Rhinotillexomania (nose picking)
En español: lee sobre esta manía en Fobias.org.
Your hand might be at your nose before you have even thought about it, chasing a feeling of dryness or something that is not quite right. Afterwards there can be a sore nose, a nosebleed or a quiet worry that someone saw, and a sense that you should be able to just stop.
What it is
Rhinotillexomania is the medical name for nose picking that has become frequent, hard to control or harmful. Picking your nose now and then is very common and perfectly normal, so this page is about picking that leads to nosebleeds, sores or infection, takes up a lot of time, or causes real distress. It is usually described as a body-focused repetitive behaviour, the same family of habits as hair pulling and skin picking. It is not named as a separate diagnosis in DSM-5-TR, but a clinician may diagnose it as body-focused repetitive behaviour disorder, which DSM-5-TR lists as an example of other specified obsessive-compulsive and related disorder.
Research on nose picking is limited, but the studies that exist show how ordinary the habit is. In one small survey of adults in the United States, around 9 in 10 people who replied said they picked their nose, and most did not see it as a problem. In a survey of 200 teenagers, nearly all picked, about 1 in 6 felt they had a serious problem with it, and a quarter had occasional nosebleeds from picking. It is very common in children, and it often sits alongside other habits such as nail biting, skin picking or hair pulling.
How it differs from a phobia
A phobia is a fear that makes you want to get away from something. Rhinotillexomania works the other way round: it is a pull towards an action. An itch, a feeling of dryness or a build-up of tension creates an urge, picking brings a moment of relief or satisfaction, and then regret or embarrassment can follow, especially if it causes bleeding. Nothing is being avoided out of fear; the struggle is with an urge that keeps coming back.
Read more about manias and phobias
Common signs
- Picking many times a day, often without noticing
- Frequent nosebleeds
- Sore, crusty or scabbed areas inside the nose
- Redness or tenderness around the nostrils
- Picking at scabs before they have had time to heal
- Feeling unable to leave the nose alone when it feels dry
- Picking even after deciding to stop
- Embarrassment or worry that others have noticed
When it tends to show up
- A dry, blocked or itchy nose
- Feeling a crust or something out of place
- Dry air, heating or air conditioning
- Boredom or sitting still for a long time
- Driving, reading or watching a screen
- Feeling stressed, anxious or under pressure
- Tiredness, especially late at night
- Being alone where no one can see
Symptoms
In your body
- An itch, tickle or dry feeling that builds an urge
- A brief sense of relief straight after picking
- Nosebleeds, sometimes repeatedly
- Soreness, crusting or scabs inside the nose
- Redness or swelling if an area becomes infected
In your mind
- A strong urge that feels hard to ignore
- Not realising you have been picking until afterwards
- Embarrassment or shame about the habit
- Worry about being seen or judged
- Frustration at not being able to stop
What you might do
- Picking repeatedly despite wanting to stop
- Going back to the same sore spot again and again
- Picking mostly when alone or in the car
- Hiding the habit or making excuses for nosebleeds
- Avoiding close contact or situations where others might notice
What causes it
Nobody fully understands why nose picking becomes hard to control for some people, and it is probably a mix of things rather than one cause. Physical problems can play a big part: a dry nose, allergies or other kinds of rhinitis, or differences in the shape of the nose can all create a feeling that seems to need dealing with. Picking can then damage the lining, which forms crusts and scabs, and these create fresh urges to pick, so the cycle keeps itself going. As with other body-focused repetitive behaviours, stress, anxiety and boredom are common triggers, and because picking brings quick relief the brain learns to repeat it until it becomes automatic. Brain chemistry and family history may also play a part, and in older adults it can sometimes be linked to other health conditions. It is not a sign of poor hygiene or weakness.
How it can affect your life
For most people the main effects are sore noses and nosebleeds, along with embarrassment or worry about being seen. Heavy, long-term picking can cause more lasting damage inside the nose, and in rare cases it can wear a hole in the wall between the nostrils. Repeated picking can also carry germs into small breaks in the skin and lead to infection. Some people find it affects their confidence at work or in relationships, or spend a lot of energy hiding it.
Treatment
The main evidence-based treatment for body-focused repetitive behaviours like this is habit reversal training, a type of cognitive behavioural therapy (CBT). It helps you notice when picking happens and what sets it off, change your surroundings to make it harder, and use a harmless action with your hands until the urge passes. Treating any physical cause also matters, so a doctor or pharmacist may suggest ways to ease dryness, allergies or a blocked nose, and a damaged nose may need to be checked by a doctor. A doctor may discuss medication in some cases, especially if anxiety or low mood are part of the picture. In the UK your GP is the usual first step and can check your nose and refer you for therapy; in England you can also refer yourself to NHS talking therapies.
Things that can help day to day
- Keep a simple note of when and where you pick
- Ask a pharmacist about easing a dry or itchy nose
- Keep tissues handy and blow gently instead of picking
- Keep your hands busy with a stress ball or fidget toy
- Keep nails short and wash your hands often
- Try slow breathing or a short walk when the urge builds
When to get help
See your GP if you get regular nosebleeds, if sores or crusting in your nose are not healing, if you cannot stop picking, or if it is affecting your mood or daily life. If an area inside or around your nose becomes red, swollen, hot or painful, see a GP or pharmacist. Go to A and E if a nosebleed lasts longer than 10 to 15 minutes even after pinching the soft part of your nose and leaning forward, if the bleeding is very heavy, or if you feel weak or dizzy or have trouble breathing; do not drive yourself, and call 999 if you need an ambulance. OCD-UK has information on body-focused repetitive behaviours, and if you are also feeling very low, talk to your GP or call Samaritans free on 116 123.
How I can help
When I work with someone whose nose picking has got out of hand, I use hypnotherapy and NLP over Zoom alongside, not instead of, habit reversal training and a proper check of the nose by a doctor. Much of this habit happens on autopilot, so we begin by noticing the small moments and feelings that come just before the hand moves. In hypnosis we work on easing the tension and the itch-like urge, and on rehearsing a calmer response so that it starts to feel natural. Many clients find it a relief simply to talk about something they have felt embarrassed by for years, without being judged.
Common questions
Is it normal to pick your nose?
Yes. Surveys suggest that the great majority of adults and teenagers pick their nose at least sometimes, and for most people it is harmless. It is only worth looking at more closely if it is frequent, hard to stop, causing nosebleeds or sores, or upsetting you.
Can nose picking cause nosebleeds?
Yes. The NHS lists picking your nose as one of the most common causes of nosebleeds. If you get nosebleeds often, see your GP, and go to A and E if a nosebleed will not stop after 10 to 15 minutes of pressure.
Is rhinotillexomania a form of self-harm?
No. Like hair pulling and skin picking, it is usually a way of easing an urge, an itch or tension, or a habit that happens without thinking, rather than an attempt to cause harm. Any damage is an unwanted side effect, not the aim.
My child picks their nose a lot. Should I worry?
Nose picking is very common in children, and children also get nosebleeds more easily. Gentle reminders and keeping their nose from getting too dry can help, but if it is causing frequent nosebleeds, sores or distress, it is worth talking to your GP, and you should always see a GP if a child under 2 has a nosebleed.
Further reading: NHS: Nosebleed · OCD-UK: Body-focused repetitive behaviours (BFRBs) · MSD Manual Professional: Body-focused repetitive behavior disorder · Andrade and Srihari (2001): A preliminary survey of rhinotillexomania in an adolescent sample, Journal of Clinical Psychiatry · Shah et al. (2020): Chronic rhinotillexomania leading to multiple infectious sequelae, Cureus (PMC)
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