Nail biting is serious — even the Berenstain Bears knew so and they're bears. Imaginary bears. It's taken psychiatry almost 27 years to catch up with imaginary bears, but let us not quibble with the slow, ponderous locomotive that is modern medicine. Let's instead learn all about how nail biters might be deeply disturbed.
NPR's Amy Standen weaves a personal history of nail biting (full disclosure: I am a nail biter and have been ever since I got a stubborn hangnail in preschool when nail biting went from being a mere bad habit to a waltz with thousands of insidious pathogens) in with the latest clinical news: when the newest version of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders drops early next year, it will show "pathological grooming" in the same category as obsessive compulsive disorder. Pathological grooming, explains Standen, an avowed 30-year nail biter, also includes behaviors like skin picking (dermatillomania) and hair pulling (trichotillomania) à la Charlize Theron in Young Adult. The new classification offers pathological groomers and psychiatrists a new way to think about and treat what were before widely dismissed as bad habits.
Carol Matthews, a psychiatrist at the University of California, San Francisco who specializes in pathological grooming, first identified Standen's nail biting habit with a quick glance at her "pushed back" cuticles, displaying what sounds like an eerily sharp eye and keen insight into all manner of human foibles. Matthew then explained that pathological grooming is simply an extension of normal grooming behaviors, except gone awry, like the Hulk or King Kong. The pathological groomer isn't triggered by a hangnail or a deliciously loose flap of dead foot skin — he or she is triggered by seemingly unrelated external stimuli like driving or being generally stressed out. After a while, the particular pathological grooming behavior comes unhinged from its initial trigger and becomes its own automatic behavior, a vortex of teeth-gnashing-cuticles that starts to spin out of control (in so many words).
The reason pathological grooming has now been linked to OCD is that, in both cases, a normal, even healthy behavior has been put into, as Standen describes it, "overdrive," and is carried out excessively. Matthews, however, notes a key difference — OCD compulsion is unwanted, prompted by a subject's fear that something terrible will happen if hands aren't washed a certain number of times before bed, for instance. Matthews says that her patients who suffer from pathological grooming enjoy the act of biting, pulling, or picking. "It's rewarding," she explains. "It feels good. When you get the right nail, it feels good. It's kind of a funny sense of reward, but it's a reward."
Standen also includes (by way of explaining that she's quitting nail biting for fear that her daughter will pick up the habit) some insight into pathological grooming based on the research of Francis Lee, a psychiatrist and neuroscientist at Weill Cornell Medical College in New York who studied mice bred with a specific gene mutation that apparently caused them to groom so assiduously and often that they gave themselves little bald spots by adorably moving their little paws over their faces. What's more, these mice were incredibly anxious. Though Lee's findings are intriguing, humans are more complex monstrosities of nature than mice, and probably don't pass on very much pathological grooming behavior to their offspring (the risk to a family member of someone who has OCD is only about 20 percent, according to Matthews).
What this means, of course, is that nail biting is no one's fault and, if you do bite your nails (as I am right now, just really getting after them like they're kernels on a cob of corn), it's not your fault, no matter what the judgey Berenstain Bears and their austere morality tells you. I mean, faking sick to miss school is fine every once in a while and kids shouldn't feel like the flu is waiting to smite them for taking a day off to masturbate and play video games.
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