Do you find yourself frequently biting the inside of your cheeks? Is it often the same spot? Have you noticed blood or cuts inside your mouth? You may not even realize what you’re doing, until it begins to hurt. Maybe a loved one has had to point your behavior out to you, or it’s taken a lingering, infected sore for your biting to grab your attention. It’s also possible you’ve been biting the inside of your mouth in secret, embarrassed by your seeming inability to stop.
If your behavior has become almost automatic, you’ve likely been engaging in it for a while. To understand how you can stop biting the inside of your mouth, you first have to understand why you’re doing it. It may be that you’re experiencing body-focused repetitive behavior (BFRB). Behaviors like this are not merely a “nervous habit.” BFRBs can lead to shame and social withdrawal, emotional stress and physical damage—including scarring or infection.
While cheek-biting can occur for a range of reasons—and very occasional biting is likely not cause for concern—it’s important to know what’s triggering your behavior, so you can address any impacts accordingly. Whatever the cause, you can take steps to correct the problem, such as seeing a dentist or seeking help from a trained mental health professional.
Why does cheek-biting happen?
There are many reasons you might find yourself biting the inside of your mouth, including:
Dental problems
If you’re noticing that you’re biting the inside of your mouth in your sleep or struggling to bite down at all without biting your own cheeks, you could be experiencing dental problems. Misaligned teeth, a deviated molar, or issues with wisdom teeth can all be common causes of unintentional, chronic cheek-biting.
In these cases, you may experience discomfort where your teeth and cheek meet, if you try to bite down. It’s also not uncommon to experience irritation or even small lesions inside the mouth, as a result. Seeking dental care will be the best course of action, as it’s unlikely that your cheek-biting is motivated by a mental health concern.
Body-focused repetitive behavior (BFRB)
Chronic cheek-biting, or morsicatio buccarum, can be a common body-focused repetitive behavior (BFRB). A body-focused repetitive behavior describes a repeated behavior performed on your body, such as picking at your skin, biting your nails, pulling out your hair, or biting the inside of your cheek, lips, or tongue. NOCD therapist Tracie Ibrahim, LMFT, CST explains that these behaviors differ from a nervous habit, since they typically cause significant distress or impairment to daily life, and can be very difficult to stop.
BFRBs can also coincide with other mental health conditions, including anxiety, depression, obsessive-compulsive disorder (OCD), attention-deficit hyperactive disorder (ADHD), or autism.
“BFRBs are really common…especially, alongside OCD,” explains Ibrahim. “Cheek-biting is just one of the many ways BFRB shows up.”
You may engage in a BFRB, like biting the inside of your cheeks, because you’re feeling stressed, anxious, depressed, or even bored or impatient. Often, this behavior becomes a way to manage negative emotions.
It’s not uncommon to be somewhat unaware of your BFRB. You may be watching TV, reading, or daydreaming, and suddenly realize that you’ve been chewing on the inside of your cheek without even noticing. “Sometimes you’re aware that you’re doing it and it’s just really hard to stop,” says Ibrahim. “[But] you can end up doing things unintentionally, as well.”
How can I tell if my cheek-biting is a compulsion?
It’s important to note that while BFRBs commonly occur alongside OCD, BFRBs are a distinct diagnosis. Both conditions are characterized by an out-of-control feeling around certain acts or behaviors, but the motivation behind these feelings and actions is typically different.
“Cheek-biting is not an OCD compulsion,” Ibrahim says. If you live with OCD, your compulsive behaviors are likely driven by a desire to find relief from distressing and intrusive thoughts, images, feelings, sensations or urges. OCD compulsions can take the form of repetitive behaviors, mental actions, or avoidance of certain places or situations. For example, if you have contamination OCD, you might feel unclean every time you think about entering a public space. As a result, you might find yourself avoiding those spaces, or compulsively washing your hands.
