Nail-Biting

    ‘Childhood Anxiety Disorders,’ that is what I went to talk to parents of children at the early childhood center at UCLA today at noon. Ten questions from parents; six about nail-biting. I go through my mantras. Children should be exuberant about their lives. Anxiety is normal in children, but it is a problem if it interferes with social or school functioning. Anxiety disorders in children is divided into six categories, according to our current diagnostic manual. Five of those disorders are the same as adult anxiety disorders. Medications are helpful, but they are a last resort. Mindfulness, for children and adults, along with deep breathing should be tried first.

    After that came the questions. “What should I do with my three year old who bites his nails?” “First” I say, “be an observer of your child. Determine what settings the nail-biting gets better or worse. Determine if your child seems to self-soothe by nail-biting. See how bad it is over time.” The parents nod in recognition that they have heard all that before. “The question,” I say, “is whether the nail-biting is a window into internal distress, and if so, how severe that distress might be.” “This is a field of subjectivity,” one mother says, expressing distress about the subject. “Absolutely,” I say. “Parenting is subjective. You have to use your intuition, your reflective functioning, to speculate about the internal state of your child.” I guess she was a scientist, since she looked at me with dismay. “It is hard to be a parent,” I say, trying to redeem myself in her eyes. She smiled and she seemed to relax. I think to myself that maybe next time I will stick with symptoms and checklists and avoid talking about internal states. Then, I think again, and say, no, maybe I will start with nail-biting as a symptom which might indicate distress, but it might also indicate the ability to self-soothe. Nail-biting, like all childhood anxieties, are curiosities demanding further exploration before intervention. I will stick with that.