Skin picking and nail biting are often viewed as “bad habits”. People are told to “stop these behaviours”, but that can be challenging for many. Skin picking and nail biting, when they occur excessively, can be understood as a Body Focused Repetitive Behaviour (BFRB). BFRBs, such as skin picking and hair-pulling impact a significant amount of the US population (3.5% and 1.7% respectively). In fact, an additional 15-25% of the US population also experiences subclinical symptoms of BFRBs. This encompasses a large number of individuals who are experiencing these symptoms and, likely, a great deal of distress as well.
You might feel that you can’t stop biting your nails. This can happen in response to stress, tension, sensory overload or distressing emotions. In response, nail biting or skin picking may serve as a way to self-soothe. People will typically report picking at dry skin, biting skin around the nails and looking for small imperfections to remove. All these patterns can become deeply ingrained and difficult to change by oneself. Our blog will explore why skin picking and nail biting happen, why these urges arise, how evidence-based BFRB therapy can help and gentle coping tools for urges that seem unstoppable.
1. What Do Skin Picking and Nail Biting Really Mean?
People may ask themselves, why do I pick my skin, and why do I bite my nails? It is very understandable to become frustrated by these behaviours when they are longstanding and difficult to stop.
Behaviours such as nail biting and skin picking fall into our understanding of body focused repetitive behaviours (BFRBs). While skin picking disorder (excoriation disorder) is a recognized diagnosis in the Diagnostic and Statistical Manual of Mental Health Disorders, 5th Edition, Text Revision (DSM-5-TR), nail biting (or onychophagia) is not yet listed as a recognized standalone condition.
Nail biting (or onychophagia) is understood as an “Otherwise Specified Obsessive Compulsive and Related Disorder: Other Body-Focused Repetitive Behaviour Disorder (i.e., presentations other than hair pulling and skin picking, and may include nail biting, lip biting and cheek chewing). Importantly, the way in which nail biting may impact an individual is very similar to other “standalone” BFRBs, such as skin picking and hair pulling disorder. Therefore, tools that can be used to help with symptoms of nail biting help are very similar to skin picking help.
Let’s do a quick review of symptoms that meet diagnostic criteria for what would be considered a BFRB. We want to note that individuals should never self-diagnose, and it is always critical to meet with a psychologist or psychiatrist, or other healthcare provider who can provide you with an accurate mental health diagnosis.
Potential Signs of a BFRB Pattern (A Symptom Checklist)
- Repeated picking, biting, or pulling at skin, nails, or cuticles
- Difficulty stopping once the behaviour starts
- Feeling an urge to pick that can be brought on by feelings of skin roughness or unevenness
- Feelings of relief, satisfaction or soothing immediately afterward
- Picking, biting or pulling without awareness, especially during stress or boredom
- Visible damage such as redness, soreness, bleeding, or scarring
- Possible feelings of shame, frustration, or secrecy after the behaviour
These behaviours may happen in response to anxiety, tension or boredom. Symptoms can be very mild for some but become increasingly severe and clinically significant for others. They often occur to calm and self-soothe and should never be experienced with blame or shame. However, these emotions often occur in people who engage in these behaviours excessively. This is why it is always important to speak with a healthcare professional to fully understand how these behaviours are impacting your daily functioning and to learn what help might be available.
Many people will report experiencing strong sensory urges to engage in these behaviours. Coping strategies are often similar whether we are targeting skin picking or nail biting. We will describe more of those in a section below. Individuals may experience these behaviours in childhood or adolescence. However, diagnosis and treatment might only emerge later in life for many individuals.
If you have been searching for nail-biting help online, you are not alone. Many individuals experience these symptoms and are caught in a cycle of wanting help but also finding it hard to stop. These behaviours can serve a regulatory function that may be hard to let go of. However, when you reach out for skin-picking help, the goal is not to suppress your urges. Instead, we want to take a stance of curiosity and compassion towards ourselves and our behaviours.
Both excoriation disorder support and onychophagia support involve increasing awareness of the behaviours, implementing helpful barriers to picking and biting and encouraging other behaviours to take place (i.e., replacement behaviours). Therapy goals include learning other ways to regulate and self-soothe, which can be difficult but often help with cycles of frustration and distress.
