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What is OCDOCD SubtypesIs nail-biting a sign of OCD?

Is nail-biting a sign of OCD?

4 min read
Melanie Dideriksen, LPC, CAADC

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    What is OCD?

    According to the current Diagnostic and Statistical Manual of Mental Disorders (DSM-5), Obsessive Compulsive Disorder (OCD) is characterized first by the presence of obsessions and compulsions. 

    Obsessions are intrusive thoughts, images, or urges that cause anxiety or distress. They are often repetitive or persistent and may deal with taboo or disturbing themes. Some examples of obsessions may be:

    Compulsions are physical or mental behaviors done in an attempt to relieve the anxiety that comes from obsessions or to prevent a feared outcome. Consider some examples: 

    • Repetitive hand washing
    • Repeating words in one’s head in order to drive out an unwanted thought
    • Asking someone else for reassurance in search of absolute certainty about fears or doubts
    • Repetitively revisiting places or objects to ensure that nothing is wrong

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    Can nail-biting be a sign of OCD?

    In most cases, nail biting will not be considered a symptom of OCD—nail biting is typically classified as a body-focused repetitive behavior (BFRB). However, it can be a sign that someone is highly anxious, and can interfere in people’s day-to-day functioning or even lead to tissue damage of the hands, so if you are finding it difficult to control or stop nail biting, it could be worthwhile to get an evaluation. 

    What else could nail-biting be a sign of?

    Nail biting, or Onychophagia, is typically a sign of a BFRB or Body-Focused Repetitive Behavior. BFRB’s are classified as a closely related condition to OCD, but are most often present without intrusive thoughts. Rather, a person may feel the urge to engage in BFRB behaviors with a need to complete this behavior until it feels “just right,” without the underlying fear that commonly characterizes OCD. 

    In BFRBs, this urge is called a premonitory urge. This term refers to an internal state of tension and discomfort that is frequently experienced immediately prior to the expression of the nail biting BFRB. Nail biting is classified as an Other Specified BFRB in the DSM-5. Criteria for diagnosing a BFRB of nail biting include:

    • Recurrent nail biting resulting in damage, such as biting nails down to the quick, swelling in the nail bed, bleeding, cracking, or other medical issues
    • Repeated unsuccessful attempts to stop nail biting
    • Significant distress or interference in day-to-day functioning, such as social situations or hygiene practices

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    How can I learn to stop nail-biting?

    Nail biting that presents as a BFRB can be treated with Habit and Reversal Training (HRT). Habit and Reversal Training is an evidenced based behavioral treatment made up of three components which are: 

    Awareness training

    Involves developing greater awareness of one’s behavior: what the experience is like, the frequency with which it occurs, and what the warning signs are. For example, someone who bites their nails may notice it always happens when they are sitting and scrolling on their phone, or laying in bed at night before falling asleep.

    Competing response training 

    Involves initiating new responses to prevent the expression of a BFRB when warning signs are noticed. For example, someone with nail biting may choose to clasp their hands every time they feel the urge to bite their nails, and continue until the premonitory urge passes.

    Social support 

    Enlists the support of family members and others to help the member remain accountable for following through with HRT. A child with a nail biting BFRB may use a parent for social support, working together to stay on track. A social support person does not police behavior, but offers accountability and support in a loving, positive way. 

    There are highly effective treatment options for both OCD and BFRBs, and it is common for people to experience both conditions at the same time. Many OCD specialists also receive specialty training in treating BFRBs like nail biting with HRT. 

    Many therapists in the NOCD network are trained in Exposure in Response Prevention as well as Habit Reversal Training and can work with individuals to gain freedom from the distress that these disorders bring. I encourage you to learn about NOCD’s accessible, evidence-based approach to treatment if you think you may be suffering from one of these disorders. 

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    Patrick McGrath, PhD

    Dr. McGrath is a Licensed Clinical Psychologist and the Chief Clinical Officer at NOCD. He is a member of the Scientific and Clinical Advisory Boards of the International OCD Foundation, a Fellow of the Association for Cognitive and Behavioral Therapies, and the author of "The OCD Answer Book" and "Don't Try Harder, Try Different."