Caleb Foster
Skin picking and nail-biting are common habits, but they can also be signs of underlying disorders. Dermatillomania (skin picking) and Dermatophagia (nail-biting) are classified as body-focused repetitive behaviours (BFRBs) related to obsessive-compulsive disorder (OCD). People with these conditions may pick their skin with their fingers, fingernails, teeth, or tools, causing bleeding, scarring, and even life-threatening infections. Treatment for these disorders typically involves a combination of medication and cognitive behavioural therapy (CBT).
| Characteristics | Values |
|---|---|
| Condition | Dermatillomania (Skin Picking), Dermatophagia, Body-Focused Repetitive Behavior (BFRB), Skin Picking Disorder (SPD), Excoriation Disorder |
| Symptoms | Picking scabs, biting nails, chewing skin around fingers, using tools like tweezers or pins, automatic or focused picking |
| Causes | OCD or OCD-related disorders, depression, anxiety, bipolar disorder, Prader-Willi syndrome, self-stimulation, relief, anger, shame, avoiding discomfort or boredom |
| Treatment | Medication, therapy, stimulus control, cognitive behavioral therapy (CBT), keeping nails short, wearing gloves, using distraction items, keeping skin moisturized and clean |
| Risks | Infection, scarring, skin damage, embarrassment, shame, negative impact on work and social life |
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What You'll Learn
- Nail biting is a common coping mechanism to deal with nervousness, boredom, or loneliness
- Dermatophagia is a disorder where people compulsively bite and eat the skin around their fingers
- Scab picking can lead to serious health complications, such as scarring or infection
- Skin picking can be a symptom of dermatillomania or excoriation disorder
- Cognitive behavioural therapy and medication can help treat skin picking disorders
Nail biting is a common coping mechanism to deal with nervousness, boredom, or loneliness
Nail biting, or onychophagia, is a common habit that can bring comfort and gratification. It is often a way for people to cope with nervousness, boredom, loneliness, or even hunger. While it can be comforting, nail biting can also damage your fingers and nails, and in some cases, lead to infection. Repeated nail biting can make the skin around your nails feel sore and damage the tissue that makes nails grow, resulting in abnormal-looking nails. It can also leave you vulnerable to infection as you pass harmful bacteria and viruses from your mouth to your fingers and from your nails to your face and mouth.
Nail biting is frequently associated with anxiety, as the act of chewing on nails reportedly relieves stress, tension, or boredom. People who bite their nails often do so when feeling nervous, bored, or lonely. It can also be a habit transferred from thumb or finger sucking during childhood. While nail biting can occur without symptoms of another psychiatric condition, it can be associated with attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder, separation anxiety, enuresis, tic disorder, and other mental health issues.
Chronic nail biting is rarely a result of OCD. More often, it is a sign of Body-Focused Repetitive Behavior (BFRB) Disorder. People with this disorder repeatedly perform behaviors involving their bodies, such as nail biting, to relieve feelings of tension and anxiety. BFRBs appear to be more common among females than males. In some cases, nail biting can be a medication side effect, so if a nail-biting habit starts suddenly, it may be something to discuss with your doctor.
If you want to stop biting your nails, it is recommended to keep your nails trimmed short and identify your triggers. You can also try replacement behaviors such as chewing gum or playing with a stress ball or fidget toy.
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Dermatophagia is a disorder where people compulsively bite and eat the skin around their fingers
The exact cause of dermatophagia is unknown, but it is believed to be related to underlying mental health conditions. Treatment for dermatophagia typically involves a combination of therapy, medication, and self-care strategies. Cognitive behavioural therapy (CBT) is a common treatment approach that helps individuals develop awareness of their triggers and coping strategies to manage the urge to bite or chew. Other self-care strategies include keeping your hands busy with fidget toys or stress balls, using relaxation techniques such as deep breathing or meditation, and keeping your nails well-trimmed.
In addition to psychological treatment, addressing any physical damage caused by dermatophagia is crucial. Skin treatments may include treating open wounds, scarring, or infection. It is important to keep the affected area clean and covered with bandages until it heals. Antibiotics may be necessary to treat or prevent infection.
Dermatophagia is not typically the cause of serious medical complications, but it can significantly affect an individual's physical and mental health. The condition can lead to skin thickening around the hands and nails, as well as infections and diseases of the nails. In some cases, dermatophagia may be associated with conditions such as Alzheimer's disease, intellectual disabilities, and autism spectrum disorders.
If you or someone you know is exhibiting signs of dermatophagia, it is important to seek help from a doctor or mental health professional for a swift diagnosis and treatment.
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Scab picking can lead to serious health complications, such as scarring or infection
If bacteria get beneath a scab, the wound can become infected. This may cause a crusty, yellow scab to develop. An infected wound under a scab can lead to cellulitis, a severe infection that can be fatal if not treated right away. The scab itself is made of dead cells and cannot become infected. It is the wound that becomes infected.
