Excoriation (Skin Picking) Disorder

Clinical Description

Excoriation Disorder, also known as Skin Picking Disorder, Pathological Skin Picking, neurotic/psychogenic excoriation, and Dermatillomania, is a relatively common body-focused repetitive behavior (BFRB) characterized by compulsive picking of skin causing tissue damage. Patients often experience significant social, occupational, and personal consequences resulting from their picking behavior. At its most severe, Excoriation Disorder may be life-threatening (e.g., due to blood loss or septicemia) and require neurosurgical intervention (e.g., gamma knife capsulotomy has been used in a severe case).

While any part of the body can be picked, the most commonly endorsed area of picking is the face. Medical complications are common, and include infections, scarring, septicemia, and ulcerations. Skin Picking Disorder is common and more prevalent in females with prevalence rates ranging from 1.4-5.4% of the general population.

Excoriation Disorder appears to have a trimodal age of onset: in childhood (<10 years old), adolescence/early adulthood (1521 years), and between the ages of 30-45. Excoriation Disorder is associated with a lower quality of life, reduced self-esteem, and avoidance of social situations due to shame and embarrassment resulting from the picking. The majority of affected individuals have never sought treatment or discussed their picking behaviors with healthcare professionals.

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