Skin Picking Disorder

Skin picking disorder, also known as dermatillomania or excoriation disorder, is a mental health condition characterized by repetitive and compulsive skin picking, resulting in skin damage.

Definition and Diagnosis

The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) defines skin picking disorder as a condition where an individual recurrently picks at their own skin, leading to skin lesions or injuries. To diagnose skin picking disorder, the following criteria must be met:

• Recurrent skin picking resulting in skin damage
• Repeated attempts to stop or reduce skin picking
• Skin picking causes significant distress or impairment in social, occupational, or other areas of life
• Skin picking is not better explained by another mental disorder or medical condition

Prevalence and Demographics

Skin picking disorder affects approximately 1.4% to 5.4% of the general population, with women being more likely to be affected than men. The condition can occur at any age, but it typically begins in adolescence or early adulthood.

Causes and Risk Factors

The exact causes of skin picking disorder are not fully understood, but several factors may contribute to its development:

• Genetic predisposition
• Neurobiological factors, such as abnormalities in brain regions responsible for impulse control and emotional regulation
• Psychological factors, including stress, anxiety, and trauma
• Certain medical conditions, such as eczema or acne, which may trigger skin picking behaviors

Symptoms and Clinical Features

Individuals with skin picking disorder often exhibit the following symptoms:

• Recurrent skin picking, often accompanied by feelings of tension or anxiety before picking and relief afterwards
• Skin lesions or injuries, such as cuts, scratches, or scabs
• Attempts to conceal or camouflage skin damage with makeup or clothing
• Feelings of guilt, shame, or embarrassment related to skin picking behaviors
• Significant distress or impairment in daily life due to skin picking

Treatment and Management

Treatment for skin picking disorder typically involves a combination of psychological therapies and pharmacological interventions:

• Cognitive-behavioral therapy (CBT), which helps individuals identify and change negative thought patterns and behaviors associated with skin picking
• Habit reversal training, a type of behavioral therapy that teaches individuals to become aware of their skin picking habits and replace them with alternative behaviors
• Medications, such as selective serotonin reuptake inhibitors (SSRIs) or n-acetylcysteine, which may help reduce symptoms of skin picking disorder

Complications and Prognosis

If left untreated, skin picking disorder can lead to various complications, including:

• Severe skin damage or scarring
• Infections or other medical complications related to skin lesions
• Social isolation or difficulties in relationships due to feelings of shame or embarrassment
• Co-occurring mental health conditions, such as depression or anxiety disorders

With proper treatment and support, individuals with skin picking disorder can experience significant improvement in symptoms and quality of life.