In moments of idleness or stress, you find yourself chewing on your fingers or fingernails. Maybe you make yourself bleed, maybe it’s painful, but you can’t seem to stop. You might not even be aware of it all the time—it’s likely a habit that has become automatic. Perhaps a loved one points out that you’re doing it, or perhaps you do it in secret, feeling embarrassed or ashamed. It’s possible the habit formed in childhood, proving itself as a longtime comfort, even if you can’t remember exactly why or when it became comforting.
There’s a name for this behavior: body-focused repetitive behavior (BFRB). You may have heard the act of chewing on your fingers and fingernails dismissed as being just a “nervous habit,” but that fails to capture the damaging nature of BFRBs. Read on to learn about the symptoms of a BFRB, when to seek help, and how you can get better, based on advice from Dr. Nicholas Farrell, a licensed psychologist, Regional Clinical Director at NOCD, and BFRB expert.
Why are you chewing on your fingers?
A body-focused repetitive behavior consists of any repetitive act performed on your body, such as chewing your fingers/fingernails, picking at your skin, or pulling at your hair. It often causes skin lesions, distress (after the initial relief of performing the behavior), and people feel unable to stop. BFRBs consist of body-against-body contact—note that self-harm is not considered a BFRB. Other symptoms you might experience with BFRBs include:
- Medical complications from chewing on your fingers/fingernails, such as infections, open wounds, scarring, and scabbing
- Attempts to hide your fingers, such as by pulling your sleeves down over them, so that family and friends can’t see how much you’ve been chewing on them
- Shame and embarrassment over chewing on your fingers and how they look as a result
- A heightened urge to chew on your fingers during times of stress
- A heightened urge to chew on your fingers during times of overstimulation, sensory overload, or understimulation
There’s no definitive answer to what causes of BFRBs, but research has shown that those with immediate family members who have a BFRB are more likely to experience one themselves, indicating that there may be a genetic predisposition. Even if predisposition plays a role, it is widely believed that there are other factors involved in whether or not a BFRB will emerge, like environmental stress, temperament, and age of onset. BFRBs most often develop in late childhood or early adolescence, but they can appear in adulthood, too.
BFRBs can also coincide with other mental health conditions like anxiety, depression, obsessive-compulsive disorder (OCD), attention-deficit hyperactive disorder (ADHD), or autism. Dr. Farrell stresses that secondary disorders, such as depression or social anxiety, can also arise from the impact that BFRBs have on one’s life. He illustrates this example, “Because of their BFRB, someone is no longer comfortable engaging in social interactions or valued living activities, like spending time with family and friends. Naturally, by virtue of not being able to connect with those valued living activities, they are probably going to experience some degree of depression,” he says. In some cases of BFRBs, he continues, the end result of that behavior, such as scabbed or bloody skin, “becomes very visible to others, and that can give rise to anxiety in social settings like school or similar environments.”
BFRBs are categorized in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as “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 involve certain acts or behaviors that feel as if they’re beyond one’s control, but the motivation behind them is different. In OCD, compulsions are driven by distressing and intrusive thoughts, images, feelings, sensations, or urges, and compulsions are performed in order to find relief from the resulting distress. People with OCD do not like engaging in their compulsions.
BFRBs, on the other hand, are not typically driven by intrusive triggers. Rather, they are done to relieve someone of negative physical sensations or feelings, and can serve as a tactic for self-regulation, whether sensory, emotional, or both. There is often a sense of comfort that one gets while engaging in these behaviors. Though one can have OCD and a BFRB at the same time, the distinction is important because they actually require different forms of treatment to find relief.
How do you know when to seek treatment for chewing on your fingers?
If you’re wondering how to determine whether this is something that might benefit from professional help, and if it’s more than just a “nervous habit,” here are some signs that it’s time to seek treatment:
- You are causing your fingers to bleed, scab, scar, or be otherwise damaged
- You feel out of control when it comes to chewing your fingers
- You want to hide the habit from others
- You feel a sense of shame or embarrassment around the behavior
- It’s impacting your daily life and functioning in any way
- It’s causing you to feel depressed
Remember—you don’t have to “just live with” any behavior, experience, or condition that brings you distress or hinders your functioning. Sometimes, if we’ve been dealing with a condition or experience for an extended period of time, we have the tendency to get used to it and believe that it’s an unavoidable fact of our lives, 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 your fingers?
I asked Dr. Farrell what step one is in getting help for a BFRB. He says: “Reaching out and making contact with a provider or resource where one can access evidence-based treatment.” He says that BFRBs are one of the more misunderstood mental health conditions, and therefore, access to evidence-based care can be a challenge.
If you were to seek treatment from somewhere that does not have experience treating BFRBs using one of the evidence-based treatments listed below, your progress is likely to stall. During the brief consultation that most therapists offer to ensure they’re a good fit for you, ask what their experience is working with BFRBs and what modalities they use to do so. Their response should involve one of the following treatment models.
The longest-standing treatment for BFRBs is a form of therapy called habit reversal training (HRT). HRT has three primary components: awareness training, competing response training, and social support. Awareness training teaches the sufferer to identify the circumstances surrounding them when they perform their BFRB, meaning how they’re feeling and where they are. This enables the individual to anticipate when the behavior will occur and utilize the tools developed in the second stage: competing response training. This component teaches one to substitute their BFRB for a different response. For example, instead of chewing on your fingers, you might learn to gently squeeze hands into fists or play with a fidget tool. The third component—social support—involves bringing loved ones into your treatment plan. They can help you notice when you’re performing your BFRB. By sharing the recovery process with them, you can begin to let go of the shame surrounding it.
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, identify and target domains, implement interventions, and evaluation. The assessment portion consists of working with a therapist to determine what function the BFRB serves for you, as well as the internal and external factors that trigger it. Assessment is guided by five factors that have been identified as triggers for BFRBs: 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 your BFRB, you can work together to identify which SCAMP factors need to be targeted. Together, you’ll discuss how and why the behaviors occur, as well as why they persist or even get worse over time.
After the assessment and identification of target domains have been completed, you and your therapist will work together to develop individualized strategies that address the “why” behind the BFRB. 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 (i.e., fidgets or fidget tools).
Another tool that one can practice alongside therapeutic intervention—or often with guidance from with their therapist—is mindfulness. Mindfulness refers to the act of being aware but not judgmental of your thoughts and feelings, and is quite similar to the awareness training and assessment components of HRT and ComB, respectively. Mindfulness can be utilized in all areas of your life to help you become more present, accepting, 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 chewing on your fingers. If you think you may be struggling with a BFRB, such as biting or chewing on your fingers, and you’d like to learn more about effective, evidence-based treatment with trained specialists, please book a free 15-minute call with the NOCD Care team.