Understanding Nail Picking: Causes and Effects

Nail picking, otherwise known as Onychotillomania, is a compulsive disorder where a person constantly picks or tears at their nails (finger and toenails). This differs from nail biting which is known as Onychophagia. While nail picking and biting are often associated with children, these habitual behaviours can extend into adulthood. Often this condition is under-reported. Patients may be reluctant to disclose self-manipulation or self-trauma to the nail/s, or they may not be aware of nail picking habits if it is done unconsciously. Nail picking is body- focused repetitive behaviour often associated with anxiety or obsessive-compulsive disorder. People with Onychotillomania feel an overwhelming urge to pick at their nails and find it difficult to resist the urge.  They may be triggered by a rough or jagged nail, uneven nails, or if the nails feel different from one another. Eventually, this condition can lead to nail deformities, chronic infections, and pain due to the repetitive trauma inflicted on the nails.

Some Common Signs of Nail Picking:

• Ragged nails due to persistent picking or biting

• Bleeding or sore skin around the nail. For example, the cuticles may become damaged, red, swollen and in some case may be absent

• Nail deformities over time, such as ridges or pitting

• Increased risk of infection (bacterial or fungal) due to open wounds

Managing onychotillomania involves addressing both the physical damage to the nails and the underlying psychological factors.

Treatment can include:

• Behavioural therapy (e.g., cognitive-behavioural therapy or habit-reversal training)

• Nail protection such as bandages, topical treatments, bitter polishes, or wearing gloves to reduce access to the nails

• Nail Care by a Podiatrist: Regular medical pedicures, moisturizing creams, and nail-strengthening treatments can promote healing and reduce the temptation to pick.

• Psychological counselling or referral to mental health professionals. For patients with severe or chronic nail-picking behaviour, referral to a psychologist or psychiatrist for further assessment and treatment may be necessary.

In podiatry, supporting patients with nail picking can involve managing damaged nails, offering practical nail care solutions, and collaborating with mental health professionals for comprehensive care. If you or a family member show signs of nail picking, please contact us at Relief Podiatry.