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Snot machines: Can nose picking be an obsessive-compulsive disorder?

How does it make you feel when you see someone picking their nose and then eating what they have found? Disgust? Contempt? Amused? Whatever your reaction it’s unlikely to be neutral. Nose-picking on the face of it (no pun intended) is probably one of the most under-researched activities given the fact that it is an every day activity for many people and appears to be a universal activity across cultures. It is believed that across many cultures, nose-picking belongs to a set of behaviours considered a private act (such as burping, breaking wind, urinating and defecating).

There is also an element of the activity being mildly taboo despite it being so prevalent. The definition I’ve come across most often in non-academic journals (i.e., on the internet) is that nose-picking is the act of extracting dried nasal mucus (snot) and/or foreign bodies with a finger from the nose. There have been anecdotal reports that people engaging in some sorts of activity appear to be more likely to pick their noses in seemingly public places (drivers stopping at traffic lights or junctions being one example I came across in a blog on nose-picking). But what does the empirical research say about nose-picking?

A paper published on nose picking in the Journal of Clinical Psychiatry (JCP) in the mid-1990s by James Jefferson and Trent Thompson (University of Wisconsin Medical School, USA), reported that 91% of people surveyed in Wisconsin were current nose-pickers (n=254). Three-quarters of the sample thought that “almost everyone else does it”. Five respondents (2%) said they picked their nose for enjoyment, and one person said they found picking their nose sexually stimulating. Two respondents reported that their nose-picking had led to a perforation of the nasal septum. Another two people in the study said they were excessive nose-pickers (with one respondent spending 15-30 minutes a day picking their nose, and the other one claiming they spent 1-2 hours a day picking their nose). It is possible that these two excessive nose-pickers may have been suffering from rhinotellexomania that is characterized as a constant, repetitive and/or pathological picking of the nose and viewed by some as a form of undiagnosed obsessive-compulsive disorder. They also reported the incidence of other associated behaviours. A total of 25% picked their cuticles, 20% picked at skin, 18% bit their fingernails (18%), and 6% pulled out their hair.

More recently (and taking their lead from the earlier study published in the 1995 JCP paper), two psychiatrists – Dr Chittaranjan Andrade and Dr B.S. Srihari (National Institute of Mental Health and Neurosciences in Bangalore, India) – published a study on rhinotillexomania among 200 adolescents in the Journal of Clinical Psychiatry. They reported that adolescents pick their noses about four times a day. They started from the position that any human activity – if carried to excess – could potentially be viewed as a psychiatric disorder. They made reference to earlier case studies in the literature which seemed to indicate that excessive nose-pickers written about affected were psychotic (e.g., Gigliotti & Waring, 1968 – 61-year-old woman with extensive self-mutilation of the inner nose such that a nasal prosthesis and complete upper denture had to be constructed; Akhtar & Hastings 1978 – a 36-year-old male compulsive nose picker, who had life-threatening nosebleeds as a result of excessive nose picking). A more recent case study published by Ronald Caruso and colleagues (State University of New York Health Science Center at Syracuse, USA) presented a case of rhinotillexomania in a woman. They noted:

“Chronic self-mutilation resulting in the loss of body parts is characteristically seen in schizophrenic patients. Such patients can have delusions of parasitic infestation of body parts, may believe the body part to be encumbered by foreign bodies, or may view the body part as no longer a part of themselves. Such behavior, however, may also be manifested by persons who are severely obsessive-compulsive or malingerers… A 53-year-old right-handed woman related a history of compulsive nose picking (rhinotillexomania) of the right nasal cavity since age 10. She could not control her compulsion, which involved removing recurrent intranasal crusts. This condition persisted while in the care of a psychiatrist… Therapy was instituted in an effort to disrupt the cycle of digital trauma, mucus production, and crusting. This included behavior modification and supportive rhinologic care with nasal spray, crust suction, and medication. Early follow-up showed improvement”

They noted that the psychiatric literature has recognized that “rhinotillexomania is a common, benign habit in children and adults” but that in rare cases it can become a serious affliction advancing to significant self-injury.

Andrade and Srihari’s main findings were that (i) 96% had picked their nose, (ii) 80% used their fingers to pick their nose, (iii) half picked their noses four or more times a day, (iv) 7% picked their noses 20 or more times a day, (v) over 50% picked their noses to unclog nasal passages, to relieve discomfort, or to relieve itching, (vi) 11% picked their nose for cosmetic reasons, and (vii) 11% picked their noses for pleasure. They also observed that based on their sample, nose-picking practices were the same across all social classes.

