Rhinotillexomania Treatment To Reduce Compulsive Nose Picking

This is the technical terminology for someone who has a compulsion to pick their nose. People often think of nose pickers as little children, but it's a condition that can affect adults as well.   

If you think you may be experiencing rhinotillexomania, there are numerous treatment options available. Below, we’ll explore rhinotillexomania in more detail and look at treatment options for this condition.

What is rhinotillexomania?

Rhinotillexomania can be defined as a compulsive picking of the nose or nasal septum. While some people may think of nose-picking as something that only children engage in, surveys suggest that almost everyone picks their nose to some degree. One survey found that half of the respondents pick their nose about four times a day. 

Therefore, not everyone who picks their nose has rhinotillexomania. People who pick their noses may not have any compulsion to do so. However, the habit can still result in some of the dangers listed below. One of the main differences between rhinotillexomania and simple nose-picking is the compulsion that exists within the disorder and the repetitive, body-focused behaviors that characterize it.

When nose picking becomes a problem

Everyone experiences dried nasal mucus, and it may not be unusual to give the nose a swipe with your finger to clear it out. However, for some, nose picking can become problematic.

From removing dried nasal mucus to compulsive behavior

Nose picking to, colloquially, remove boogers, is not typically an issue, but repeated attempts at clearing out what may not even be there can be harmful. For some, nose picking can become a way to relieve stress. If left unaddressed, this maladaptive coping mechanism may cause embarrassment, infection, or even damage to the nose. 

Repeated attempts to stop picking and loss of control

If you notice that despite repeated attempts, you have a difficult time keeping your finger away from your nose, you may be experiencing more than just a habit. If you feel that your nose picking is out of control, it may be worth looking into whether it is the symptom of a larger issue. 

Conditions related to rhinotillexomania

Nose picking or other types of skin picking can be a symptom of several mental health conditions, although it may also simply be a nervous habit or stress release. If you experience other symptoms or if your nose picking causes disruption in your daily life, a medical or mental health provider can help determine the cause and offer a treatment plan. 

Anxiety, OCD, and excoriation disorder

Rhinotilexomania can be caused by a number of different mental or physical issues, including: 

• Anxiety
• Obsessive-compulsive disorder (OCD)
• Rhinitis
• Dementia
• Empty nose syndrome

Body dysmorphic disorder and obsessive grooming behaviors

Nose picking can be considered one of several body-focused repetitive behaviors (BFRB) or obsessive self-grooming behaviors. Other types may include: 

• Nail picking
• Hair pulling
• Excoriation disorder (skin picking)
• Eating one’s own hair

These behaviors can often be linked to obsessive-compulsive disorder and may become more severe during times of stress. 

Physical risks and possible complications

While it can be embarrassing when someone catches you picking your nose, mental discomfort can be one of the less severe outcomes of chronic nose picking. 

Tissue damage and infection risk

When nose picking becomes compulsive, some potentially serious risks may occur. These risks can be higher for individuals with weaker immune systems or chronic illness and may include: 

• Spreading sickness
• Infection in the nose caused by micro cuts from the fingernails
• Sores and nosebleeds from tissue damage

Rare but serious complications

While rare, some serious consequences may occur as a result of rhinotillexomania. These include physical damage to the nasal cavity, including:

• Medial orbital wall erosion (erosion of the thin wall of bone between the nasal passages and eye socket)
• Unilateral external nasal stenosis (abnormal narrowing of one nasal passage)
• Self-induced ethmoidectomy (septum perforation)

Why stress can make nose picking worse

Emotional triggers, such as feeling stressed or overwhelmed, can make BFRBs, including nose picking, worse. Most people who engage in these behaviors do so when they are anxious, as the picking can offer a feeling of gratification and help relieve negative feelings in the moment. 

Evidence-based treatment options

Treatment for rhinotillexomania can help individuals manage the symptoms of the disorder. Typical treatment options include talk therapy, medication, or a combination of the two. A psychiatrist or psychologist may be able to determine whether a person has the condition and then come up with a plan for treatment.

Medication when appropriate

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) classifies rhinotillexomania under obsessive-compulsive disorder and related disorders, such as body-focused repetitive behavior. If rhinotillexomania is caused by OCD or another type of anxiety disorder, the individual may be prescribed medication, such as an antidepressant. It’s recommended that you always consult a doctor before deciding to start or stop a medication.

Habit reversal training and behavioral therapy

If you experience rhinotillexomania, you may benefit from speaking to a licensed therapist. Given that rhinotillexomania is listed in the same context as trichotillomania (a compulsion to pull one’s hair), a therapist may use therapeutic methods that apply to this condition, such as habit reversal training, cognitive therapy, and acceptance and commitment therapy. 