2. Why Do These Behaviours Feel So Hard to Stop?
These behaviours feel powerful when they happen – the urges are strong and the resulting regulation is impactful. Therefore, stopping them is not just a matter of willpower. There are different reasons why you can’t stop biting your nails. Let’s take a moment to understand the cycle of emotions, thoughts and behaviours that can accompany BFRBs.
Individuals with BFRBs will often experience some type of urge prior to nail biting or skin picking. This urge might be in the form of an emotion, such as anxiety, boredom or stress. Following this, individuals will engage in the BFRB and typically experience short-term relief, and then, often, long-term distress. This is because there can be very negative consequences to nail biting and skin picking. For example, people may experience bleeding, scarring and infection. Appearances may also be altered, and individuals will feel shame and embarrassment should others see this self-inflicted bodily damage. Understandably, experiencing shame can also make it hard for people to seek BFRB therapy.
As discussed, body-focused repetitive behaviours, such as skin picking and nail biting, are much more than “bad habits”. It is understandable to wonder, “why do I pick my skin?” The neurobiological underpinnings of BFRBs are not yet well understood. However, some interesting research is starting to help shed light on these pathways and possible biological pathways.
One of the largest neuroimaging studies regarding BFRBs and reward-related task activation was conducted by Grant and colleagues (2022). They found that individuals with BFRBs experienced “dysregulated reward systems”. Findings suggested that individuals experiencing BFRBs may be biologically hypersensitive to the possibility of rewards. Although more research needs to be done to replicate and deepen these results, they provide important evidence of potentially altered reward systems in individuals experiencing BFRBs. This does imply that easily stopping these behaviours is likely not possible. Furthermore, findings from this research suggest that BFRBs are not due to simple impulse control.
BFRBs are typically experienced as frustrating because they feel so hard to stop. People will ask themselves and their therapist questions such as, “why do I bite my nails?” The answer is really not that easy or straightforward. As we spoke about, there are complex pathways involved and repeated BFRBs possibly contribute to further reinforcement of the biology of those behaviours. As we start to think about therapy and treatment interventions, it is important to remember that the goal should never be to suppress the urge. During BFRB therapy, you want to work with your therapist to understand the urges and navigate how to respond to them differently.
The following imaginary clinical vignette illustrates the BFRB cycle that individuals can experience. It is based on years of Dr. Taube-Schiff’s clinical experience, but in no way resembles any actual clients seen. It is purely fictional.
Alison often found herself picking at the skin around her fingers during long meetings or while unwinding on the couch in the evening. However, she didn’t always notice when she started picking. It would often begin with her hand feeling a small rough patch on her finger. Or it might even follow a moment of tension in her chest or stomach. She would often tell herself that picking would give her a brief sense of relief, as if she was able to let go of tension from her body while picking. However, later on she would experience feelings of frustration and embarrassment when the skin would become red and sore and people could see this when she was out.
Alison often asked herself, “why do I pick my skin?”. She felt that her body had somehow learned how skin picking would help her to feel better and provide a moment of calm and soothing when everything else around her felt tense and stressful.
But later, she would feel frustrated and embarrassed when the skin became red or sore. Alison wasn’t choosing to pick; her nervous system had learned that this tiny ritual offered a moment of relief in an otherwise stressful day.
3. Evidence-Informed Strategies to Support Change
Now that we have a clearer understanding of why these behaviours might be happening, we can turn to a discussion on evidence-based interventions that support change. It is hard to implement behaviour change. It is important to work with someone who can help you implement these changes with awareness and self-compassion. You likely want to engage in gentle coping tools for urges and want to work with someone in a supportive environment.
Change is often most effective when we apply it in small and consistent steps. When engaging in skin picking help, we want to do so by learning and applying small, consistent strategies that can help to support our regulation strategies. When people seek out therapy, they often want different tools that can assist with nail-biting. And they certainly want to hone in on their emotional responses and learn how to stop picking without shame and blame being a part of what they experience.
