Pacan, P., Reich, A., Grzesiak, M., & Szepietowski, J. C. (2014). Onychophagia is associated with impairment of quality of life. Acta Dermato-Venereologica,94(6), 703-706. In Wroclaw, Poland, medical professionals performed a cross- sectional study correlating nail biting to quality of life(QoL) and stigmatism. Subjects were asked to complete questionnaires assessing QoL ( symptoms, emotions and functions) and stigmatisation level. 339 Medical Students participated in this study. They found that 67 participants suffered from onychophagia at the time of examination and 93 participants reported nail biting in the past, but stopped before the study. All in all, researcher discovered that no matter the cause of the nail biting, there is a positive correlation between nail biting and impaired quality of life/ psychological problems. Similarly to the quality of life, subjects with onychophagia demonstrated higher level of stigmatisation, when compared to those without onychophagia. Something to consider a limitation is that their meaning of “Quality of Life” is never fully elaborated. Towards the end, the authors infer that they are talking about psychological issues, however it is never really specified which is something to do differently. Also, only medical students, who are frequently under very stressful circumstances, were used for this study. Researchers should use subjects from various different career fields to efficiently study this correlation. This article is relevant to my topic because it discusses the problems of nail biting and how onychophagia grows and becomes more problematic throughout adulthood. In conclusion this is a very interesting article and should be followed up with more research on the connection between nail biting and well being. Siddiqui, J. A., Qureshi, S. F., Marei, W. M., & Mahfouz, T. A. (2017). Onychophagia (nail biting): A body focused repetitive behavior due to psychiatric co-morbidity. Journal of Mood Disorders,7(1), 47-49. Researchers/ psychiatrists explored a case study where a 20 year old active male student was facing anxiety and depressive symptoms due to pressure to meet his family’s expectations. He couldn’t concentrate when he was studying, began to feel anxious and sad, leading to nail biting to relieve stress. In response to these findings he was prescribed an antidepressant and was referred to start cognitive behavioral therapy. Eventually, the patient’s mood changed decreased his habit onychophagia . From this case, researchers learned more about Onychophagia and how it is a habit that cannot be managed without considering comorbidities and it is best managed with the use of pharmaceuticals and cognitive therapy to help the patient develop conscious awareness. The patient’s father had previously faced depression, which coincidentally supports previous research they mention about nail biting is more common in those who have one or more parents suffering from at least one psychiatric disorder. The researchers put a large emphasis on cognitive therapy and pharmaceuticals as treatment however, if the patient is facing other comorbidities this approach to treatment may need to be altered to receive positive results. Only one case of onychophagia is explored in this article , therefore more cases should be tried with these treatment methods to see how well they work for patients with NB. All in all, researchers provide a thorough case study with positive results with cold eventually help many more of the percentage of children- adults who encounter nail biting impulses. Singal, A., & Daulatabad, D. (2017). Nail tic disorders: Manifestations, pathogenesis and management. Indian Journal of Dermatology, Venereology & Leprology,83(1), 19-26. Retrieved November 24, 2017. Onychophagia, along with many other nail tic disorders, were explored and studied in recent research in New Delhi, India. In the review article , doctors discuss onychophagia and its social factors, including the findings that majority of kids/ adolescents who suffer from onychophagia are bullied , as well as perceived as nervous, socially awkward individuals. Researchers briefly discussion the association with OCD, ADHD, anxiety, and a few other psychological co-morbidities. Researchers concluded that it is essential to effectively evaluate a patient and individualize treatment depending upon the severity of the tic disorder and the underlying co-morbid psychiatric condition. The researchers presented photographed examples of each nail biting disorder which was helpful so that the audience could visually understand how each nail biting disorder differentiates. However, the researchers could have used real case study examples to make this work stronger. If they used case study examples it may have better helped readers understand each disorder better, along with help effectively connect each nail biting case with specific comorbidities, with some correlations stronger than others. This article is important because could possibly help other research, prevention, and treatment methods. For onychophagia and other nail biting disorders. Nino G; Singareddy R. Severe onychophagia and finger mutilation associated with obstructive sleep apnea. Journal of Clinical Sleep