It seems counterintuitive that one would purposely damage or substantially deform their nails, but most self-induced damage to the nails is not carried out with the intention to create changes that can alienate, frighten, or even repulse others. These behaviors are usually secondary to anxiety, depression, boredom, frustration, or genetic disorder. These patients represent a heterogeneous population often with numerous personal and family comorbidities. Thus far, few placebo controlled double blinded interventions have been carried out in relation to the treatment of self-induced nail disorders. In this chapter, we will review the most common self-induced nail disorders and their most effective treatments.
KeywordsOnychotillomania Onychophagia Nail dystrophy Self-induced Biting Picking Pulling Obsessive compulsive Depression Anxiety Habit reversal Cognitive behavioral Mindfulness Anxiolytic SSRI SNRI Pimozide n acetyl cysteine
- 4.Grant JE, Stein DJ, Woods DW, Kauthen NJ, editors. Trichotillomania, skin picking, and other body-focused repetitive behaviors. Washington, DC: American Psychiatric Publishing; 2012.Google Scholar
- 5.Baran R, de Berker D, Holzberg M, editors. Baran and Dawber’s diseases of the nails and their management. 4th ed. Hoboken; 2012.Google Scholar
- 8.Diagnostic and statistical manual of mental disorders. 5th ed. Washington, DC: American Psychiatric Association; 2013.Google Scholar
- 10.Bowen S, Chawla N, Marlatt GA. Mindfulness based relapse prevention for addictive behaviors: a clinician’s guide. New York: Guilford; 2011.Google Scholar
- 11.www.trich.org. The Trichotillomania Learning Center (TLC).
- 13.www.smartrecovery.org. 2016.
- 14.Jones IH, Barraclough BM. Automutilation in animals and its relevance to self-injury in man. 2007;58–1:40–7.Google Scholar
- 21.Koo JYM, Nguyen CM, Kourosh BS. Advanced psychodermatology. Handbooks in Healthcare Company; 2016.Google Scholar
- 24.Fried RG. Take your “Pick”: could neurotic excoriations be a forme fruste of Tourette’s disorder? The Dematologist. 2012;20(10):38–9.Google Scholar
- 25.Sliverman WK, Albano AM. Anxiety disorders interview schedule for DSM-IV-child version. San Antonio: Psychological Corporation; 1996.Google Scholar
- 26.Mostaghimi L. Dermatological assessment of hair pulling, skin picking, and nail biting. In: Grant, et al., editors. Trichotillomania, skin picking and other body-focused repetitive behaviors. Washington, DC: Am J Psychiatry; 2012. p. 97–112.Google Scholar