A therapist may be able to help you stop picking with evidence-based techniques developed for behavior change. Habit reversal training (HRT) may be considered a first-line treatment for rhinotillexomania and includes:

• Awareness training to identify triggers for nose picking
• Stimulus control to avoid these triggers whenever possible
• Competing response training to substitute this behavior with other, less potentially harmful behaviors

Coping strategies you can try right now

If you're not ready to seek out counseling just yet, consider trying out some of the following strategies to safeguard your health in the meantime. Additionally, should you choose to see a therapist, you can still try to implement these methods into your life as an additional source of help.

Avoid using your fingernails

While you’re working on picking your nose less, it may help to avoid using your fingernails when doing so. Consider using a cotton swab instead of using your fingers to pick your nose. This may lower your risk of developing a perforation of the nasal cavity or an infection.

Blow your nose

Instead of picking your nose, you might try blowing it into a tissue instead. It may not provide the same relief and satisfaction, but it may help you reduce the urge to pick.

Use a bandage or a fidget toy

One strategy to reduce nose picking is to wrap the finger you usually use to pick your nose in a small Band-Aid. The strange sensation of the bandage on your nose may keep you from picking your nose without thinking about it.

Also, there are many different options that can provide relief from stress and anxiety. Fidget toys may be useful because they can help keep you distracted from picking your nose and keep your hands busy. Without fingers to pick and an extra distraction, it might be harder to pick your nose.

Deep breathing and stress reduction

Reducing overall stress can help reduce the compulsion to pick your nose. Deep breathing techniques can be effective for stress management and may, in turn, help you to stop picking. Some deep breathing techniques include: 

• Pursed lip breathing. Breathe through your nose, then breathe out through pursed lips for double the amount of time you inhaled.
• Diaphragmatic breathing. Put your hands on your belly while breathing slowly, and notice how your stomach rises and falls with each breath. 
• The 4-7-8 technique. Inhale for a count of four, hold your breath for a count of seven, and then release the breath for a count of eight. 

Moisturizing the nasal passages safely

Keeping your nasal passages safely moisturized may also help to reduce the urge to pick. Use medical-grade saline spray, or gently apply coconut oil to the rims of the nostrils to keep the nasal passages moist. This may prevent mucus from hardening and help you to stop picking in the area. 

Who has rhinotillexomania?

Rhinotillexomania tends to occur in children and young adults. Rhinotillexomania usually doesn't have anything to do with hygiene or necessity. Instead, it's typically a compulsive way to ease tension or stress.

Someone who feels a large amount of stress or who experiences an anxiety disorder may be susceptible to the disorder. Those with other types of compulsion disorders, such as different forms of obsessive-compulsive disorder, may be more susceptible to rhinotillexomania. Additionally, they may be more likely to live with a combination of various conditions with similar causes. 

Medical research and extreme cases

Severe, untreated cases of rhinotillexomania have led to some extreme consequences in controlled human infection study settings. One study examined a 66-year-old woman who experienced recurring infections that providers linked to her nose picking behavior, including sepsis, meningitis, endocarditis, cystitis, and discitis. 

Another study followed three clinical cases of individuals who suffered self-destructive nasal injuries due to rhinotillexomania, with one individual requiring an amputation of her middle turbinate (the cartilage that separates the nasal passages). 

When to seek professional help

While some cases of rhinotillexomania may be related to external factors that create physical issues (such as exposure to demolition sites, or empty nose syndrome), in some cases, it may be the result of psychiatric disease.An individual with rhinotillexomania typically picks their nose because they feel an irresistible compulsion to do so. They may continue to do so even to the point of severe irritation because they can't seem to stop themselves from doing it. 

These individuals may also experience excessive tension and anxiety that can lead to rhinotillexomania. They may then feel relief or gratification after they engage in the activity, but feel shame or guilt because of the behavior. They might attempt to hide the behavior, but it can still be somewhat apparent to those around them.

Someone who engages in this type of behavior may engage in other similar behaviors as well. Some people who report picking their noses excessively have also reported behaviors such as picking at their skin, biting their fingernails, pulling out their hair, and picking at their cuticles. Someone may pick at various parts of the body or different areas more or less frequently than they do others. 

Getting support through BetterHelp

If you’re experiencing compulsive behaviors that feel out of your control, it can lead to serious consequences; you may benefit from speaking to a licensed counselor. If you don’t feel comfortable with traditional in-office therapy, you might consider online therapy through an online platform like BetterHelp. With BetterHelp, you can connect with a therapist from the comfort of your home via phone, videoconferencing, or live chat, which may be more comfortable if you’re experiencing obsessions or compulsions. You can also contact your therapist at any time through in-app messaging, and they’ll respond as soon as they can.

The efficacy of online counseling

Individuals experiencing compulsive behaviors may benefit from online counseling. In an assessment of an online video teletherapy treatment, researchers found that the intervention “resulted in clinically and statistically significant improvements, with a 43.4% mean reduction in obsessive-compulsive symptoms.” Additionally, participants experienced fewer symptoms of depression, anxiety, and stress.