Excoriation Disorder DSM-5 Criteria

What is excoriation (skin picking) disorder?

Excoriation disorder, also known as skin picking disorder or dermatillomania, is a mental health condition characterized by repetitive skin picking that results in skin lesions and significant distress or impairment in daily life. It typically begins during adolescence or early adulthood and affects between 1.4% and 5.4% of the population, with women being more commonly affected than men (Mental Health America, n.d.).

Excoriation disorder frequently co-occurs with other body-focused repetitive behaviors (BFRBs) and mental health conditions, such as hair-pulling disorder (trichotillomania) (Snorrason et al., 2012).

How is excoriation disorder diagnosed?

To diagnose excoriation disorder, mental health professionals follow these steps:

Gather information

During the initial consultation, you may need to ask detailed questions about the individual's skin-picking behaviors. This includes inquiring about the frequency, duration, and severity of the picking episodes and any associated feelings of distress or impairment in daily functioning. You may also ask about the individual's motivations for skin-picking, such as seeking to remove perceived skin imperfections or relieve tension.

Physical examination

Following the information-gathering stage, you will conduct a thorough physical examination to assess the presence and severity of any skin lesions or damage resulting from the recurrent skin-picking behavior. This will rule out any underlying medical conditions, such as dermatological disorders or neurological conditions, that may be contributing to the individual's skin picking.

Psychological assessment

In addition to the physical examination, you will conduct a comprehensive psychological assessment to evaluate the individual's mental health history and identify any co-occurring conditions that may be related to or causing the recurrent picking behavior. This may include screening for obsessive-compulsive disorder (OCD), body dysmorphic disorder (BDD), anxiety disorders, depression, or other mental health conditions.

Diagnostic criteria

Finally, you will carefully evaluate the individual's symptoms against the diagnostic criteria for excoriation disorder as outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

By following this comprehensive assessment process, mental health professionals can accurately diagnose excoriation disorder and develop an appropriate treatment plan tailored to the individual.

Excoriation disorder DSM-5 diagnostic criteria

The DSM-5 criteria for excoriation disorder include:

• Recurrent skin picking resulting in skin lesions
• Repeated attempts to decrease or stop the pathologic skin-picking behavior
• The skin picking causes clinically significant distress or impairment in daily functioning
• The skin picking is not better explained by the symptoms of another mental disorder (e.g., delusions or tactile hallucinations in a psychotic disorder, attempts to improve a perceived defect or flaw in appearance in BDD, stereotypic movement disorder, trichotillomania, or a general medical condition)

Differences between the DSM-4 and DSM-5 criteria

In the DSM-5, excoriation disorder was added as a new diagnostic category. In contrast, the DSM-4 did not recognize it as a distinct disorder and often subsumed it under the category of "impulse control disorder not otherwise specified." This recognition underscores the importance of acknowledging the unique aspects of this condition.

How is excoriation disorder treated?

Excoriation disorder is typically treated with a combination of psychotherapy and medication:

• Psychotherapy: Cognitive-behavioral therapy (CBT), particularly habit reversal training (HRT), is the most effective psychotherapeutic approach. HRT involves increasing awareness of the skin-picking behavior, identifying triggers, and learning alternative coping strategies.
• Medication: Selective serotonin reuptake inhibitors (SSRIs) are the first-line pharmacological treatment for excoriation disorder. Other medications that may be used include antidepressants, anticonvulsants, and antipsychotics.
• Supportive care: Individuals with excoriation disorder may benefit from support groups, stress management techniques, and self-care strategies such as keeping the skin clean and nails trimmed.

References

Mental Health America. (n.d.). Excoriation disorder (skin picking or dermatillomania). https://mhanational.org/conditions/excoriation-disorder-skin-picking-or-dermatillomania

Snorrason, I., Belleau, E. L., & Woods, D. W. (2012). How related are hair pulling disorder (trichotillomania) and skin picking disorder? A review of evidence for comorbidity, similarities and shared etiology. Clinical Psychology Review, 32(7), 618–629. https://doi.org/10.1016/j.cpr.2012.05.008

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