Much less is known about the act of eating the extracted contents directly from the nose (known as mucophagy). A case report dating back to 1966 by Sidney Tacharow on copraphagia (eating faeces) also examined the eating of other bodily substances. The author claimed that the reason people ate nasal debris was because they found it “tasty”. In the study by Jefferson and Thompson, it was reported that 8% of their respondent admitted to eating their nasal content (but there was no reason given as to why they did it). The study by Andrade and Srihari’s reported that 4.5% of their participants ate their nasal debris.

I did a literature search looking for academic papers on snot eating snot and only came up with only one by Maria Jesus Portalain – a 2007 book chapter entitled “Eating snot – Socially unacceptable but common: Why?” in an edited book collection called “Consuming the inedible: neglected dimensions of food choice” (which also had chapters on topics such as geophagia and cannibalism). She questioned to what extent snot could be classed as edible? As she noted, the composition of snot was water (95%), glycoprotein (2%), other proteins (1%), immunoglobin (1%), lactoferrin (trace), lysozyme (trace), and lipids (trace). She observed that the eating of snot could be studied from a number of different scientific disciplines but it was only psychologists that had ever studied it. She argued that nasal mucus was socially accepted but eating it was not. In preparation of writing her chapter, she asked a small group of adults if they ate they ate their snot and they all vehemently said they didn’t. She then asked the same people if when they kissed their partner they put their tongue in their partner’s mouths. It was a ‘yes’ all around. She then posed the question why consuming your partner’s saliva was better than eating your own snot?

In February 2008, an Austrian lung specialist (Dr Friedrich Bischinger) was reported as saying that picking your nose and eating it was good for you. He claimed that people who pick their noses with their fingers were healthy, happier and probably better in tune with their bodies than those who didn’t. He was reported as saying:

“With the finger you can get to places you just can’t reach with a handkerchief, keeping your nose far cleaner. And eating the dry remains of what you pull out is a great way of strengthening the body’s immune system. Medically it makes great sense and is a perfectly natural thing to do. In terms of the immune system the nose is a filter in which a great deal of bacteria are collected, and when this mixture arrives in the intestines it works just like a medicine. Modern medicine is constantly trying to do the same thing through far more complicated methods. People who pick their nose and eat it get a natural boost to their immune system for free. I would recommend a new approach where children are encouraged to pick their nose. It is a completely natural response and medically a good idea as well. Children happily pick their noses, yet by the time they have become adults they have stopped under pressure from a society that has branded it disgusting and anti social”

He went on to suggest that if anyone was worried about what other people think, they should pick their noses privately if they want to get the benefits. Despite the alleged benefits of nose picking I will leave you with a 2002 case reported by Dr L.F. Fontenelle and colleagues (Federal University of Rio de Janeiro, Brazil) who described a person with rhinotillexomania that may have been secondary to body dysmorphic disorder (BDD). The man in question developed a self-destructive habit of pulling and severely scraping hairs and nasal debris out of his nose. The authors proposed the term rhinotrichotillomania to emphasize the overlapping between trichotillomania (compulsive hair pulling) and rhinotillexomania (compulsive nose picking). The main motivation behind the man’s actions was a distressing preoccupation with an imaginary defect in his appearance (a core characteristic of BDD). The authors suggested that certain features of trichotillomania, rhinotillexomania, and BDD may in some circumstances overlap and produce serious clinical consequences.

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Akhtar, S. & Hastings, B.W. (1978). Life threatening self-mutilation of the nose. Journal of Clinical Psychiatry, 39, 676-677.

Andrade, C. & Srihari, B.S. (2001). A preliminary survey of rhinotillexomania in an adolescent sample. Journal of Clinical Psychiatry, 62, 426-31.

Caruso, R.D. Sherry, R.G., Rosenbaum, A.E., Joy, S.E., Chang, J.K. & Sanford, D.M. (1997). Self-induced ethmoidectomy from rhinotillexomania. American Journal of Neuroradiology 18, 1949-1950.

Fontenelle, L.F. Mendlowicz, M.V., Mussi, T.C., Marques, C. & Versiani, M. (2002). The man with the purple nostrils: a case of rhinotrichotillomania secondary to body dysmorphic disorder. Acta Psychiatrica Scandinavica, 106, 464-466.

Gigliotti, R. & Waring, H.G. (1968). Self-inflicted destruction of nose and palate: Report of case. Journal of the American Dental Association, 76, 593-596.

Jefferson, J.W. & Thompson, T.D. (1995). Rhinotillexomania: Psychiatric disorder of habit?  Journal of Clinical Psychology, 56 (2), 56-59.

Portalain, M.J. (2007). Eating snot – Socially unacceptable but common: Why?” In J. MacClancy, J. Henry & H. Macbeth (Eds.), Consuming the inedible: neglected dimensions of food choice. New York: Berghahn Books.

Tarachow, S. (1966). Coprophagia and allied phenomena. Journal of the American Psychoanalytic Association, 14, 685-699.

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