Medicine 2013;9(4):379-381.A case study was presented to doctors, further contributing to the inquiry whether or not onychophagia has a correlation with neurological disorders. A 47 year old man with a history of quadriplegia due to a car accident , suffered from severe snoring, multiple awakenings, depression and nocturnal breathing difficulties. He was tested and was found to have severe obstructive sleep apnea. However, that was not the only thing medical professionals discovered. During a physical examination, doctors found there to be extreme eradication of nail beds and finger mutilation which on many occasions, lead to medical attention due to soft tissue and nail infections. As a result of the patient beginning treatment for the sleep apnea, the depressive symptoms and onychophagia improved dramatically. The doctors found that those who suffer from any form of sleep deprivation also may suffer from impulse control behavior. This hypothesis was proven in recent evidence where researchers explored the neurological activity and how dopamine affects impulse control behaviors when sleep deprived. The researcher mentions that the patient was experiencing depressive symptoms ,which should be further explored to make this conclusion stronger. The patient’s onychophagia could’ve been caused by the depression, not only the sleep apnea , therefore other cases should be examined to make the findings stronger. This case study is a great example of how onychophagia can be triggered in adulthood , however can be cured with the best suited treatment methods . O. Marouane, M. Ghorbel, M. Nahdi, A. Necibi, and N. Douki, “New Approach to Managing Onychophagia,” case reports in dentistry, vol. 2016, Article ID 5475462, 5 pages, 2016. doi:10.1155/2016/5475462New methods to help patients quit the nail biting habit have recently been developed and experimented with. When presented with the case study of a 26 year old severe nail biter, dentists presented an appliance utilizing stainless steel twisted round wire. The appliance is placed in the space between the incisors, which is the site of most nail biting With this , all dental interincisal contacts are prohibited whenever nail biting is attempted. After the appliance was installed, the patient appeared for a follow-up every two weeks, where the patient reported a large decrease in nail biting. A month later they reported no nail biting at all and eventually the appliance was removed. The appliances are a successful method making the nail biting habit physically and mechanically difficult to maintain and psychologically reinforce the patient to stop trying to. A limitation to this study is that if patients nail bite due to stressors and this appliance prevents them to do so, something to question is if this could trigger other habits like skin picking, hair pulling, nose picking, etc. This manage method should be tried on other as well to see how effective it is in society. Altogether , the appliance installment is a step in the right direction and could be very useful for future onychophagia cases. Tzang, R., Chang, Y., & Hsu, K. (2015). Factors influencing nail biting habit in children with ADHD. International Journal of Child Development and Mental Health,4(1), 7-16. Retrieved November 29, 2017.Researchers often claim that onychophagia or the habit of nail biting is a method of dealing with anxiety and mental disorders. In this study, medical professionals in Taiwan challenged that idea. They embarked on a cross-sectional study in order to get to the bottom of the risk factors that cause onychophagia in children with ADHD. Researchers questioned whether the onychophagia is triggered solely on the anxiety, or if there was more to it. The study involved 109 children with ADHD, almost half who reported of nail biting. Each parent filled out a questionnaire. Researchers were then able to use these questionnaires to conclude that majority of the nail biters were younger, as well as the amount of ADHD nail biters who were also diagnosed with ADHD-C was significantly higher versus the non nail biters. In addition, each parent was examined and results displayed that parents of the nail biter group were older, had higher rates of marital discord, and displayed poor management skills. Altogether this study challenges the idea that nail biting is triggered by the ADHD itself. It is more related to poor parenting skills, rather than being part of general anxiety symptoms.The study took place in a affluent area of Taiwan therefore there could be different results of the study was taken in a more rural area. Also, parents reported the degree of nail biting so it is unknown how accurate the results are .This article offers a new perspective that challenges many researchers theories on onychophagia. Vyas , T. (2017). Effect of chronic nail biting and non-nail biting habit on the oral carriageof enterobacteriaceae. Journal of Advanced Medical and Dental Sciences Research,5(5), 53-60. Retrieved December 6, 2017.A study was conducted in 2017 exploring diseases that the action of nail biting can produce. Dr. Vyas lead a comparative cross-sectional study to compare the frequency of enterobacteriaceae (E-coli, Salmonella, Klebsiella) in children, male and female with or without the nail biting habit. The goal was to discover which group is more prone to disease. Researchers obtained 80 subjects. 