Nail biting to be classified as a psychiatric disorder; same category as OCD

Lia Grainger
Shine On
October 3, 2012

If you're a nervous nail biter, chances are good you're used to hearing friends and family tell you to get your fingers out of your mouth. But next year, biting your nails will go from bad habit to psychiatric disorder, because the new edition of the bible of mental illness known as the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM)  that comes out next year will classify nail biting as a form of obsessive compulsive disorder (OCD).

Nail biting along and other pathological grooming habits like hair pulling and cuticle chewing will be grouped in the same category as OCD in the fifth edition of the DSM, reports ABC News. In previous editions, nail biting was placed in a section of the DSM titled "not otherwise classified" where random disorders that didn't fit elsewhere appeared to be dumped.

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On the surface, habits like nail biting would appear to have much in common with OCD, which is characterized by obsessive thoughts that lead to compulsive unwanted behaviours, including hand washing, organizing objects, or checking doors and stoves repeatedly. Both repetitive grooming and OCD habits take a normal behaviour and turn it into consuming ritual that must be performed.

But in at least one way, many therapists find that pathological grooming behaviours are quite different from classic OCD, reports CBS.  The difference is that for many nail biters, skin pickers and hair pullers, there's a feeling of reward that is absent from the repetitive behaviours performed with OCD. For them the action is driven by fear, not reward.

Compulsive hair puller Nicole Santamorena tells ABC News that there was something pleasurable about her habit.

"There is a sensation I get before I pull," Santamorena tells ABC. "It's like a pulsating scalp and if I don't pull, it doesn't go away. It's kind of a compulsion."

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So should nail biters be concerned about their behaviour?

"Nail biting, as with other symptoms, enters the range of emotional or behavioral difficulties when it is experienced by the individual as 'compulsive,'" says Debbie Sookman, director of the Obsessive Compulsive Disorder Clinic at the McGill University Health Centre. The clinic is the only clinic in Canada that specializes in OCD and spectrum disorders.

Sookman defines "compulsive" as when "the person wishes to stop but feels unable." She says nail biting may become a problem that needs treatment if the compulsion is "associated with repeated thoughts about nail biting, takes more than an hour a day and/or causes significant distress, interference, and/or health problems."

In other words, nail biters need not rush out and seek professional help unless the habit is significantly interfering with their quality of life. Still the DSM classifications are taken seriously, not just in the United States but also here in Canada and around the world. It's enough to make nail biters think twice.

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