Excoriation Disorder Skin Picking

About Excoriation Disorder Skin Picking

Excoriation disorder, also called skin picking disorder or dermatillomania, involves recurrent picking of the skin that results in skin lesions, along with repeated attempts to reduce or stop. Picking often targets pimples, scabs, calluses, cuticles or small irregularities, most commonly on the face but also on the arms, hands and other areas, and may involve fingernails, teeth or tools. Like hair pulling, picking may be focused, as a response to tension, urges or emotions, or automatic, occurring without full awareness. DSM-5 added it as a separate diagnosis in 2013 within the obsessive compulsive and related disorders chapter. It is more commonly diagnosed in women and often begins in adolescence. Complications include infections, scarring and tissue damage, and people commonly feel shame and may avoid social situations or cover affected areas. It frequently co occurs with trichotillomania, OCD, body dysmorphic disorder, depression and anxiety. Habit reversal training is a first line approach, combining awareness of triggers, a competing response that is incompatible with picking, and stimulus control such as covering affected skin, and cognitive behavioral approaches drawing on acceptance and commitment therapy or dialectical behavior therapy can help with emotion regulation. SSRIs and N acetylcysteine have been studied, with mixed results, and patient organizations provide education and peer support.