Obsessive compulsive disorder - OCD treatment and therapy from NOCD

Why you struggle to stop picking your hangnails 

By Erica Digap Burson

Jul 17, 20239 min read minute read

Reviewed byPatrick McGrath, PhD

It’s one of those things that you know you really shouldn’t be doing, but it’s just way too tempting to resist: picking at your hangnails. 

Whether you’re giving yourself a quick mental escape from an uncomfortable situation, feeling bored and fidgety, or just want the satisfaction of getting that dead skin off of your cuticle, picking at hangnails is pretty common. In many cases, this nervous habit is not a cause for concern at all. 

However, if you find that you’re getting to the point where you’re causing serious damage to your nailbeds or hiding just how often you feel the need to indulge in the painful habit, this behavior could be a sign of other underlying issues at play. 

In this article, we’ll explore some of the reasons that you just can’t resist picking those hangnails, and some options that you have if you want to seek help getting a handle on the urge. 

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One of the simplest reasons that people may find themselves messing with their nails is to cope with a stressful situation, as is often the case with people who pick at their nails when they’re dealing with a difficult conversation or an overwhelming workday. 

Nail picking can be a nervous habit or a fidget, particularly if you are feeling anxious or nervous. It could also just be a coping mechanism, or something to do when you’re bored and looking for something to do. It’s also a pretty common behavior. Dr. Patrick McGrath, PhD., NOCD’s Chief Clinical Officer, explains: “Very often, nail picking is a distraction for people. It’s just something to focus on other than the thing that is uncomfortable. That being said, it can be harmful to the nailbed, increase chance for infection, and also just been seen as an undesirable behavior.”

So how do you know if your nail picking is just a bad habit, or if it’s a sign of a mental health issue? 

A seemingly innocuous nail-picking habit can potentially be more serious if the picking becomes a compulsive behavior. It’s especially important to take a closer look if the habit is leading to physical damage, but you still can’t stop doing it. 

As Dr. McGrath explains, “All of us will randomly look at our nails and say, ‘Oh, there’s a little dirt under there’ and grab it with the other nail, and that’s not a big deal at all. Many people fidget and use their hands, and that’s not necessarily a problem either. But when it starts getting to a point where things are getting infected or there’s a line of blood around the nails, but we continue to do the behavior anyways, that’s when we’re looking at a more diagnosable situation.” 

Hangnail picking can be painful at the best of times. But if it’s getting to the point where your constant picking is leading to nail damage and pain, and is disrupting your normal quality of life, you may need to take a closer look. 

What’s a nail picking disorder? 

Nail picking disorder, or onychotillomania, is a type of body-focused repetitive behavior (BFRB). Someone with onychotillomania will habitually and repetitively pick at their fingernails, sometimes to the point of extreme damage to the nail. It’s most common to do this manicuring activity with just your fingers, although it’s not unheard of to use tools like cuticle scissors or nail files. 

BFRB disorders are categorized as OCD related disorders in the DSM-5. BFRB disorders include nail picking as well as other self-grooming behaviors like trichotillomania (compulsive hair pulling) and excoriation (skin-picking disorder). Someone with a BFRB might repetitively and compulsively engage in these behaviors especially if they’re feeling stressed, anxious, or bored. 

BFRBs are thought to be triggered by a buildup of tension, explains Dr. McGrath. People with BFRBs like onychotillomania might feel that buildup until they pick at their nails, which might feel physically good, satisfying, or interesting to them. They might then continue to pick compulsively at their nails in order to experience that same physical sensation.  

Studies have found that nail picking disorder is less common than other related disorders like onychophagia, or nail biting. But in the same vein, nail-picking is also fairly under-researched. As a result, some experts believe that nail-picking disorder is actually underreported, especially when compared to other BFRB disorders like trichotillomania or excoriation. 

Is picking your hangnails a sign of a BFRB or OCD? 

If your nail picking is compulsive and frequent, you might also find yourself wondering if it’s a manifestation of obsessive-compulsive disorder, or OCD. People with OCD experience intrusive thoughts, or obsessions. They then cope with those intrusive and distressing thoughts with compulsions, or repetitive, ritualistic behaviors that are meant to soothe, but only reinforce obsessions. These compulsions may sometimes manifest in behaviors like nail picking. 

So how do you know if your preoccupation with your hangnails is a BFRB or OCD? There are certainly overlaps between BFRB and OCD when it comes to nail picking: both involve repetitive behaviors that you might struggle to control. However, the biggest difference between a BFRB and OCD would be the underlying cause behind the compulsion. 

