Do You Bite Your Nails or Pick at Your Skin? New Research Says This Simple Trick Might Help

• Gently touching your arms and fingertips could help you stop biting your nails, picking your skin, or engaging in other body-focused repetitive behaviors, a new study has found.
• More than half of the study participants who tried the technique, known as habit replacement, said they saw improvement.
• The technique could be helpful for people who can't see a mental health professional for treatment for BFRBs, experts said.

A simple technique may help people who engage in repetitive behaviors such as fingernail biting, skin picking, and hair pulling, according to a new study.

The research, published last month in JAMA Dermatology, found that making gentle circling motions on certain body parts throughout the day could reduce body-focused repetitive behaviors (BFRBs)—the clinical term for motor habits that become compulsive. An estimated 3% of the global population has a BFRB, according to the TLC Foundation for Body-Focused Repetitive Behaviors.

People might dismiss these behaviors as harmless, but they can lead to serious consequences, Steffen Moritz, PhD, a researcher in the department of psychiatry and psychotherapy at the University Medical Center Hamburg-Eppendorf in Germany and the study’s lead author, told Health.

“There are a number of published cases of life-threatening incidents following sepsis after skin picking and clumps of digested hair in those who eat their pulled-out hair,” Moritz said. “Fortunately, these cases are rare, but BFRBs are not a minor problem across the board and can lead to depression and low quality of life, for example by avoiding intimacy.”

The gold standard for treating BFRBs is cognitive behavioral therapy (CBT), which aims to help a patient identify circumstances and thought patterns that may trigger BFRBs. However, many people don’t seek it out or can’t access it due to a lack of insurance or long appointment wait times. Experts said the strategy examined in the new study—a habit replacement technique—could be especially helpful for people with BFRBs who haven't had the opportunity to receive mental health treatment.

 “I think something like this could be a great way to start to break the cycle,” said Thea Gallagher, PsyD, a clinical psychologist at NYU Langone Health.

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What Is a BFRB?

Other examples of BFRBs include cheek or hair chewing and knuckle cracking. These body-focused behaviors are often triggered by circumstances, Susan Albers-Bowling, PsyD, a psychiatrist and psychologist at Cleveland Clinic, told Health. “At the heart of it, it’s a way of coping with negative emotions, stress, or tension,” she said.

Not everyone who occasionally bites their nails or picks their lip needs mental health treatment, Vanessa Litoff, PsyD, an assistant professor in the department of psychiatry and behavioral health at the Icahn School of Medicine at Mount Sinai, told Health. “BFRBs are considered clinically significant—and more than just a nervous habit—when they cause emotional distress, are experienced as beyond that person’s control, and become disruptive to their life,” said Litoff.

They often take a toll on both the mind and body. “Because of the recurrent nature of BFRBs, they often have unwanted physical consequences," she said. "This ranges from physical pain, bruising, and bleeding to scarring, hair loss, and infections.” In extreme cases, BFRBs can lead to fatal medical problems, she added.

"It can be really distressing when you feel like you can’t control something you want to," Gallagher told Health. People often think they will be able to quit the behavior with ease, but it's "so much more difficult than that," she said.

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How the Circling Technique Fits in With Current Treatment

Aside from CBT, there aren’t many options for treating repetitive behaviors. Antidepressants such as selective serotonin reuptake inhibitors (SSRIs) may help some patients, but researchers haven’t pinpointed a medication that consistently produces effective results in studies. 

Compounding the issue is a lack of access to mental health care or embarrassment around having the disorder. “People with BFRBs are often ashamed of their behavior and do not seek treatment,” Moritz said.

Such barriers make alternative remedies an attractive solution, experts said. Moritz said that fidget toys, often recommended for people with BFRBs as a substitute behavior, inspired his team to examine a different habit replacement technique.

“We wanted to teach a simple behavioral loop that is inconspicuous, easy to implement, self-soothing, and, most importantly, not harmful,” he said.

For the six-week study, the researchers recruited 268 people from social media who said they had a BFRB. They told half of them that they were on the waiting list for a new BFRB treatment, and instructed the rest to do the circling techniques at least twice a day, and anytime they felt the urge to pick, pull, or bite. 

They were given a manual and shown a video demonstrating the various techniques, which included crossing arms and making circles on the forearms or using the index finger to circle the tip of the thumb. Crucially, the instructions directed participants not to apply pressure or touch their nails to their skin.

Almost 53% of participants introduced to the technique reported improvement after six weeks. Only 19% of people in the control group said they saw improvement during this time, leading the researchers to believe the treatment was effective for some participants.

The study was limited in two ways, the authors wrote: There was no verification that participants had received a formal BFRB diagnosis, and the researchers didn’t follow up with participants after the study to determine whether the strategy helped long-term. For this reason, researchers should conduct future studies on habit replacement techniques, said Moritz.

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Who May Benefit From Habit Replacement Techniques?

The habit replacement techniques outlined in the study could help anyone who struggles with a BFRB but doesn’t work with a mental health professional, said Gallagher.

She said it’s important to remain patient because it can take time to stop your repetitive behavior. “It’s not going to go away overnight,” she said, adding that it's important to celebrate even incremental improvement. “Even if you only do [a habit replacement technique] 10 percent of the time, that’s still a reduction in the behavior."

That said, Albers-Bowling acknowledged that not everyone who tries the circling technique will see improvement. “The effectiveness can vary depending on the individual and the severity of their BFRB,” said Albers-Bowling.

She advised making an appointment with a cognitive behavioral therapist or adding yourself to a waitlist if the habit replacement technique doesn’t work for you.

“Because BFRBs can be an unseen and sometimes hidden problem, it can cause people to feel painfully alone," said Litoff. "It’s important that people going through this are given the message that this is not uncommon, there is treatment, and change can happen.”