Summary about Disease
Excoriation disorder, also known as skin-picking disorder, is a mental health condition characterized by the repetitive and compulsive picking of one's own skin, resulting in skin lesions, significant distress, and impairment in social, occupational, or other important areas of functioning. It is classified as an obsessive-compulsive and related disorder.
Symptoms
Recurrent picking of skin, resulting in skin lesions.
Repeated attempts to decrease or stop skin picking.
The skin picking causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
The skin picking is not attributable to the physiological effects of a substance (e.g., cocaine) or another medical condition (e.g., scabies).
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 perceived defects or flaws in appearance in body dysmorphic disorder, stereotypies in stereotypic movement disorder, or intention to harm oneself).
Picking can occur on any area of the body, but common areas include the face, arms, hands, and legs.
Individuals may use their fingernails, pins, tweezers, or other objects to pick their skin.
Skin picking can be preceded or accompanied by feelings of tension, anxiety, or boredom.
Individuals may experience a sense of relief, pleasure, or gratification while picking.
The picking may be focused (intentional) or unfocused (automatic).
Individuals may spend a significant amount of time picking their skin, thinking about picking, and trying to resist picking.
Skin picking can lead to feelings of shame, guilt, and embarrassment, which can lead to social isolation and avoidance of activities.
Causes
The exact cause of excoriation disorder is not fully understood, but it is believed to be a combination of genetic, neurological, and environmental factors. Risk factors may include:
Genetics: A family history of excoriation disorder or other obsessive-compulsive and related disorders may increase the risk.
Neurological Factors: Imbalances in brain chemicals, such as serotonin and dopamine, may play a role.
Environmental Factors: Stressful life events, trauma, or learned behaviors may trigger or exacerbate skin picking.
Other Mental Health Conditions: Excoriation disorder often co-occurs with other mental health conditions, such as anxiety disorders, depression, and obsessive-compulsive disorder (OCD).
Temperament: Individuals who are perfectionistic, impulsive, or have difficulty regulating emotions may be more likely to develop excoriation disorder.
Medicine Used
Selective Serotonin Reuptake Inhibitors (SSRIs): These antidepressants, such as fluoxetine, sertraline, and paroxetine, can help reduce obsessive thoughts and compulsive behaviors.
N-Acetylcysteine (NAC): This amino acid supplement may help reduce skin-picking behavior.
Cognitive Behavioral Therapy (CBT): Specifically, habit reversal training (HRT) is a form of CBT that helps individuals identify triggers for skin picking and develop alternative coping strategies.
Other Medications: In some cases, other medications, such as antipsychotics or mood stabilizers, may be used to treat co-occurring mental health conditions.
Is Communicable
No, excoriation disorder is not communicable. It is a mental health condition, not an infectious disease.
Precautions
Seek Professional Help: If you are struggling with skin picking, it is important to seek help from a mental health professional.
Identify Triggers: Keep a journal to track when and where you pick your skin. This can help you identify triggers and develop strategies to avoid them.
Develop Alternative Coping Strategies: Find healthy ways to cope with stress and anxiety, such as exercise, yoga, or meditation.
Keep Your Hands Busy: Engage in activities that keep your hands busy, such as knitting, drawing, or playing a musical instrument.
Create a Skin-Care Routine: Establish a regular skin-care routine to keep your skin healthy and prevent picking.
Cover Affected Areas: If possible, cover affected areas with bandages or clothing to prevent picking.
Enlist Support: Talk to friends, family members, or a support group about your struggles.
Reduce Stress: Minimize stress through relaxation techniques and lifestyle changes.
Improve Sleep Hygiene: Ensure you are getting adequate sleep.
How long does an outbreak last?
The duration of an "outbreak" or episode of skin picking can vary widely. Some individuals may experience brief periods of increased picking, while others may have chronic, ongoing symptoms. There is no set duration for an episode, and the course of excoriation disorder can fluctuate over time.
How is it diagnosed?
Excoriation disorder is diagnosed based on clinical criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). A mental health professional will conduct a thorough evaluation, which may include:
Clinical Interview: The clinician will ask about the individual's symptoms, history of skin picking, and impact on their life.
Physical Examination: The clinician may examine the individual's skin for lesions and other signs of skin picking.
Psychological Assessments: The clinician may use standardized questionnaires or rating scales to assess the severity of symptoms and co-occurring mental health conditions.
Differential Diagnosis: The clinician will rule out other medical or mental health conditions that could be causing the symptoms.
DSM-5 Criteria: The clinician will determine if the individual meets the diagnostic criteria for excoriation disorder, as outlined in the DSM-5.
Timeline of Symptoms
The onset of symptoms can vary, but it often begins in adolescence or early adulthood. The timeline of symptoms can be:
Trigger: Something triggers the urge to pick.
Urge: Experiencing an intense urge to pick at skin.
Picking: Giving in to the urge and picking at the skin.
Relief/Guilt: Feeling relief or pleasure during/immediately after, followed by guilt or shame.
Lesions: Visible skin lesions from picking.
Cycle: The cycle repeats, often becoming habitual. The condition can be chronic with waxing and waning of symptoms.
Important Considerations
Co-occurring Conditions: Be aware of co-occurring mental health conditions, such as anxiety, depression, and OCD, as these can affect treatment outcomes.
Stigma: Excoriation disorder is often associated with shame and stigma, which can prevent individuals from seeking help.
Treatment Adherence: Adherence to treatment is crucial for successful management of excoriation disorder.
Long-Term Management: Excoriation disorder is often a chronic condition that requires long-term management.
Self-Care: Implementing self-care strategies can significantly improve quality of life.
Relapse Prevention: Develop a relapse prevention plan with your therapist.