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Nail biting is a common habit in children. In most cases, it is of cosmetic concern only; however, if not controlled, it can lead to serious morbidity. A case is presented of a child who developed osteomyelitis of a distal phalanx as a result of chronic nail biting.
Twenty-five adult subjects with severe morbid onychophagia (nail biting) and no history of obsessive-compulsive disorder were enrolled in a 10-week double-blind cross-over trial of clomipramine hydrochloride and desipramine hydrochloride. For the 14 subjects who completed the study, clomipramine hydrochloride (mean +/- SD dose, 120 +/- 48 mg/d) was superior to desipramine hydrochloride (mean +/- SD dose, 135 +/- 53 mg/d) in decreasing nail biting as measured by a repeated-measures analysis of variance on the Nail Biting Severity, Nailbiting Impairment, and Clinical Progress scales. The high dropout rate at every stage of the study was in sharp contrast to that seen with psychiatric populations. From a neuroethologic perspective, similar biologic systems are hypothesized to mediate a spectrum of grooming behaviors, including onychophagia, trichotillomania, and obsessive-compulsive disorder.
Trichotillomania is a form of traction alopecia resulting from compulsive repetitive removal of one's own hair. This entity can mimic the clinical appearance of many other forms of hair loss including alopecia areata, androgenetic alopecia, and tinea capitis. It is important to differentiate trichotillomania from other forms of alopecia because its treatment is quite different. We present three cases of trichotillomania demonstrating the "tonsure pattern" or "Friar Tuck sign" and onychophagia (nail-biting), which we describe as clinical identifying features of this syndrome.
Examination of individuals affected by onychotillomania led us to describe a new cause of longitudinal melanonychia (LM) of the finger-nails. Damage of the finger-nails was caused both manually and by chewing. The nail cuticles were usually pushed back, and biting caused pressure damage of the base of the nail. It is likely that finger-nails respond similarly to toe-nails and the matrix melanocytes can be stimulated by trauma. Such stimulation can apparently persist long after cessation of the trauma. Histological examination of the nail plates demonstrated that the pigment was melanin. In the matrix an increase in melanin content of melanocytes was found without melanocytic proliferation. LM due to onychotillomania should not be overlooked.
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Parents are frequently concerned about their children's behaviour patterns, especially if they are repetitive or stereotyped. These patterns are important: they are common in children with normal psychological status, but they may also occur in children with developmental problems or emotional difficulties, or may be secondary to physical disorders.
A statistical study was carried out to evaluate the circumstances of the oral habits of the children aged 3-15 yr. (423 boys and 379 girls, 802 children in total) in a mountain village through psychological tests and investigation of the living environments of children and their parents. The following results were obtained: 1. The peak age of finger sucking was 3 years with girls (35.7%) and 4 years with boys (22.2%). After these ages a tendency to decrease in frequency was observed. 2. The peak age of the nail biting was 11 years in girls (26.5%) and 10 years in boys (18.8%). However, the nail biting was observed in girls from infancy. 3. The peak age of bruxism was 7 years in boys (22.7%) and 4 years in girls (15.4%). 4. Based on sex, nail biting was found more with girls than with boys, on the other hand, bruxism was found more in boys than in girls. There was no difference in finger sucking. 5. Based on the analysis of the relationship between oral habits and personality characteristics, nail biting and bruxism showed a tendency towards a low percentile in almost all of the items of personality characteristics, however, scarcely any relationship was found in finger sucking. 6. Based on the analysis of quantification type III, the development of each oral habit showed a relationship to different personality characteristics. 7. In relation to the living environments, the nail biting occurred more in children whose mothers did not work than with those whose mothers worked, and bruxism occurred in the children who often play outdoors.
A study was carried out on the incidence and possibility of collective treatment of non-occlusal parafunctions in 216 elementary school children aged 7-14 years. Two objectively detectable non-occlusal parafunctions were analysed: nail-biting and pencil-biting. The study included four meetings during which the fingernails and pencils were inspected in all children and a talk was given, explaining the harmfulness of motor habits in the masticatory system, and the children with these habits were told to replace them with other non-harmful movements as habits. Among 216 children 131 (60.6%) had such non-occlusal parafunctions with nail-biting in 51.9% of them, and pencil-biting in 31%. In 22.2% both habits were found. During the third control visit the overall incidence of both parafunctions was found to be decreased, from 60.6% to 37.9%. Elimination of nail-biting was obtained in 37.5% of cases, and pencil-biting in 64.2%, with the proportions of treated children varying in various classes. The study showed that nail-biting and pencil-biting are widely spread habits in the studied population and that collective treatment of these parafunctions is possible.
