Do you find yourself biting the inside of your mouth almost constantly? Is it raw, painful, or even bleeding? You might not even notice you’re doing it until it begins to hurt. Maybe a loved one has had to point it out to you, or it’s taken a lingering, infected sore for your biting to grab your attention. It’s also possible you’ve begun to bite the inside of your mouth in secret, embarrassed by your seeming inability to stop.
If it’s become almost automatic, you’ve likely been engaging in the behavior for a while. To understand how you can stop biting the inside of your mouth, you first have to understand why you’re doing so. The most likely answer is that you’re experiencing a body-focused repetitive behavior (BFRB). Behaviors like this are not merely a “nervous habit”—that dismisses the impact they can have on your daily life. I talked with Dr. Nicholas Farrell, licensed psychologist, Regional Clinical Director at NOCD, and BFRB expert about how you can stop biting the inside of your mouth and regain control over a harmful habit that can be extremely hard to break.
Why are you biting the inside of your mouth?
A body-focused repetitive behavior describes repeated behavior performed on your body, by your body, such as picking at your skin, biting your nails, picking out your hair, or biting the inside of your mouth, lips, or tongue. This behavior can cause redness, swelling, lesions, or bleeding, and it’s often very difficult to stop. Though it may bring an initial comfort or self-soothing effect, the sufferer likely feels distress afterward over the inability to control their behavior and the physical effects of the BFRB. Other symptoms of this particular BFRB include:
- Medical complications from biting the inside of your mouth, such as infections, open wounds, scarring, and scabbing
- Shame and embarrassment over biting the inside of your mouth; you might find yourself doing it only in private
- A heightened urge to bite the inside of your mouth during times of stress
- An increased urge to bite the inside of your mouth during times of overstimulation or understimulation
- Feeling pain or tenderness when you eat
As far as what causes BFRBs, research is limited and there is no one definite answer. However, studies have shown that people who have an immediate family member with a BFRB are more likely to develop one themselves, suggesting a genetic component. Other factors thought to influence the development of a BFRB include environmental stress factors, general temperament, and age of onset. BFRBs most often present in late childhood and early adolescence, but they can emerge at any time.
BFRBs can also coincide with other mental health conditions, including anxiety, depression, obsessive-compulsive disorder (OCD), attention-deficit hyperactive disorder (ADHD), or autism. Dr. Farrell emphasizes that secondary disorders, such as depression or social anxiety, can arise from the impact that BFRBs have on one’s life. For example, if you are constantly seeking the comfort that biting the inside of your mouth brings you, you may be more likely to skip out on social activities, not engage in your hobbies, and not live in accordance with your values. This will ultimately result in feelings of isolation and depression. On the other hand, because biting the inside of your mouth is a BFRB that’s easier to do without others noticing than, say, biting your nails, you might still engage in your normal activities but find yourself less present or more frustrated when doing so. This, too, can result in feelings of isolation and depression, as you are disconnected from the people and activities around you—it’s almost like being two places at once.
BFRBs are categorized in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as an “unspecified obsessive-compulsive and related disorders.” It’s important to note that while BFRBs share similarities with OCD, they are a distinct diagnosis. Both conditions experience an out-of-control feeling around certain acts or behaviors, but the motivation behind them is different. In OCD, compulsive behaviors are driven by distressing and intrusive thoughts, images, feelings, or urges, done in an attempt to relieve the distress caused by these triggers and/or to prevent unwanted outcomes. The sufferer does not actually enjoy their compulsions.
When people bite the inside of their mouth, on the other hand, they are not typically driven by intrusive thoughts. Rather, the behavior is done to relieve one of negative physical sensations or feelings and can serve as a tactic for self-regulating. There is often a sense of comfort that one gets while biting the inside of their mouth. Though one can have OCD and a BFRB at the same time, the distinction between the two is important, because their treatments are different.
How do you know when to seek treatment for biting the inside of your mouth?
In trying to determine whether or not you should seek treatment for biting the inside of your mouth, consider the following questions:
- Are you causing the inside of your mouth to bleed, scab, scar, or be otherwise damaged?
- Is your biting causing oral pain when eating certain foods or at any other time?
- Do you feel unable to stop biting the inside of your mouth?
- Do you try to keep this behavior a secret from others?
- Do you feel a sense of shame or embarrassment around the behavior?
- Is it impacting your daily life and functioning in any way?
- Does it make you feel isolated or disconnected from your life/surroundings?
