ONYCHOTILLOMANIA

By Gary M. White, MD


Onychotillomania, or nail-picking disorder, is defined as self-induced damage of the nail. It is distinguished from onychophagia which is excessive biting of the nails. The word onychotillomania is derived from Greek onycho (nail), tillo (to pull), and mania (madness). Behaviors described include recurrent picking or pulling and the manicuring of fingernails and/or toenails leading to onychodystrophy. Although patients often use their own fingers or fingernails to manipulate other digits, they may also use tools such as pliers or scissors to destroy the nail plate.

In contrast to onychophagia, onychotillomania may signify an underlying psychiatric disturbance.

Clinical

The nails may be dystrophic in a variety of ways. Clues to the diagnosis of onychotillomania include asymmetric involvement of nails, bizarre architecture of the nail plate, anonychia, macrolunula, melanonychia and/or hyperpigmentation of proximal nail folds, and trauma (e.g., erythema, erosions, excoriations, chronic paronychia) of the hyponychium and nail fold.

Treatment

Referral to a psychiatrist is in order. One of the most effective interventions is behavioral modification (habit reversal) therapy. With the aid of a therapist, the patient learns to identify problematic behaviors (i.e., manipulating nails) and the ways they can be predicted and modified. Patients learn to anticipate the situations in which these behaviors are likely to occur and induce a simple competing response immediately before the onset of the behavior.

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