The purpose of this study was to attempt to correlate possible etiologic factors with the occurrence of occlusal tooth wear in a young Saudi population. The material comprised 90 individuals with a mean age of 22 years within a range of 19-25 years. A dentition wear index, in addition to anterior and posterior wear subindices were derived from tooth-by-tooth evaluations of casts. Factors found to correlate significantly with increased occlusal wear were bruxism, biting habits such as pen- and nail-biting, use of an indigenous chewing-stick called miswak, and high intake of fruit juices. There was no correlation between subjects from differing geographic and/or climatic habitats and the severity of tooth wear. The common element of a harsh desert terrain may constitute the dominant passive abrasive etiologic factor in the present sample.
This study compared two methods of treating nail-biting. One method involved the use of a mild aversive stimulus in which subjects painted a bitter substance on their nails, and the other required the subject to perform a competing response whenever they had the urge to bite or found themselves biting their nails. Both methods included self-monitoring of the behaviour, and a third group of subjects performed self-monitoring alone as a control condition. The study lasted four weeks. Twenty-one subjects, seven per group, participated. Both methods resulted in significant improvements in nail length, with the competing response method showing the most beneficial effect. There was no significant improvement for the control group. The competing response condition also yielded significant improvements along other dimensions such as degree of skin damage and subjects own ratings of their control over their habit. These were not seen for the other two conditions. The benefits of this abridged version of Azrin and Nunn's (Behaviour Research and Therapy, 11, 619-628, 1973) habit reversal method in terms of treatment success, use of therapist time and client satisfaction, are discussed.
In order to discourage her habit of nail biting and to repair her damaged nails, a 50-year-old woman sought cosmetic improvement in a beauty salon, where a manicurist suggested the use of sculptured nails. A permanent paresthesia resulted from this procedure without allergic reaction.
The relationship between childhood onychophagia (finger-nail biting) and the mean age of suicidal and nonsuicidal veterans was investigated among 70 V.A. hospitalized males, diagnosed as personality disorders. The results show that the mean age of suicidal veterans was significantly lower than that of nonsuicidal veterans, and the childhood onychophagia variable, "focal suicide," significantly lowered the mean age of suicidal veterans, but did not significantly lower the mean age of nonsuicidal veterans.
The research has investigated the occurrence of somatic and behavioural disorders in 100 hospitalised children. A hundred subjects, 55 males & 45 females, aged between 6 and 14 years were asked to fill in questionnaires. These, which were of a completely new type, related to 12 situations in a typical day. The results showed statistically significant differences between the two sexes. Girls manifested a much higher percentage of disorders than did boys. Further, young children and especially pre-adolescents (subjects aged 10-11) manifested more disturbances than did those in the adolescent category. Of the subjects 32% showed a number of disorders below the norm; 36% of the cases were within normal values, 17% were above the norm and the remaining 15% of the subjects were considered to be of particular interest. The most frequent somatic disorders were in heart-rate variations, abnormal sweating (especially of the hands when being orally tested at school), abdominal-aches and headaches. Of the behavioural disorders the most frequent were in the inability to stand still and nail-biting. Also worthy of note, though less frequent, were disorders in eating and in sleeping. It was especially at the end of the day ("before going to sleep") that all these problems occurred. They were also frequent, however, during the periods "at school", "during oral tests" and "watching television". The results obtained in parallel research on 125 primary school children confirm all of the above findings.
Emphasis is brought to similarities between informations collected from the study and treatment of patients suffering from nail biting and trichotillomania, by behavioural treatment and the concept according to which such troubles are "tics", learned responses which will become non adapted, present in a given situation, reinforced by time and progressively more resistant to extinction on the one hand, and ethological concepts which consider those behaviours as displacement of activity such as "grooming" in primates, ritual activities, free from nutritions activities, triggered by some attitudes and facilitated by the presence of fear affects, aggressivity or sexual drive.
In children a "normal" aggressiveness should be distinguished from "hostile" and "inhibited" aggression; the latter usually become apparent as heteroaggressive or autoaggressive behaviour. Autoaggression is more common with younger children. Different hypotheses about the origin of aggressiveness are discussed. In the younger child nail biting, trichotillomania, rocking, an intensified phase of contrariness and enkopresis may have components of aggressiveness. In older children and adolescents dissocial forms of development, drug taking, attempted suicid, and anorexia nervosa may be parts of aggressive behaviour. Minimal brain dysfunction, autism, and postencephalitic syndromes predominate amongst organic alterations of the brain as causes for aggressive behaviour. Particularly the Lesch-Nyhan-syndrome, but equally the Cornelia de Lange-syndrome show autoaggressive tendencies.