Association of nail biting and psychiatric disorders in children and their parents in a psychiatrically referred sample of children

Abstract

BackgroundNail biting (NB) is a very common unwanted behavior. The majority of children are motivated to stop NB and have already tried to stop it, but are generally unsuccessful in doing so. It is a difficult behavior to modify or treat. The objective of this study was to investigate the prevalence of co-morbid psychiatric disorders in a clinical sample of children with NB who present at a child and adolescent mental healthcare outpatient clinic and the prevalence of psychiatric disorders in their parents.MethodA consecutive sample of 450 referred children was examined for NB and 63 (14%) were found to have NB. The children and adolescents with nail biting and their parents were interviewed according to DSM-IV diagnostic criteria. They were also asked about lip biting, head banging, skin biting, and hair pulling behaviors.ResultsNail biting is common amongst children and adolescents referred to a child and adolescent mental health clinic. The most common co-morbid psychiatric disorders in these children were attention deficit hyperactivity disorder (74.6%), oppositional defiant disorder (36%), separation anxiety disorder (20.6%), enuresis (15.6%), tic disorder (12.7%) and obsessive compulsive disorder (11.1%). The rates of major depressive disorder, mental retardation, and pervasive developmental disorder were 6.7%, 9.5%, 3.2%, respectively. There was no association between the age of onset of nail biting and the co-morbid psychiatric disorder. Severity and frequency of NB were not associated with any co-morbid psychiatric disorder. About 56.8% of the mothers and 45.9% of the fathers were suffering from at least one psychiatric disorder. The most common psychiatric disorder found in these parents was major depression.ConclusionNail biting presents in a significant proportion of referrals to a mental healthcare clinic setting. Nail biting should be routinely looked for and asked for in the child and adolescent mental healthcare setting because it is common in a clinical population, easily visible in consultation and relatively unintrusive to ask about. If present, its detection can then be followed by looking for other more subtle stereotypic or self-mutilating behaviors.

Onychophagia and Onychotillomania: Prevalence, Clinical Picture and Comorbidities

“…Joubert (39) using the manifest anxiety state ascertained that higher manifest anxiety scores received nail biters who regarded their behaviour as a serious problem. Ghanizadeh (40) investigated the comorbidity of some mental disorders in 63 children with nail biting and found that one of the most common comorbid mental disorders was separation anxiety; however, no other anxiety disorders were examined. To the best of our knowledge no study investigated the comorbidity of nail biting and anxiety disorders in early adulthood.…”

Evaluation of Cutaneous Findings in Children and Adolescents with Attention Deficit Hyperactivity Disorder: A Preliminary Study

“…The most frequent finding in patients with ADHD in this study was onychophagy. In a previous study, at least one major psychiatric comorbidity was detected in more than two‐thirds of patients with onychophagy and ADHD was present in 74.6% . Acute or chronic traumatic skin changes were detected in approximately one‐third of patients.…”

Habits- A contemporary review

“…The deformity reaches maximum when discrepancy between maxillary and mandibular incisors become equal to the thickness of the lower lip. This habit is related to dryness and inflammation of lip and in severe cases will cause vermilion hypertrophy and in some people can cause chronic cold sore or lip crack (Ghanizadeh A, 2008 …”