OCD and Nail Biting: Is There a Connection?

If you bite your nails, you’re not alone: According to research, about 20-30% of the population engages in this habit. It’s more common in younger people, as nail biting tends to subside with age (and, frankly, it probably disappears altogether with dentures).

But what’s at the root of the tendency to chew? Is it a benign bad habit or related to OCD? The answer: It depends.

Getting in the Groove: Why Nail Biting Happens

There are all sorts of reasons why any given individual may bite their nails, getting in the groove of their nail grooves. It may be as simple as learned behavior; children whose parents engage in this habit learn to do the same. People may also do it because they’re bored, hungry, need to fidget, or reacting to medication (which is rare but it does happen). People may even bite their nails because their nail clippers have disappeared into the abyss of their bathroom cabinet and they see their front teeth as just as efficient for a little trimming.

Of course, some nail biters chew because of nerves. This isn’t always indicative of an anxiety disorder or another type of underlying problem. For example, an avid football fan may bite their nails when watching their favorite team but stop biting once the game clock ticks down to zero. An ambitious go-getter may bite their nails when waiting for news about a promotion but stop after they hear from their boss. Someone who isn’t thrilled with the idea of flying may bite their nails during turbulence on a cross-country trip but otherwise never engage.

However, sometimes nail biting is a sign of an underlying concern, such as ADHD or separation anxiety (which is especially common in children). It may be a symptom of obsessive compulsive disorder as well. But whether it is or isn’t due to OCD is determined by the reason behind the chew.

Nail Biting as a Compulsory Act

Nail biting can be a compulsory act, which is one of the reasons it’s sometimes brought up in conversations as a partner to OCD. OCD is a disorder marked by intrusive thoughts and the compulsions aimed at neutralizing the anxiety these intrusive thoughts cause.

The OCD cycle works the following way: 1) The OCD sufferer experiences an intrusive thought (e.g., they touch a doorknob and fear they’ve been exposed to a deadly virus, they hit a bump while driving down the road and fear they’ve hit a pedestrian, they see a number they deem “unlucky” and fear a plane will crash because of it, they hear their partner talking on the phone and assume they’re cheating on them, they fear shouting out vulgarities in public spaces, etc.); 2) The OCD sufferer engages in a compulsion as a way to regulate their anxiety and either stop the thought from coming true or make sure it isn’t already true (e.g., they scour their hands over and over again with soap and hot water, they turn their car around to check for bodies on the road, they think of a “lucky” number to make air travel safer, they ask their partner for reassurance in their relationship, they hold their hands over their mouth when walking through a mall or sitting in a church); 3) The OCD sufferer experiences a temporary surge of relief as a result of their compulsion; 4) The anxiety returns and the cycle starts up again; 5) The OCD sufferer re-engages in their ritual, making the OCD worse with each compulsion.

OCD is, fortunately, rather rare; it’s believed to affect only about 1 in 100 people. By comparison, nail biting is very, very common; almost a third of the population engages in this habit. With these stats, it’s easy to conclude that not every person who bites their nails has OCD. In fact, the vast majority of nail biters do not. Still, that doesn’t mean none of them do. Again, it depends on the why?

If a nail biter is biting their nails as a way to negate intrusive thoughts, because they believe that something bad will happen if they don’t bite their nails, as a way to cancel out disturbing images, or as a way to keep themselves and loved ones safe, then nail biting would certainly be indicative of OCD. These acts are examples of true compulsions and are no different from other compulsions, such as handwashing, counting, asking for reassurance, checking, and avoiding.

When nail biting is used in a ritualistic manner as a way to decrease the anxiety intrusive thoughts cause, it will always make OCD more potent. Engaging in the ritual, just like any ritual, only validates the OCD and makes the intrusive thoughts more powerful and harder to ignore. This results in an increasingly debilitating illness.

Regardless of the above, ritualistic nail biting is probably not overly common in OCD sufferers. Many people with OCD keep their rituals secret, so it’s impossible to know everyone’s routines. But there are certain rituals more common than others and nail biting doesn’t fit into this category.