These are very important goals for therapy. When seeking out skin-picking help or nail-biting help, you also want to ensure that you are working with therapists who are well-trained in evidence-based approaches. Here at Forward Thinking Psychological Services®, that is exactly what we do. We want to ensure that you are learning effective and gentle coping tools for urges so that you feel well-equipped to make a change and feel good about yourself.
One of the best evidence-based interventions used during BFRB therapy is Cognitive Behavioural Therapy (CBT). There are several techniques within this umbrella of CBT for BFRBs that have been shown to be effective. Let’s review some of the earlier models as well as more recent ones:
- Habit Reversal Training (HRT): During this earlier treatment approach for BFRBs, individuals would be supported in developing an increased awareness of their triggers. For example, during nail biting help, people would record when the behaviour happens, including where they are (i.e., context) and physical body postures that might allow it to happen more easily. People then learn to develop competing responses to the repetitive behaviours. In doing so, they are often able to decrease these repetitive behaviours over time. For example, an individual might put glue on their skin and pick that off instead of engaging in skin-picking behaviours of their actual skin. This approach was developed in the 1970s by researchers Nathan Azrin and Gregory Nunn.
- The Comprehensive Behaviour (ComB) Model: This model of treatment was developed by Dr. Charles Manseuto and his colleagues in 2019. During this approach, therapists and clients work together to identify sensory, cognitive, affective, motor and place/location (SCAMP) that play a role in maintaining BFRBs. Individualized strategies are also developed in order to address each of these factors. This helps people to understand the “why, where and how” aspects of their particular BFRB.
- Acceptance and Commitment Therapy (ACT): ACT is a transdiagnostic approach developed by Dr. Steven Hayes that helps individuals to learn: emotion regulation strategies, present moment awareness, recognize and accept difficult thoughts, feelings and urges and develop self-compassion rather than push away or try to eliminate behaviours. This approach can enhance the strategies delivered within HRT and ComB-based intervention models.
- Dialectical Behaviour Therapy-Informed Skills (DBT): DBT-informed therapy involves therapists drawing on the main tenents of the DBT model to augment other skills that are being learned in treatment. In order to do so, clinicians will draw from four skills-based modules that are at the core of DBT. These include mindfulness, distress tolerance, emotion regulation and interpersonal effectiveness. These skills can be used, as needed, to enhance or address other potential areas of difficulty for individuals with BFRBs.
Here’s a helpful table that summarizes the different therapeutic approaches:
|
Therapeutic Approach |
Core Focus |
How It Helps |
|---|---|---|
|
Habit Reversal Training (HRT) |
Builds awareness of triggers and develops alternative actions |
One of the earliest treatments for BFRBs (Azrin & Nunn, 1970s). Individuals learn to recognize urges and use competing responses (e.g., clenching fists, squeezing a stress ball) to interrupt the habit cycle. |
|
Comprehensive Behavioral (ComB) Model |
Identifies the sensory, cognitive, affective, motor, and place (“SCAMP”) factors |
Developed by Dr. Charles Mansueto and colleagues (2019). Helps tailor interventions to each person’s unique triggers and environments — answering the “why, where, and how” behind the behaviour. |
|
Acceptance and Commitment Therapy (ACT) |
Builds emotional tolerance and self-compassion |
Developed by Dr. Steven Hayes for many different disorders. Focuses on accepting difficult urges and feelings rather than fighting them. Enhances HRT and ComB by teaching mindfulness and flexible behaviour change. |
|
DBT-Informed Skills (Dialectical Behaviour Therapy) |
Strengthens emotion and distress regulation |
Draws on mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness to reduce emotional triggers and strengthen coping alongside other BFRB treatments. |
The following imaginary clinical vignette illustrates how BFRBs can occur for regulatory purposes and without awareness. It is based on years of Dr. Taube-Schiff’s clinical experience, but in no way resembles any actual clients seen. It is purely fictional.
During exam season, 16-year-old Alex often noticed he was biting the skin around his nails. Although he would do this occasionally, it was happening far more often during exam time. It usually occurred when he was studying or mindlessly scrolling on his phone during breaks. However, he didn’t realize he was biting until he would eventually taste blood (when sucking on his fingers while studying) or if he started to experience a painful sting. This behaviour seemed to help him quickly release tension and regain his focus. However, he knew it was uncomfortable and painful in the long run. He started to meet with a therapist. They were able to explore the reasons why this was happening and raise his awareness. He also found it helpful to try out other gentle coping tools for urges and to regain focus. Over time, and through the work with his psychologist, he learned how to stop picking without shame and felt that he had a healthy toolkit of distress tolerance tools during exam time.