Scab picking can also lead to scarring. Scars can be very hard to completely remove. Repeatedly picking off scabs can result in long-term scarring. If there is concern that a wound will turn into an "ugly scar," it is recommended to schedule an appointment with a plastic surgeon.
In addition to the risk of infection and scarring, scab picking can also be a sign of an underlying health condition called dermatillomania. This condition is characterized by an uncontrollable urge to pick at a certain part of the body and can lead to excessive skin picking, causing damage to large areas of the skin.
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Skin picking can be a symptom of dermatillomania or excoriation disorder
Dermatillomania is classified in the DSM-V as a type of OCD due to the compulsive urge to perform repetitive behaviours. However, it is important to note that skin picking disorder and OCD are not the same. People with OCD do not typically injure themselves while engaging in their obsessions or compulsions. Additionally, they do not experience a rewarding feeling from these activities, unlike those with dermatillomania, who often describe a feeling of relief after picking their skin.
The picking usually involves fingers, fingernails, and fingertips, but can also include biting with teeth, especially when the affected area is on the lips. In some cases, sharp items like tweezers, pins, needles, or scissors may be used. This behaviour can occur in one of two ways: "automatic" or "focused". Automatic picking often happens without conscious thought, and individuals may do it while engaged in other activities like driving or watching TV. It is sometimes called "scanning" as individuals run their hands or fingertips over their skin to find irregularities, which then become the focus of more intense picking. Focused picking is more severe and can go on for hours, leading to more severe skin damage.
The exact causes of dermatillomania are not fully understood, but it is believed to be a combination of genetic, neurological, and environmental factors. Individuals with this disorder are more likely to have first-degree relatives with the condition, suggesting a genetic component. Brain imaging studies have also revealed differences in brain structure and function in areas that control habits and impulses. Additionally, stress, anxiety, and other mental health challenges may contribute to the development of this disorder.
If you or someone you know is struggling with dermatillomania or excoriation disorder, it is important to seek professional help. Treatment options are available, and early intervention can lead to more effective management of the condition.
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Cognitive behavioural therapy and medication can help treat skin picking disorders
Skin picking, or dermatillomania, is a type of body-focused repetitive behaviour (BFRB) that is not caused by another medical or mental health condition. It is often carried out "automatically", where a person runs their hands over their skin and picks at any irregularities, or "focused", where a person will pick at a specific area for an extended period, which is more likely to cause damage. Skin picking can cause tissue damage, scarring, and infection, and in rare cases, can lead to life-threatening sepsis.
Cognitive Behavioural Therapy (CBT) is an effective treatment for skin picking disorders. Through CBT, individuals can identify triggers and learn to alter their behaviours to reduce or eliminate skin picking. CBT is often used in conjunction with exposure and response prevention (ERP), which gradually exposes the individual to anxiety-provoking situations to reduce avoidance behaviours. Habit reversal training (HRT) is another behavioural therapy technique used to treat skin picking, which helps to replace unhealthy habits with healthier choices.
Medications can also be used to treat skin picking disorders. A drug used to treat Alzheimer's disease, memantine, has been found to reduce symptoms of skin picking in adults. Antipsychotic agents, antianxiety agents, antidepressants, topical cortisone agents, and antiepileptic agents are also used to treat skin picking disorders.
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Frequently asked questions
Picking scabs is a common symptom of skin picking disorder (SPD), also known as dermatillomania or excoriation disorder. People with SPD often feel compelled to pick at their skin, including scabs, bumps, pimples, or other irregularities. This can lead to bleeding, scarring, and even infection if not properly managed.
Fingernail chewing is often associated with dermatophagia, a type of body-focused repetitive behavior (BFRB) where individuals compulsively bite, chew, or eat the skin around their fingers. This behavior can lead to bloody, damaged, and infected skin.
Yes, both scab picking and nail chewing can be harmful behaviors. If left untreated, these actions can cause skin damage, scarring, and infection. In rare cases, severe infections can lead to life-threatening medical emergencies such as sepsis. Additionally, these behaviors can negatively impact one's emotional well-being, causing feelings of shame, embarrassment, anxiety, and depression.
Treatment for scab picking and nail chewing often involves a combination of medication and therapy, particularly cognitive behavioral therapy (CBT). Medications such as antidepressants (SSRIs) and anticonvulsants may be prescribed to help manage underlying mental health conditions and control urges. Additionally, stimulus control techniques, such as keeping your nails short, wearing gloves, or using distraction tools like stress balls, can help reduce the frequency of scab picking and nail-chewing episodes.
If you find yourself repeatedly attempting to stop picking scabs or chewing your nails but feel unable to control the urges, it may be time to seek professional help. These behaviors can significantly impact your daily life, causing emotional distress and affecting your social and work functioning. A licensed mental health provider can provide a proper diagnosis and develop an effective treatment plan to help manage these behaviors.
