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Excoriation Disorder or Skin-Picking Disorder is also known as dermatillomania and is brand new in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5)*. People who have the disorder have a constant desire to pick at their skin even if it causes it to rupture, bleed and damages it. It’s classified as an obsessive compulsive disorder.

Excoriation Disorder is comparable to trichotillomania or hair-pulling disorder, where people feel the need to pull their own hair. Hair pulling is also an obsessive compulsive disorder.

Up to as much as 5.4 percent of people are estimated to have Excoriation Disorder. About half of the people with the disorder develop it prior to the age of 10. Many people are found to develop the disorder between 30 and 45 years of age. More females have the disorder than men, and symptoms often begin when acne starts to show. But, even after a problem with acne is solved, the Skin-Picking still continues.

The disorder is also associated with traumatic experiences when the individual was a child and as the result of stress in adults. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1705499/)

The DSM-5 is published by the American Psychiatric Association.

Symptoms of Excoriation (Skin-Picking) Disorder DSM-5 698.4 L98.1

The essential symptom of Excoriation Disorder is an obsession to pick, squeeze or scratch a section of the skin that a person feels is an imperfection. This is usually done when he feels stressed or anxious. The picking is usually on the face, followed by the legs, arms, hands and the scalp. While there’s usually a key area where a person picks his skin, the picking may switch to another area in order for the injured section to heal.

The picking is mostly done for short periods of time, but may be picked at constantly. Although the fingers are normally used for the picking, some people use other items, such as needles.

People with Excoriation Disorder sometimes feel guilty and ashamed of themselves when they pick the skin. About 15 percent of people with the disorder have had psychiatric hospitalization, 12 percent of the individuals experienced suicidal thoughts and 11 percent attempted suicide. (https://pdfs.semanticscholar.org/0363/5abb419c826c21557c49559dd7a1f7a5a2ac.pdf)
Skin-Picking, like hair-pulling, is an obsessive behavior, but it’s not begun because of obsessive thoughts. Anxiety or depression are the triggers. The obsessive compulsive act of picking the skin with a lack of control lessens the person’s anxiety. There are feelings of pleasure while engaging in the behavior.

According to the DSM-5, people with the disorder pick the skin without having other obsessions and other concerns about abnormalities on the body.

Skin-Picking may cause skin lesions, and many people make attempts to halt the picking. This has resulted in a great amount of distress, as well as social and career problems. The DSM-5 considers it a disorder when the picking isn’t due to the effects of a drug and isn’t because of a medical or other mental disorder.

The following summarizes the symptoms of Excoriation Disorder.

  • Repeated picking of the skin that results in skin lesions.
  • Repeated attempts to lessen or stop skin picking.
  • Causes an extreme amount of distress or impairment in social relationships, career or other areas.
  • Isn’t attributed to psychological effects of a substance, such as cocaine or another medical condition.

Causes of Excoriation (Skin-Picking) Disorder DSM-5 698.4 L98.1

The following are a few of the causes of Excoriation Disorder.

  • Self-disfigurement to lessen a person’s attractiveness because of mental, emotional or behavioral attitudes concerning sex.
  • Skin-Picking has brought about anger that has been covered up in children in order to cope with very domineering parents.
  • Abnormal way to cope with stress or anxiety.
  • Many people pick because they’re certain their skin is contaminated.

It’s thought that dopamine (neurotransmitter that helps to control the brain’s reward and pleasure centers) is involved in Skin-Picking.

Treatment of Excoriation (Skin-Picking) Disorder DSM-5 698.4 L98.1

Only between 30 and 45 percent of people with Excoriation Disorder find treatment. Behavioral treatments are helpful in people with the disorder, where the habit is reversed in combination with awareness training to put the focus on the picking behavior. The person in therapy is taught to use a different response than Skin-Picking, such as making doing something healthy in situations that normally cause the picking.

Cognitive Behavioral Therapy has been successful in helping the individual learn behavior to occupy his time and energy instead of picking.

People With Excoriation (Skin-Picking) Disorder DSM-5 698.4 L98.1

According to psychiatrist Dr. Peggy Richter, who is the director of the clinic for Obsessive Compulsive Disorders and related disorders at Sunnybrook Health Sciences Centre, everyone picks at their skin to a certain degree—popping a pimple, squeezing a blackhead or pulling off a scab. While that’s normal behavior, Excoriation Disorder is a recurrent problem.

“For these folks, they may have damaged their skin to such a point that they’re significantly distressed and very self-conscious about the impact on their appearance and how others perceive them,” Richter said.

The reality of the impact may be such that they’re not comfortable going out on a bad picking day, because they have raw, red areas on their face, for example, that are painful, she said. “So, maybe they’re calling in sick for work a few days a month after a bad episode.”

Richter’s patients include parents who won’t take their children to school after a picking the evening before and have dug at their skin so much they need stitches.

Skin-Picking Disorder affects people in every walk of life, famous and unknown. The following are a few well-known people who have symptoms of Excoriation Disorder.

  • Tulisa Contostavios, of the United Kingdom, is part of the hip hop group, N-Dubz. The group has won the acclaim of critics and fans, with albums going platinum and earning awards. Contostavios is also a judge on the reality talent show, the X-Factor UK. In her 2012 autobiography, “Honest: My Story So Far,” she wrote about her experiences with Excoriation Disorder.
  • Author Elizabeth Hayt wrote “I’m No Saint: A Nasty little Memoir of Love and Leaving.” She described her Skin-Picking habit for Elle magazine celebrity esthetician Renee Rouleau, telling the writer she’s suffered from the disorder for many years. Because of her Skin-Picking, she’s selected a career path as an expert in skin care, where she’s recognized by the rich and famous.
  • Actress Cameron Diaz is rumored to be a Skin-Picker. Based on speculation from past interviews and quotes, Diaz shows symptoms of having the disorder.

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