Onychophagia Progressing to Extensive Finger Amputation: A Brief Review Addressing Severe Body-Focused Repetitive Behavior Disorder in an Adult

Abstract

Individuals engaging in repetitive, persistent and intentional behaviors resulting in significant self-injury can, for many medical and psychiatric care providers, stir vexing questions as to how such behavior should be conceptualized and managed. Onychophagia (nail-biting), categorized as a Body-Focused Repetitive Behavior Disorder (BFRBD) in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition , is a common oral habit, observed in both children and adults. For most persons, the nail-biting is merely a cosmetic concern that does not attract clinical attention. Although more extreme forms of this behavior can manifest with moderate complications, we present an unusual case of an adult for whom persistent onychophagia progressed to significant injury to his hands due to recurrent osteomyelitis. Emerging research exploring the underpinnings of severe forms of BFRBDs are discussed. This case illuminates management challenges that can arise when clinicians fail to recognize the condition and highlights the need for early coordinated multidisciplinary intervention to mitigate the behavior and its sequelae longitudinally. [ Psychiatr Ann . 2023;53(3):145–148.]