What are the DSM-5 diagnostic criteria for excoriation (skin-picking) disorder?

Updated: Jul 10, 2018
  • Author: Roxanne Graham, MD; Chief Editor: Dirk M Elston, MD  more...
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The specific DSM-5 criteria for excoriation (skin-picking) disorder are as follows [2] :

  • Recurrent skin-picking, 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 cannot be attributed to the physiologic effects of a substance (eg, cocaine) or another medical condition (eg, scabies)

  • The skin picking cannot be better explained by the symptoms of another mental disorder (eg, delusions or tactile hallucinations [psychotic disorder], attempts to improve a perceived defect or flaw in one’s appearance [body dysmorphic disorder], stereotypies [stereotypic movement disorder], or intention to harm oneself [nonsuicidal self-injury])

Associated features supporting the diagnosis include a range of behaviors or rituals involving the skin that has been picked. Examples include examining, playing with or even swallowing the skin after it has been pulled off. Picking can be accompanied by different emotional states. The act of picking can be triggered by anxiety or boredom and be preceded by a sense of tension. Afterwards individuals might feel a sense of pleasure, relief or gratification. Pain is not routinely reported. [2]

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