For one thing, those with contamination OCD, a prevalent subtype of OCD, are highly unlikely to engage in nail biting because fingernails tend to be full of very real germs. People with relationship OCD may be unlikely as well, believing damaged nails could make them unattractive to their partners. People with health anxiety OCD may fear that the bacteria underneath nails could lead to chronic health conditions down the road.

Nonetheless, nail biting does happen as an OCD ritual since nearly anything can happen as a ritual. Rituals are very individualized and OCD sufferers access all sorts of things in an attempt to manage their anxiety. Sometimes, these rituals are at their fingertips.

Nail Biting as a Form of Pleasure

Even when nail biting is done habitually or in a way that appears ritualistic, it may not involve OCD: If it’s done as a way to stop or neutralize OCD, it falls into the obsessive compulsive disorder category; if it’s done for another reason, it falls outside of the OCD boundaries.

One of the most common reasons people bite their nails is because it elicits pleasure to some degree. This pleasure might not be extreme — people don’t make wild and crazy Friday night plans to chew on their thumbs — yet it does offer some sort of satisfaction in many cases.

Animal studies have demonstrated this pleasure component in rats and many people willingly admit that nail biting is something they like to do. This is directly counter to OCD compulsions, as they are not something sufferers find pleasure in (although they do find relief).

For example, someone with contamination OCD may take a 60-minute shower every time they return home. The sufferer does not want to shower for an hour; they get no joy in doing so. Instead, they do it because they fear being out in public has exposed them to various germs and they want to relieve themselves of the anxiety this feared exposure causes them. The shower itself is not a pleasurable experience; conversely, because the OCD sufferer feels that they have to wash just right, making sure to sanitize every square inch of their body, showering can be an unpleasurable experience, even a painful one. It eventually results in relief, which is why the OCD sufferer engages.

This is much different from nail biters who bite their nails because it makes them feel good, releases endorphins, or brings some semblance of gratification. Yet even this can push the limits of normal.

Some nail biters may suffer from pathological grooming, which can show up in the form of nail biting, hair pulling, skin picking, and other ways. This disorder is believed to be related to OCD (and some classify it as a type of OCD).

Similar to the OCD we all know and hate, pathological grooming can drastically interfere with the sufferer’s life and elicit feelings of shame. Pathological groomers often feel that they have no choice but to engage in their compulsion, whether that’s repeatedly picking a scab or plucking strands of hair and eyelashes. Pathological groomers may continue to groom even when it compromises their appearance (via missing patches of hair or scars on their skin).

One important difference is the motivation behind the compulsion. In OCD, the compulsion is fully based on fear (and relieving that fear); in pathological grooming, it’s typically based, in part, on pursuing enjoyment.

Despite some differences, OCD and pathological grooming have enough in common that it’s believed they share similar causes, including problems with serotonin. This may be why some people suffer from both or elements of both.

Along these lines, nail biting can be a form of body dysmorphic disorder (BDD) if that disorder is focused on the hands. The sufferer may believe their nails are imperfect and repeatedly bite them to make them look the way they want. BDD is highly related to OCD, as the two disorders appear together up to 43% of the time.

Splitting the Difference

We can also split the difference between the two above scenarios (OCD sufferers who bite their nails ritualistically and people who bite their nails for alternative reasons). In other words, some OCD sufferers may bite their nails but not as a ritual; they simply bite them for the same reasons the general population does. They bite them because they’re bored, nervous about something, or to elicit pleasure.

But is this bad?

As long as the OCD sufferer does not bite their nails as a way to neutralize intrusive thoughts (or because of a comorbid condition), there aren’t many consequences to the act if it’s only done on occasion.

Short nails might compromise one’s ability to scratch a lottery ticket or open a can of soda, but nail biting shouldn’t worsen OCD as long as it’s not used as an OCD compulsion. However, when nail biting is done with frequency, regardless of the reason, it does come with some risk.

Repeated biting can ruin the nail and leave it structurally damaged or infected to the point where it will no longer grow normally. Nail biting can also leave the biter prone to colds, the flu, and other germ-based illnesses (including COVID) because they frequently put their hands in their mouth. They may suffer from dental problems as well, as the repetitive grind of the nail against a tooth can interfere with enamel, which protects teeth. Some people may crack or chip a tooth if the nail is especially hard (when damaged nails grow back, they tend to be harder and thicker than before).

