La medicina: tradición entre la ciencia y el arte

The data analysis indicated that the professional health workers held different views on the possible causes of nail biting, probably because of their diverse professional backgrounds and approaches. These identified causes fell two main sub-themes: psychological and nutritional or physiological factors. The former involves anxiety and stress while the latter covers mineral or vitamin deficiency, diet/malnutrition, thyroid disorders, and parasites.

5.4.1.1 Psychological factors

There was a strong indication from the comments of the health professionals that nail biting is generally caused by psychological factors such as anxiety, stress, and nervousness.

Firstly, many health professionals identified anxiety as an important contributing factor to the development of nail biting habit. Accordingly, nail biting was explained as a “nervous habit related to an unhealthy way to reduce or regulate anxiety” (HP- 4). It is important to note that these health professional tended to speak with absolute certainty regarding this causal link between anxiety and nail biting. The following remark clearly illustrates this point.

Generally, nail biting is caused by anxiety. (HP-11)

Anxiety tends to associate with nail biting. (HP-10)

A few health professional participants also discussed anxiety as an underlying cause of nail biting among adults, referring specifically to the issue of obsessive-

compulsive disorder (OCD). For example, HP-1 noted, “In adult, the underlying causes of nail biting are usually obsessive compulsive disorder (OCD) or thyroid problems.” OCD is basically an anxiety disorder among people who tend to perform

repetitive excessive actions in dealing with persistent unwanted obsessions. It is interesting to note the widely held perception that there seems to be an association between nail biting and anxiety or psychological or emotional conditions in general. As another psychological factor, stress was also described as a possible cause of nail biting by the participating health professionals. For many of them, stress felt by the nail biting patients could be built up from various reasons. These reasons were in turn associated with other psychological and socioeconomic factors, including anxiety, familial issues, or major changes to one’s personal life. A participant indicates:

Nail biting could be caused by other health issues, anxiety, any stress, and family problems such as parents recently divorce or changing school. (HP-2)

The third psychological factor noted by the health professional participants was related to nervousness. Nervous system was believed to be triggered by different agents. Interestingly, intestinal parasites were hypothetically linked to nervousness, which then led to nail biting as a self-calming mechanism.

Nail biting could be commonly caused by intestinal parasites. Intestinal parasite maybe the cause of nervousness in children hence nail biting maybe a symptoms of nervousness. (HP-7)

Generally, a recurring theme highlighted by the health professionals was that a disturbance to or instability in emotional and psychological state could result in nail biting habit in the patient as an attempt to cope and regain balance.

5.4.1.2 Nutritional deficiency / Physiological factors

Apart from the psychological factors, the participating doctors also believed that nail biting could be caused by other nutritional/physiological elements. Particularly, mineral deficiency was stressed by most participants as an important contributing factor to nail biting. The shortage of many minerals was specifically mentioned to be at play, including calcium, silica, magnesium, potassium, and zinc. It is worth noting that this factor of mineral deficiency was widely expressed in a number of

statements, reflecting a high confidence level among the health professionals. Some of the comments are presented below.

Mineral deficiency is probably the initial cause of nail biting in children. It could be any minerals but the common deficient mineral that I found is Calcium and Silica. (HP-3)

Mineral deficiency, commonly calcium, magnesium, potassium, silica and zinc. (HP-5)

Intestinal parasites can also reduce the amount of nutrients that are being absorbed by the body so it could cause a decrease in the amount of essential minerals (such as calcium, magnesium, zinc, silica and iron) being absorbed from food. (HP-7)

Calcium deficiency tend to be the common causative trigger of nail biting in children. (HP-8)

Mineral deficiency, particularly Calcium or Magnesium or Silica or iron. (HP- 9)

I find people biting nails for many reasons but mineral deficiency is the most common initial cause of nail biting in children. (HP-10)

While discussing mineral deficiency in relation to nail biting, some health professional even attempted to provide possible explanations, such as mal- absorption disorder (HP-9) or poor diet (HP-10).

Apart from mineral deficiency, other types of nutritional deficiencies and disorders were noted by the health professionals as an underlying cause of nail biting. The frequently mentioned issues included iron deficiency, and mineral deficiency or thyroid disorders. One of thyroid’s main functions is to maintain body’s metabolism, and thus thyroid disorder could detrimentally affect the production of energy from food or nutritional sources.

However, nail biting could be caused by other underlying causes such as iron deficiency or thyroid disorders, especially hypothyroidism or hyperthyroidism. (HP-1)

Nail biting in children is commonly caused by iron deficiency or just a growing up habit. (HP-14)

Recent test for Vitamin D level. (HP-2)

As a whole, there was a general agreement among the participating health

professionals that nail biting was associated with a wide range of psychological and physiological/nutritional causes. It was felt that no single factor could be used to fully explain the development of nail biting habit.