You might think that just because this BFRB is concealed, it’s not as damaging as biting your nails or picking at your skin. However, as you may have already experienced, just because others can’t see it does not mean that the pain or discomfort it causes you isn’t real and serious. If you regularly have lesions, broken or bleeding skin, swollen skin, or feel tenderness when you eat, you should seek help.
Remember, you don’t have to “just live with” any behavior, experience, or condition that brings you distress or suffering. Since biting the inside of your mouth may be a long-ingrained habit, you might feel it’s an unavoidable fact of your life, but that’s not true. You deserve to pursue the highest quality of life possible, and there are trained professionals and other resources available to help you do so.
So, how can you stop chewing on the inside of your mouth?
Dr. Farrell says step one in getting help for a BFRB, after recognizing the problem, is “Reaching out and making contact with a provider or resource where one can access evidence-based treatment.” He says, “Many professionals don’t know nearly as much about BFRBs as they do about other mental health conditions, and for that reason, access to evidence-based treatment is unfortunately difficult for many folks.” Evidence-based simply means that a particular treatment modality has been proven to effectively treat the condition at hand. Accessing evidence-based care is imperative for any mental illness, as conditions can stall or get worse if not approached correctly.
Habit Reversal Training
The most effective form of treatment for BFRBs is a therapy called habit-reversal training (HRT). HRT has three primary components: awareness training, competing response training, and social support. Awareness training will teach you to identify the circumstances surrounding you when you bite the inside of your mouth: how you feel, where you are, and if any stressors are present. This enables you to anticipate when you’ll start biting and to utilize the tools developed in competing response training.
The second component—competing response training—teaches you to substitute biting the inside of your mouth for a different action. For example, instead of biting the inside of your mouth, you might learn to chew gum or use a mouthguard. Finally, the third component, social support, involves bringing loved ones into your treatment plan. They can help you notice when you’re biting the inside of your mouth, and by sharing the process with them, you can let go of the shame and isolation surrounding your behavior.
Comprehensive Behavioral Intervention
Another treatment that has proven useful is the comprehensive behavioral model (ComB), which Dr. Farrell says is not “a fundamental shift away from HRT, but rather builds on the foundation that HRT created.” It takes a more individualized approach to the treatment of BFRBs. ComB treatment has four components: assessment, identifying and targeting domains, implementing interventions, and evaluation. In the assessment portion, the therapist and you would determine what function biting the inside of your mouth serves as well as the internal and external factors that trigger it. Assessment is guided by five factors that have been identified as triggers for BFRB occurrences: sensory (physical sensation), cognitive (thoughts), affective (emotions), motor (behavior), and place (environment). To remember these factors, the acronym SCAMP is used.
Once both you and your therapist are knowledgeable about the why, how, and when behind biting the inside of your mouth, you work together to determine which SCAMP factors need to be targeted. You would determine what makes the behavior persist and what needs to change for the behavior to change. For example, you might realize you bite the inside of your mouth when you watch television. You and your therapist would then focus on that environment when devising strategies for alternate behavior.
After the assessment and identification of target domains have been completed, you and your therapist work together to develop individualized strategies that address that “why” behind biting the inside of your mouth. Because this treatment is so individualized, strategies vary widely but may include: learning healthy coping skills, cognitive restructuring (learning to change unhealthy thinking patterns), competing response training (as used in HRT), and sensory substitutions, such as chewing gum, sucking on a mint or hard candy, or keeping water nearby and taking a sip whenever you have the urge to bite.
When practiced in conjunction with the above strategies, mindfulness is a useful tool in recovering from a BFRB like biting the inside of your mouth. Mindfulness is the practice of being aware of your thoughts and feelings, and is encapsulated in the awareness training and assessment components of HRT and ComB, respectively. The opposite of mindlessness, it prompts you to live with intention, purpose, and awareness. This skill will serve you in knowing when and why you bite the inside of your mouth and can be utilized in all areas of your life to help you become more present and self-aware.
The bottom line is good news: you are not alone in this experience, and there are treatments designed to help you stop biting the inside of your mouth. For further education, resources, and support, check out The TLC Center for Body-Focused Repetitive Behaviors (you can also find a provider directory here), podcast episode “8 Tips to Manage Your BFRB” from Kimberley Quinlan’s Your Anxiety Toolkit, and this BFRB Support Group supported by the International OCD Foundation.
You can also access evidence-based HRT treatment with specialty-trained therapists at NOCD. All of our therapists have received training in treating BFRBs with HRT therapy, and can help you regain control over your biting behaviors. Schedule a free 15-minute call with the NOCD Care team to get started.