Excoriation disorder is a mental health condition that manifests through the compulsive urge to pick at one’s own skin. While a natural grooming behavior, 2-5% population struggles with skin picking to various degrees. It falls under the umbrella term of body-focused repetitive behaviors (BRFBs), which includes trichotillomania, rhinotillexomania, and scab eating disorder.
In May of 2013, excoriation disorder was added to the fifth edition of the Diagnostic and Statistics Manual of Mental Health Disorders under Obsessive-Compulsive and Related Disorders. Before it’s inclusion in the DSM 5, excoriation disorder was known as dermatillomania, psychogenic/ neurotic excoriation, acne excoriee, and compulsive/ chronic/ pathological skin picking.
Diagnostic criteria for excoriation disorder include: 1
- 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
Skin picking can occur automatically, ritualistically or during sleep. Those with excoriation disorder often go into a trance-like state where they become preoccupied with real or perceived imperfections. They compulsively pick at spots on their skin or create new lesions with the intention of removing the flaw. The need to pick at one’s skin creates anxiety, which is alleviated after engaging in the behavior but often creates distress due to the visible marks left behind.
Individuals with excoriation disorder experience social anxiety from the embarrassment and shame of their appearance or inability to manage the urge. It may become isolating, as they may avoid situations where their marks are exposed. Compulsive skin picking can become a time-consuming behavior to engage in trying to hide damage with clothing and/ or makeup. Skin pickers are more likely to experience depression, low self-esteem, and poor body-image because of how encompassing this disorder is.
Excoriation disorder can be a co-morbidity with (but not limited to) other body-focused repetitive behaviors, depressive disorders, anxiety disorders, personality disorders, ADHD, and body dysmorphia. It can manifest in individuals with neuro-cognitive disorders (ie alzheimers) and the intellectually disabled. Skin picking may also present as a tic disorder (ie tourette’s syndrome) or a “stim” for those on the autism spectrum.
Often mischaracterized as a self-harming behavior, skin pickers do not intentionally cause damage; they want to “fix” an imperfection, with more lesions being undesired consequences for relieving an urge.
Many with this disorder still believe that they are the only ones as it is still not widely known to the public or within the medical profession. More awareness for excoriation disorder and other BFRBs is needed to eliminate shame and stigma.
- Substance Abuse and Mental Health Services Administration. Impact of the DSM-IV to DSM-5 Changes on the National Survey on Drug Use and Health [Internet]. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2016 Jun. Table 3.28, Excoriation (Skin Picking) Disorder. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519704/table/ch3.t28/
PHOTO: © Gillian Drake 2013
MODEL: Angela Hartlin