OCD sufferers who bite their nails as part of their rituals are at high risk of the above. If they’re in an OCD cycle, they’ll bite their nails over and over in spite of any damage they’re inflicting or pain they’re experiencing.

Stopping Nail Biting

People who bite their nails from time to time might not be all that interested in quitting. If their habit doesn’t negatively impact their life, they may very well be fine engaging in it. It may be no worse a habit than drinking the occasional soda or rummaging through the refrigerator for a midnight snack every so often.

But when nail biting has negative consequences, and especially when it’s done as part of an OCD ritual, the biter will benefit from hanging their habit up for good.

Those who bite their nails due to boredom, nerves, or pleasure might be able to stop by trying the following:

• Keeping their nails short so there’s nothing to bite
• Getting regular manicures that emphasize the beauty of the hands
• Applying bitter-tasting nail polish to act as a deterrent
• Covering their nails with Band-Aids, gloves, or tape
• Identifying triggers and employing vigilance
• Stopping gradually (some people are able to stop bad habits by going cold turkey but most find it easier to wean themselves off bit by bit)
• Chewing on something else, such as a stick of gum or a piece of taffy

If nail biting is the result of an OCD compulsion, the above isn’t likely to be effective. Instead, nail biting should be treated the same way OCD, in general, is treated. This includes the following:

• Psychotherapy that’s heavy on Cognitive Behavioral Therapy (CBT) and Exposure and Response Prevention (ERP), although other modalities, such as Acceptance and Commitment Therapy (ACT), are being increasingly used
• Commonly-prescribed OCD medications that increase serotonin or improve chemical signals within the brain, such as Anafranil, Prozac, Paxil, Zoloft, Lexapro, Effexor, and Luvox
• Off-label medications that aren’t typically used for OCD but may improve symptoms by increasing serotonin (one example of this is Tramadol)
• Lifestyle changes, such as getting enough sleep; exercising; eating a diet rich in iron, omega-3s, vitamins, and serotonin-boosting foods (such as turkey, sweet potatoes, and eggs); engaging in mindfulness; and limiting tobacco and alcohol (lifestyle changes aren’t likely to treat OCD on their own but they can help limit the everyday stress that tends to worsen symptoms)
• Transcranial Magnetic Stimulation (TMS), a non-invasive method that uses magnetic stimulation to change brain activity, which was approved by the FDA for OCD in 2018
• Support groups that are subtype-specific, which are particularly helpful for OCD sufferers who suffer from taboo subtypes that can elicit a great deal of shame (such as harm OCD and pedophilia OCD)

In Conclusion

If you’re a nail biter, we’re not pointing fingers at you; it’s a common habit in people from all walks of life. It’s also a habit that may or may not be related to OCD (how’s that for helpful?).

Most nail biters don’t have OCD and most people with OCD don’t bite their nails (at least not as a ritualistic compulsion). But the two can overlap in some individuals, either on their own or due to comorbid conditions. When this happens, nail biting is like any other OCD ritual. It must be stopped before things get out of hand.

References:

https://www.theverge.com/2016/11/13/13597824/why-nail-biting-habit-science

https://www.mayoclinic.org/diseases-conditions/separation-anxiety-disorder/symptoms-causes/syc-20377455

https://impulsetherapy.com/what-does-an-ocd-cycle-look-like/

https://iocdf.org/about-ocd/who-gets

https://impulsetherapy.com/dirty-on-the-inside-mental-contamination-and-ocd/

https://pubmed.ncbi.nlm.nih.gov/530471/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5597179

https://www.smh.com.au/lifestyle/when-grooming-becomes-pathological-20130716-2q17b.html

https://www.sciencedirect.com/science/article/pii/S0031938421001244

https://www.fda.gov/news-events/press-announcements/fda-permits-marketing-transcranial-magnetic-stimulation-treatment-obsessive-compulsive-disorder

https://impulsetherapy.com/how-to-treat-pocd-you-are-not-your-intrusive-thoughts/