Dermatillomania (Skin Picking) (original) (raw)

According to the DSM-5, excoriation disorder can be diagnosed when the following criteria are met:

• recurrent skin picking results in skin lesions
• repeated attempts are made to decrease or stop the skin picking
• the skin picking causes clinically significant distress—including a feeling of loss of self-control, embarrassment, and shame—or impairment in functioning

In most cases, skin picking does not generally occur in the presence of other individuals.

Repetitive skin picking extends to pulling, squeezing, scraping, lancing, and even biting both healthy and damaged skin from various parts of the body. People with dermatillomania often target their face, hands, fingers, arms, and legs; they may use either their fingers or an instrument, like tweezers or pins. This behavior may also be accompanied by rituals, such as examining or playing with skin that’s been pulled off.

Some individuals spend hours a day on their picking behavior, which can last for months or even years. Excoriation disorder can result in visible skin damage and disfigurement from lesions, discoloration, open wounds, scars, and infections. It is generally a chronic condition, though symptoms may arise and disappear from time to time.

In addition to physical damage, excoriation disorder is characterized by the psychological distress it causes. Individuals with this condition can spend hours thinking about picking and trying to resist the urge before giving in; similar to impulse control disorders such as kleptomania, they may describe a feeling of “tension” that is temporarily relieved once they give in to the urge to pick. Anxiety, depression, shame, fear of exposure, and embarrassment over the condition usually lead to attempts at covering up the skin with makeup, clothing, or other means; such emotions, and other consequences of the disorder, can also interfere with normal social interactions, resulting in uncomfortable relationships with family and friends.

Dermatillomania is not diagnosed when the symptoms are caused by another medical or psychiatric condition. For instance, skin picking can also occur with dermatological conditions, autoimmune disorders, opiate withdrawal, and developmental disorders such as autism.