40 nail biters half girls half boys , and 40 non-nail biters divided the same way. Each child was instructed to rinse their mouths out with 10 ml of saline solution for 60 sections, before the saliva sample was taken. Results of this research found that the amount of enterobacteriaceae was higher in nail biters, especially in males than females. One of the most frequently found enterobacteriaceae was E-coli. All together, this study revealed the risk factor that nail biting presents of obtaining a gastrointestinal disease caused by enterobacteriaceae. A weakness to be considered is the small sample size which only consisted of young children. The study is missing a large population of adult nail biters that are exposed to a bigger variety of environments, therefore, could impact the outcome of this study. Researchers excluded anyone with mental illness, which could limit the study because those faced with anxiety and depression are often nail biters which could affect results in the study. The oral carriage plays an significant role in the transfer of these bacterial , giving another reason why pursuing treatment of a nail biting habit is crucial. Sharma, V., & Sommerdyk, C. (2014). Lithium treatment of chronic nail biting . He Primary Care Companion for CNS Disorders,16(3). Retrieved December 15, 2017.Chronic nail biting , or onychophagia can be very severe and create emotional distress. A case report was presented of a woman with Bipolar II disorder substance use disorder, and depression. Along with the multiple comorbidities, the patient presented onychophagia so bad that she had to regularly cover the nail beds with Band-Aids to control the bleeding. Fitted to her needs, doctors prescribed her 900 mg of lithium per day which was slowly decreased as the patients symptoms declined. Ultimately, this method of treatment was very effective and eventually contributed to the patient being symptom free. This study is limited because of the fact that it is unknown if lithium will help patients with onychophagia but not bipolar disorder, or, if this treatment would work with a patient with another disorder such as anxiety. Although this case study proves an effective method of treatment for onychophagia, it is not yet explored if this route will help other types of chronic nail biting patients.Zarza, L. P., Morrondo, C. D., & Haces, J. A. (2014). Arthritis and onychophagia: A confounding factor. Reumatologia Clinica, 10(4), 260-261. Retrieved December 15, 2017.Researchers in Leon, Spain New findings correlating arthritis to onychophagia were developed when doctors were presented with a clinical case study of a 48 year old woman who experienced carpal arthritis, psoriasis along with onychophagia. The woman was prescribed methotrexate to treat the arthritis and psoriasis and gradually as the symptoms decreased, the onychophagia decreased along with it. All together, this case showed how any type of hand disease can trigger onychophagia especially in older adults. Problems with this finding is that researchers only explored this single case study, so a greater sample size would be needed to further declare the correlation between onychophagia and arthritis, Also, the woman in this case faced both psoriasis and arthritis , however, the outcome may differ if the patient only had arthritis or only had psoriasis. This study is interesting because most research is done regarding the mental illnesses that trigger onychophagia , however , this study explores how medical conditions can also trigger the nail biting obsession.Murrieta, J., Hernández, D. K., Linares, C., González, M. B., Juárez, L. A., & Montaño, V. A. (2013). Parafunctional oral habits and its relationship with family structure in a Mexican preschoolers group . Journal of Oral Research, 3(1), 29-35. Retrieved December 16, 2017.In Mexico City, a group of researchers began a cross-sectional study of preschool children aimed to measure the prevalence of oral habits, as well as, their association with the family structure. The habits researchers looked for included onychophagia, lip biting , sucking , ect. Each habit was declared by a professional via examination. Family structure was determined by the child living in a one parent or two parent household. Results declared that children raised in one parent homes performed the oral habits at a higher rate , possibly triggered by stress of living with one parent. Surprisingly, out of all the oral habits, onychophagia was the most prevalent in the study population. The result concluded that onychophagia is the more frequent result of distress and instability in young children. A limitation to this study to be considered is the experimental group was one culture of people from the same city. Also, only preschoolers were studied. Preschool children commonly perform oral habits therefore, it could be unclear whether these habits are actually results of the structure, or just because of the young age of the children. However, this study is a strong example of how distress can cause oral fixation development in young children.