4. When to Seek Help and What to Expect in Therapy
There are many reasons why people will seek BFRB therapy for nail biting and skin picking. Typically, these behaviours will become too impactful to manage on one’s own. By finding the right excoriation disorder support, people often start to learn gentle coping tools for urges that start to make a difference in terms of their symptoms. It can be hard to find the best fit therapist. We want to share with you some things to look for and what to expect in therapy.
You might wonder, where can I find a nail-biting therapist near me, and what are some questions I could ask them? Here are some questions you can have ready when you meet with your psychologist for the first time:
- What is your experience working with people who are experiencing overwhelming urges to pick their nails or the skin around their nails?
- What treatment approaches do you use?
- How quickly do you see changes?
- Will I have homework to do between sessions?
You might also be thinking, how can I find a skin-picking therapist near me, and would the questions be the same as above? Would treatment be different for nail biting versus skin picking? What if I am experiencing symptoms of both – could that happen, and would someone be able to help me with both those things?
The answer to those questions is – yes! BFRB therapy can provide skills and tools for both excoriation disorder support and onychophagia support. A psychologist who is well-trained in helping individuals with BFRBs will be able to help with a variety of BFRB presentations. It is important to ask these questions when meeting with your psychologist so you can fully understand what therapy will look like and any work that you will have to do in between sessions.
BFRB therapy is a type of CBT intervention. As we know, with CBT interventions, what you put into therapy is often what you are able to get out of it. Therefore, your therapist will assign you work to do in between sessions and which enhances and deepens the work that you do within the session.
Of course, trying to manage ongoing skin picking or nail biting behaviour can feel confusing, frustrating and sometimes isolating. These behaviours can feel extremely automatic or outside of one’s control. However, these patterns do not reflect a lack of strength or discipline. We know that these behaviours are signs that you have learned specific ways to cope with stress, sensations or different emotions. When reaching out for help, you will start to understand the urge-relief cycle, recognize your triggers and learn helpful ways to regulate your body and create meaningful change over time. No one should have to manage trying to change these behaviours all on their own.
Where can I find helpful BFRB Therapy?
Does FTPS have a skin picking therapist near me? Or a nail biting therapist near me? We absolutely do, and we hope you will consider reaching out to us so we can start your therapy journey together. We offer support throughout Canada for BFRB therapy services, including services in Ontario, Quebec, Nova Scotia, British Columbia, and New Brunswick. Contact us to learn more! We work with teens, adults, families, and couples. We are here to help support the system through treatment and recovery.
References
Azrin, N. H., & Nunn, R. G. (1973). Habit reversal: A method of eliminating nervous habits and tics. Behaviour Research and Therapy, 11(4), 619–628.
Charles S. Mansueto et al. (2020). Overcoming Body-Focused Repetitive Behaviors: A Comprehensive Behavioral Treatment for Hair Pulling and Skin Picking Paperback (2020).
Grant JE, Peris TS, Ricketts EJ, Bethlehem RAI, Chamberlain SR, O’Neill J, Scharf JM, Dougherty DD, Deckersbach T, Woods DW, Piacentini J, Keuthen NJ. Reward processing in trichotillomania and skin picking disorder. Brain Imaging Behav. 2022 Apr;16(2):547-556. doi: 10.1007/s11682-021-00533-5. Epub 2021 Aug 19. PMID: 34410609; PMCID: PMC7614803.
Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2012). Acceptance and commitment therapy: The process and practice of mindful change (2nd ed.). The Guilford Press.
Linehan, M. M. (2025). DBT® Skills Training Manual (Revised). New York: Guilford Press.
https://psychiatryonline.org/doi/book/10.1176/appi.books.9780890425787
https://iocdf.org/about-ocd/related-disorders/body-focused-repetitive-behaviors/
https://iocdf.org/about-ocd/related-disorders/body-focused-repetitive-behaviors/
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