AP Features, September 11th, 2007
Do you find your fingers drifting into your mouth when you're nervous, anxious or just bored? Are your nails chewed to splinters or your cuticles gnawed to bleeding pulp?
Nail biting is more than a bad habit. Doctors say it is one of the most common symptoms of stress or of an obsessive-compulsive disorder, especially for teenagers or younger children, and can lead to disfigurement and serious infection.
Alain-Raymond van Abbe, a former health industry and cosmetics promoter, estimates the world's pathological nail biters number 600 million or more. He saw that onychophagy was so widespread that he has opened a clinic devoted to curing nail biters.
"In four weeks, nail biting can be over _ and over forever," he says.
Studies show around 45 percent of adolescents nibble their nails. That figure drops to about 20 percent as young adults learn to cope with their anxieties or become too embarrassed by their self-inflicted deformity.
In public, compulsive biters typically keep their hands out of sight as much as they can, buried in their pockets or behind their backs. Often they feel depressed and shamed, and avoid social contact. Van Abbe says his patients suffer so much from the stigma that none would volunteer to be interviewed or photographed.
He estimates that Holland alone has 2 million chronic sufferers, enough to keep his clinic busy and profitable. He charges up to euro500 (US$670) for a course of treatment.
Van Abbe, whose background is in marketing rather than medicine, has worked for a U.S. cosmetics company and campaigned to heighten awareness of early breast cancer scanning. He describes himself as a problem solver.
After developing his solution over two years and working with about 150 pilot patients, Van Abbe refitted a gabled brick house in Venlo, near the German border, with reclining leather manicurists' chairs where cosmeticians can begin reviving damaged finger and toe nails.
Van Abbe says biting is an illness that can spread infection to the point where nails must be pulled off and even the fingertips are at risk.
Nail biting is among obsessive-compulsive disorders known as body-focused repetitive behaviors that is gaining more scientific attention. Other BFRBs include hair pulling, skin picking or incessantly biting the inside of the cheek.
Most research on nail biting focuses on the psychological stress and on the therapies that treat the source of the problem, said Lawrence S. Micheletti, an assistant professor of psychiatry at the University of Texas Medical Branch.
But there's a chicken-and-egg question because the ugly result of self-mutilation heightens anxiety. "If you cure the symptom, you reduce the stress, and the person is a happier person," Micheletti said by telephone.
The literature on nail biting says it may have a genetic component, and Van Abbe found during his two-year pilot project that 95 percent of his patients had at least one parent or grandparent with the same problem.
Working with a dental clinic, Van Abbe's treatment begins with the tooth guard and includes cosmetic repair of the nails and talks with a counselor. The patient has two 90-minute sessions.
"After four weeks, the impulse disturbance is so frustrated that it is controlled. You don't have any problem any more," he said, claiming a 98 percent success rate.
About half his patients fall between ages 7 to 18, but Abbe said he had one 94-year-old patient who told him he had been nail gnashing for 80 years and "doesn't want to lie in his coffin with bitten nails."
Micheletti, who works with many adolescents in stress management, says nail biting is one of the most common symptoms he sees among his patients.
He said Van Abbe appears to have developed "a plausible approach" since, in clinical terms, the treatment involves both cognitive and behavioral aspects. But he wonders about the Dutchman's business model.
"I never thought of opening a clinic just for nail biters," he said. "I wouldn't want to rely just on nail biters to make my living."
