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Excoriation Disorder (Skin Picking or Dermatillomania)

Excoriation disorder (also referred to as chronic skin-picking or dermatillomania) is a mental illness related to obsessive-compulsive disorder. It is characterized by repeated picking at one’s own skin which results in skin lesions and causes significant disruption in one’s life. 

Individuals may pick at healthy skin, minor skin irregularities (e.g., pimples or calluses), lesions, or scabs. This disorder is usually chronic, with periods of remission alternating with periods of greater symptom intensity. If untreated, skin-picking behaviors may come and go for weeks, months, or years at a time. It is common for individuals with this disorder to spend significant amounts of time, sometimes even several hours a day, on their picking behavior.

Skin picking is a body-focused repetitive behavior (BFRB) that typically begins during adolescence, commonly coinciding with, or following the onset of, puberty around ages 13-15, but may also occur among children (under 10 years old), or adults (between the ages of 30 and 45). [1] Excoriation disorder affects approximately 1.4% of American adults, and is experienced by women more often than men. [2]

Symptoms

To be diagnosed with excoriation disorder, a person must show the following signs and symptoms: [3]

  • Recurrent skin picking that results in skin lesions
  • Repeated attempts to stop the behavior
  • The symptoms cause clinically significant distress or impairment
  • The symptoms are not caused by a substance or medical, or dermatological condition
  • The symptoms are not better explained by another psychiatric disorder

Causes

Currently, no specific cause has been identified for excoriation disorder. However, evidence demonstrates that the disorder is more common in individuals with obsessive-compulsive disorder and their parents, siblings or children than in the general population, suggesting that there is a genetic predisposition to the condition. [4]

Treatment

Evidence suggests that both medication and cognitive-behavioral therapy (CBT) may effectively reduce symptoms of excoriation disorder. [5]

  • Medication: Successful treatment may include the use of selective serotonin reuptake inhibitors (SSRIs), which are antidepressants that also help reduce obsessive thoughts and compulsive behaviors.
  • Cognitive-behavioral therapy (CBT): Cognitive-behavioral therapy helps individuals understand how their thoughts and behavior patterns are related in order to reduce repetitive behaviors. Individuals learn how to change their thoughts so that they can avoid picking at their skin.

Co-occurring Illnesses

Excoriation disorder often co-occurs with obsessive-compulsive disorder, trichotillomania (hair-pulling), and major depressive disorder. One study indicates that 38% of individuals with excoriation disorder have co-occurring trichotillomania. [6]

Other body-focused repetitive behaviors (BFRBs), such as nail biting, may also coincide with excoriation. [3]

Also on mentalhealthamerica.net

Obsessive-Compulsive Disorder (OCD)

Trichotillomania

Therapy

Finding Therapy

Medication

Paying for Care

Additional Resources

Obsessive-Compulsive Foundation
Phone: (203) 401-2070
Email: info@ocfoundation.org
www.ocfoundation.org

SkinPick
Phone: (323) 989-2064
Email: info@skinpick.com
www.skinpick.com

The TLC Foundation for Body-Focused Repetitive Behaviors
Phone: (831) 457-1004
Email: info@bfrb.org
www.bfrb.org

 


Sources

[1] Grant, J. E., Odlaug, B. L., Chamberlain, S. R., Keuthen, N. J., Lochner, C., & Stein, D. J. (2012). Skin picking disorder. The American Journal Of Psychiatry, 169(11), 1143-1149. Retrieved from http://ajp.psychiatryonline.org/doi/pdf/10.1176/appi.ajp.2012.12040508

[2] Grant, J. E., & Odlaug, B. L. (2009). Update on pathological skin picking. Current Psychiatry Reports, 11(4), 283-288.

[3] American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5. Washington, D.C: American Psychiatric Association.

[4] Bienvenu, O. J., Samuels, J. F., Wuyek, L. A., Liang, K., Wang, Y., Grados, M. A., & ... Nestadt, G. (2012). Is obsessive-compulsive disorder an anxiety disorder, and what, if any, are spectrum conditions? A family study perspective. Psychological Medicine, 42(1), 1-13. doi:10.1017/S0033291711000742

[5] Selles, R. R., McGuire, J. F., Small, B. J., & Storch, E. A. (2016). A systematic review and meta-analysis of psychiatric treatments for excoriation (skin-picking) disorder. General Hospital Psychiatry, doi:10.1016/j.genhosppsych.2016.04.001

[6] Grant, J. E., Chamberlain, S. R., & Odlaug, B. L. (2014). Clinical guide to obsessive compulsive and related disorders. New York, NY: Oxford University Press.
 

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