There are several valid and reliable measures/scales that can be used to monitor change in symptoms during treatment.

Scales have been developed in order to aid the clinician in assessing the severity of skin picking symptoms. These scales can be used to better understand the severity of the skin picking problem along with component parts of the picking such as the time spent having urges and thoughts to pick as well as time expended on the picking behavior itself.

Yale-Brown Obsessive Compulsive Scale, modified for Neurotic Excoriation (NE-YBOCS) is a modification of the Yale-Brown Obsessive Compulsive Scale, a 10-item clinician- administered scale for obsessive compulsive disorder. Picking symptoms are assessed during the last seven days on a severity scale from 0 to 4 for each item (total scores range from 0 to 40 with higher scores reflecting greater illness severity). The first five items of the NE-YBOCS comprise the picking urge/thought subscale (time occupied with urges/thoughts; interference and distress due to urges/thoughts; resistance against and control over urges/thoughts), and items 6-10 comprise the picking behavior subscale (time spent picking;

interference and distress due to picking; ability to resist and control picking behavior). The NE-YBOCS is particularly useful to examine the difference between urges/thoughts to pick and actual picking behavior.

Skin Picking Scale-Revised (SPS-R: Appendix C) is an 8-item, self-report measure for the assessment of skin picking. Individual scale items range from 0 to 4 with a total score range of 0 to 32. While a total score should be calculated, two subscale scores for “impairment” and “symptom severity” can also be calculated.

Skin Picking Self-Assessment Scale (SP-SAS) is a modification of a reliable and valid self-report scale used for other psychiatric disorders such as gambling disorder and kleptomania. The 12-item SP-SAS assesses picking urges, thoughts, and behaviors during the previous seven days. Each item is rated 0 to 4 with a possible total score of 48.

Milwaukee Inventory for the Dimensions of Adult Skin Picking (MIDAS) is a 12-item, self-report measure developed to distinguish between automatic (unconscious) and focused (conscious) picking of the skin. Each item is rated from 1 (not true of any of my skin picking) to 5 (true for all of my skin picking). This scale can help the clinician identify how aware each patient is of his/her skin picking as a means of potentially tailoring treatment to each individual. For example, individuals who are more automatic pickers may benefit from CBT awareness training.

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