My nail-biting habit is taking over my life

I have been biting my nails for many years but in recent months the problem has become more stressful, damaging and time-consuming. I now bite the skin around my nails, which causes visible physical damage; sometimes I even have to apply a plaster. I’ve tried everything I can to stop — anti-nail-biting chemicals, sitting on my hands, elastic bands to play with on my wrist and stress balls — but eventually I have to start biting again.

I know that about 45 per cent of people my age have the same habit, but this is affecting me personally, mentally and physically, more than I can cope with. I don’t know what to do.
Richard

A. Nail-biting is also known as onychophagia. Over the years psychotherapists have had a field day explaining the reasons for it, ranging from an impaired mother-child relationship to hostility turned inwards or self-mutilation.

Most commonly it is understood as a parafunctional activity and an oral compulsive habit related to an underlying psychological and emotional state, usually anxiety or boredom. It becomes an entrenched habit, often undertaken unconsciously and therefore difficult to break. In the mental health diagnostic manuals it is described as an impulse control disorder and is classified under obsessive-compulsive and related disorders.

Onychophagia is part of a group of pathological grooming behaviours including trichotillomania (hair-pulling), excoriation (skin-picking), and dermatophagiak (skin-biting). It is also associated with bruxism (teeth-clenching and grinding) and other repetitive oral habits such as pen-chewing and cheek-biting. In children, nail-biting most typically occurs with attention deficit hyperactivity disorder and with obsessive–compulsive disorder. As you describe, the habit can cause physical harm including infections of the nail bed and wear on the teeth. Ingestion of the nails can also cause harm in the digestive tract.

Many would wonder why such a habit can’t be broken simply by using bitter-tasting polish (denatonium benzoate), wrist bands that can be snapped when the nail biting starts or stress balls to keep the hands and fingers busy. Yet for some these approaches are not effective. The habit is often used in times of stress and anxiety and can then cause further stress and anxiety as it provokes a sense of guilt and shame, affecting confidence. Nail-biting therefore is a negatively self-reinforcing behaviour.

Like anything used to relieve stress, stopping the nail-biting increases agitation and only when nails are bitten does the person feel relief (the same experience is often described by those who self-harm when anxious and unhappy). It is often associated with perfectionist personalities where anxiety levels are high owing to a fear of not being good enough and of making mistakes. The habit then becomes a coping strategy and a functional behaviour. You describe your life as relatively stress-free, but given that you are in the middle of A levels, I wonder whether your stress levels are high and this is why the habit is so relentlessly strong at the moment.

Trying to suppress the behaviour leads to a rebound effect thinking of not doing a compulsive behaviour increases stress levels as the sufferer becomes more vigilant, in turn increasing the need to do it to manage the stress. So rather than thinking about not nail-biting, explore why you do it (for example, to manage stress and anxiety) and focus on creating a substitute behaviour, such as learning relaxation strategies (see the NHS video at tinyurl.com/zdx3v66).

To replace a behaviour you must find a way to notice that it is about to happen so you can then replace it with a new strategy. Research at the Israel Institute of Technology shows that visual cues to remind us not to nail-bite are better than aversive techniques such as bitter-tasting polish. Examples include painting nails in bright colours, putting coloured stickers on the ends of fingers, wearing brightly coloured bracelets that catch the eye as the fingers go towards the mouth and putting henna patterns on the backs of hands.

Also, notice the context when you nail-bite and what triggers your stress and anxiety. Think about why travelling and social situations might be a challenge for you — perhaps you feel socially awkward? As you understand your behaviour in more detail you can devise strategies to eliminate some of the triggers and substitute behaviours in different contexts. If you find you nail-bite when watching TV, for example, you could wear gloves or a sports mouthguard, which will make the habit impossible. By cutting down the contexts where you nail-bite you will feel a sense of mastery, so keep a diary or use a nail-biting app to record your progress.

As with breaking any habit, the challenge is maintaining that change, and it is common to relapse. Do not beat yourself up about this, but instead analyse what has triggered the relapse and examine ways to address the stress and anxiety with guided meditation and relaxation (eg, headspace.com) and online anxiety management guides and techniques (eg, www.moodjuice.scot.nhs.uk/anxiety.asp).

Talk to friends, distract yourself when you feel the urge to nail bite and make sure you sleep and eat well and take regular exercise. For professional help, talk to your GP or go to bps.org.uk where you can find clinical psychologists who offer cognitive behaviour therapy to help you. Let me know how you get on.

If you have a problem and would like Professor Tanya Byron’s help, email proftanyabyron@thetimes.co.uk