Which clinical history findings are characteristic in patients with excoriation (skin-picking) disorder?

Updated: Jul 10, 2018
  • Author: Roxanne Graham, MD; Chief Editor: Dirk M Elston, MD  more...
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Answer

Patients with excoriation (skin-picking) disorder give a history of picking, digging, or scraping their skin. Sometimes an inciting incident is the cause, and sometimes no inciting incident is present. Patients might note that they do not scratch themselves consciously; rather, they pick and then notice that they are picking. Cyr and Dreher have provided an excellent summary of neurotic excoriations and their historical and clinical findings and manifestations. [10] Ultimately, neurotic excoriations are a diagnosis of exclusion. [11]

An French survey of neurotic excoriations in 10 patients found that most patients linked their initial excoriations with personal problems; 4 of the patients noted abuse in childhood or in adolescence. [12] This study appeared to suggest that skin picking was an impulsive reaction rather than an obsessive-compulsive disorder; however, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), currently classifies excoriation disorder among the obsessive-compulsive and related disorders. [2]


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