If someone is repetitively picking at their nails because of a BFRB, they might feel physical tension until they engage in the behavior. Meanwhile, someone with OCD who picks at their nails might be triggered by an intrusive thought that they then seek to relieve through the compulsive behavior. As Dr. McGrath explains, “it probably wouldn’t necessarily be OCD unless there’s an element of symmetry or order involved.” 

He continues: “There’s a lot of drive to do these things until they’re just right. You’re going to play with this nail until everything is just right. But things heal unevenly. For example, one side might scab sooner than another, so then we pull the scab off because we want it to all scab at the same time and in the same way.” 

In other words, someone with a BFRB disorder who picks at their nails might engage in this activity because it feels good to do so, and they may not even be aware that they are doing it. Meanwhile, someone with OCD might pick at their nails more consciously, as a way to make everything seem “just right.” 

It’s important to note that someone who is picking at their nails can have both OCD and a BFRB. However, Dr. McGrath explains that nail-picking in OCD is fairly rare, and the majority of the time, the habit is likely to be a BFRB. 

How to cope with your hangnail-picking habit

Picking at your hangnails might seem innocuous enough, but it can have long-lasting effects on your nail beds if it becomes a habit. Constant picking can cause serious damage to your nail beds and lead to changes in your nail shape and structure. It can also harm your nail folds and cuticles, and may even increase your risk of infections. At worst, severe nail picking may even cause a complete loss of the nail. 

So how exactly can you stop the habit? Again, this also depends on whether it is a simple nervous habit or something diagnosable like a BFRB or OCD. 

For someone who was picking at their nails as a nervous habit, it can help to start by identifying what your triggers are. Someone with a generalized anxiety disorder might also consider getting their anxiety treated by a mental health professional. This can help target the underlying anxiety that causes nervous tics. 

However, if someone’s compulsive nail-picking habit is a BFRB, you would generally approach treatment by doing awareness training to stop the behavior. “There’s usually this premonitory phase where there’s a buildup of tension,” explains Dr. McGrath. “You want to teach people to recognize when that’s happening and to monitor what’s leading to the nail picking. Then you might want them to fight their habit by engaging in an opposing or competing behavior.” 

As an example, he explains that treatment for a nail-picking BFRB is called habit reversal training, or HRT. Treatment plans might include physically discouraging yourself to pick at the nail when an urge comes. So if a patient begins to feel the urge to pick at their nails, they might instead instruct them to spread their fingers apart and hold them in that position until the urge to pick at that nail decreases. 

Another example: some people might be instructed to wear a glove on the hand that they’re picking at so that they can’t do the compulsive behavior. These awareness training exercises make the habit feel different, which ultimately makes patients aware of their behavior when the urge strikes. 

On the other hand, exposure and response prevention therapy (ERP) is the gold standard for the treatment of OCD. This form of treatment works by exposing you to the things that trigger your obsessions and discomfort to give you an opportunity to resist those compulsive responses, such as nail picking. 

Practical tips to stop picking your hangnails 

No matter where your hangnail-picking habit stems from, it can also be helpful to incorporate some practical measures that will physically deter you from messing with your nails. 

To be clear: these tips are not a replacement for therapy, especially if you’re dealing with OCD or a body-focused repetitive behavior. However, they can help you increase your mindfulness and, in some cases, present a physical barrier so that you are less inclined to pick at your nails mindlessly when the compulsion or anxiety strikes. 

For example, wearing a glove or putting bandaids on your fingers can create a physical barrier that actively prevents you from picking at your nailbeds. Keeping your hands busy is another good choice here, especially if your hangnail-picking habit stems from boredom or anxiety. Instead, try fidgeting with another object like a fidget toy to give yourself something else to do that won’t damage your nails. This lets the nail heal, providing the opportunity to then work on decreasing the use of the fidget as well. 

Investing in a professional manicure is also a good option for discouraging mindless picking, since you may be less inclined to mess with your nails if you’ve invested some money and time into making them look good. Dr. McGrath has also seen some people have success with using fake nails, which temporarily prevents people from picking at their nailbeds and gives them time to heal while working on the psychological factors beneath. 

Finally, consider rewarding yourself for not indulging in the bad habit! “This can be highly effective if you really like your nails to be nice, but it doesn’t work when you’re picking at them,” says Dr. McGrath. He explains further: “For every day that you don’t pick your nails, you can put a token in a jar and, when you get so many tokens, you can go get a manicure or another rewarding behavior. You can motivate people toward making some of these changes.” 

Where to find help 

If you are concerned about your nail picking habit and are looking for help, NOCD can help. 

NOCD’s team of providers includes licensed therapists who specialize in treating BFRBs and OCD using HRT or ERP, and have experience with various BFRBs and OCD subtypes. I encourage you to learn about NOCD’s accessible, evidence-based approach to treatment and to learn more about how the NOCD team can help. 

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