Excoriation disorder

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Excoriation disorder (also known as dermatillomania and compulsive skin picking/CSP) is an obsessive compulsive disorder characterized by the repeated urge to pick at one's own skin, often to the extent that damage is caused. Skin-picking may be done unthinkingly and the person may have tried multiple times to stop.

The cause of excoriation disorder is not fully understood, but it has been compared to obsessive-compulsive disorder. Some people with this disorder feel that "picking off" pimples or skin abnormalities may rid them of these flaws and help them look more "normal", which is a symptom of body dysmorphic disorder.

Recent research suggests that excoriation may be a part of impulse control disorders, such as eating disorders, alcoholism, obsessive-compulsive disorder, codependence, perfectionism, Borderline Personality Disorder or social anxiety disorder.

Excoriation disorder is more common among people with developmental disabilities such as autism.

DSM-5 Criteria[]

The DSM-5 criteria are:^[1]

Recurrent skin-picking, resulting in lesions
Repeated attempts to decrease or stop skin picking
The skin picking causes clinically significant distress or impairment in important areas of functioning
The skin picking cannot be attributed to the physiologic effects of a substance or another medical condition
The skin picking cannot be better explained by the symptoms of another mental disorder

Excoriation behavior[]

People with excoriation disorder find skin picking to be stress relieving or gratifying rather than painful. An episode of skin-picking is often preceded by high levels of tension, anxiety, or paranoia, coupled with a seemingly irresistible "urge" or "itch" to pick.

Focus may be placed on ingrown hairs, scabs, insect bites, pimples, or cuticles. Sufferers of the condition may enter an trance-like state for minutes or hours, only to be confronted with the results afterward.

Obsessive skin routines, bathing, and makeup application
Self-harm
Compulsive tendency to check mirrors
Some skin pickers may also suffer from trichotillomania

Some people with this disorder feel the need to create pickable surfaces in order to satisfy their compulsion. This may lead to self-harm in the form of mutilation or cutting in order to produce scabs. Some people report picking at inanimate objects or others' skin.

Resulting damage[]

Damage from excoriation is common on the face, back, scalp, and extremities, and can be caused by mixture of picking, scratching, biting, and tweezing.

The person may feel ashamed of the injuries they have caused. Some people use makeup or clothing to try to conceal the damage.

Treatment[]

Treatment for excoriation disorder is an emerging field.

Therapies may include cognitive behavior therapy, acceptance and commitment therapy, and acceptance-enhanced behavior therapy.^[2] Habit reversal training with awareness training may help patients who don't have psychological problems.^[3]

Medication may include antidepressants, anti-anxiety medication, antipsychotics, antiepileptics, and topical cortisone.^[1]

Treating skin issues like acne and eczema may also help reduce triggers.

Synonyms[]

compulsive skin picking
acne excoriee (from French)
chronic skin picking
excoriated acne
neurotic excoriation
psychogenic excoriation
skin picking
self injurious skin picking
obsessive skin picking

Hyponyms[]

acne excoriee des jeunes filles (from French)
compulsive face picking
scalp picking

External links[]

Information[]

Support forums and groups[]

Stop Picking on Me! forum
OSPA Chat Group with regular meetings
Skin Picking Recovery Message Board at ProBoards
Face and Skin Picking Support Forum at ProBoards
Pickaderms at Yahoo! Groups
Dermatillomania Center

References[]

↑ ^1.0 ^1.1 Excoriation Disorder, Medscape
↑ Ruiz FJ (2010). "A review of Acceptance and Commitment Therapy (ACT) empirical evidence: Correlational, experimental psychopathology, component and outcome studies". International Journal of Psychology and Psychological Therapy. 10 (1): 125–62.
↑ Lang R, Didden R, Machalicek W, Rispoli M, Sigafoos J, Lancioni G, et al. (2010). "Behavioral treatment of chronic skin-picking in individuals with developmental disabilities: a systematic review". Research in Developmental Disabilities. 31 (2): 304–315. doi:10.1016/j.ridd.2009.10.017. PMID 19963341.

[:0-1] 1.0 ^1.1 Excoriation Disorder, Medscape

[2] Ruiz FJ (2010). "A review of Acceptance and Commitment Therapy (ACT) empirical evidence: Correlational, experimental psychopathology, component and outcome studies". International Journal of Psychology and Psychological Therapy. 10 (1): 125–62.

[3] Lang R, Didden R, Machalicek W, Rispoli M, Sigafoos J, Lancioni G, et al. (2010). "Behavioral treatment of chronic skin-picking in individuals with developmental disabilities: a systematic review". Research in Developmental Disabilities. 31 (2): 304–315. doi:10.1016/j.ridd.2009.10.017. PMID 19963341.

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