While compulsions can take the form of repetitive behaviors, unlike BFRBs, they don’t provide a feeling of satisfaction—leading the cycle of obsessions and compulsions to repeat. People navigating BFRBs, on the other hand, are not typically responding to obsessive thoughts. Instead, BFRBs often serve as a way to self-soothe or cope with more general emotional discomfort. Actions such as skin-picking, cheek-biting, or hair-pulling may provide people with BFRBs with temporary feelings of pleasure or calm, in contrast to the sensation of engaging in an OCD compulsion.
While you can have OCD and a BFRB at the same time, it’s important to distinguish between OCD and BFRB treatments, as they differ. The recommended treatment for OCD is exposure and response prevention (ERP) therapy. When working with a therapist on ERP, you will be gradually and carefully exposed to your triggers until it is easier to resist compulsions.
BFRBs are typically treated using habit-reversal training (HRT) and comprehensive behavioral model (ComB), which focus on learning what causes the behavior and developing alternative, healthier responses.
How to stop biting your cheek
If you suspect dental issues are causing your cheek-biting, it’s important to schedule an appointment with a dentist or orthodontist. However, if you think your behavior may be driven by feelings of distress or intrusive thoughts, you may want to consult a trained therapist. When seeking treatment, it’s important to make sure you are seeing a trained professional, with specific expertise treating BFRBs.
Habit Reversal Training (HRT) for BFRBs
The most effective treatment for BFRBs is a therapy called habit-reversal training (HRT). With HRT, you’ll first learn to recognize what may be triggering your cheek-biting. By examining how you typically feel when the urge to bite the inside of your mouth strikes, you’ll gain insights that can help you stop the behavior before it occurs.
Next, you’ll learn a technique called competing response training, which teaches you to substitute biting the inside of your mouth with a different action. For example, you might realize you bite the inside of your mouth when you watch television. You and your therapist would then devise strategies for alternate behavior during that time—such as chewing gum, sucking on a mint or hard candy, or keeping water nearby and taking a sip whenever you have the urge to bite. Over time, these new behaviors can help break the cycle of chronic cheek-biting and you can begin to replace the habit with healthier ways to manage distress, boredom, restlessness, anxiety, or stress.
Lastly, your therapist will help you access social support, by bringing loved ones into your treatment plan. These trusted individuals can help you notice when you’re biting the inside of your mouth, so the burden doesn’t fall solely on you. Sharing what you’re going through can also help you let go of feelings of shame and isolation that you may be carrying.
Comprehensive Behavioral Intervention (ComB) for BFRBs
Another treatment that has proven useful for BFRBs is the comprehensive behavioral model (ComB), which provides a more individualized approach. With ComB, you and your therapist will take more time to understand the underlying factors that cause your behavior. Similar to HRT, you and your therapist will then focus on triggering activities and environments, while devising strategies for alternate behavior.
When to seek help for cheek-biting
Cheek-biting can lead to lesions, ulcers, and sores in the inside lining of your cheek. More specifically, it can cause canker sores, which are small, painful ulcers. Before a canker sore becomes visible, you may feel a tingling or burning sensation—followed by pain. Luckily, these sores typically tend to go away on their own with little to no treatment. However, they might stick around or worsen if your cheek- biting persists.
You also might think that because the impacts of cheek-biting are typically not visible, your BFRB is not as damaging as biting your nails or picking at your skin. This is not the case. Just because others can’t see your pain or discomfort, doesn’t mean it isn’t serious or real. If you regularly have lesions, broken or bleeding skin, feel swollen, or experience tenderness when you eat, you should seek help for your cheek-biting.
Bottom line
The pattern of biting the inside of your cheek can be painful, and cause you to feel shame. Managing chronic cheek-biting can be isolating and confusing, especially when the habit becomes automatic and feels difficult to break. However, whether your cheek-biting is triggered by stress, anxiety, boredom, or even misaligned teeth, there are ways to address your problem and feel less isolated in your discomfort.