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Excoriation Disorder - Causes, Symptoms, Diagnosis, and Treatment

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Repeatedly picking at skin or scratching the skin, causing a lesion or a wound, is known as excoriation disorder.

Written by

Dr. Kirti Maan

Medically reviewed by

Dr. Ramchandra Lamba

Published At November 30, 2022
Reviewed AtNovember 30, 2022

What Is Excoriation Disorder?

Every individual, once in a while, picks at their skin under stress. It is pretty common and may lead to lesion formation or scab wounds. However, constant peeling and picking may lead to more permanent or severe injuries. In addition, constant and unconscious picking leads to skin damage and increases the chances of infection; this condition is known as excoriation disorder.

Excoriation disorder is also known by other names, such as skin-picking disorder and dermatillomania. The skin-picking disorder is a chronic mental health disorder that is often associated with obsessive-compulsive disorder (OCD). Golden signs of excoriation disorder are continuous tearing, picking, and plucking at the skin. The skin in constant terror can either be healthy skin or can be previously harmed, calloused, scabbed, or present pimple skin.

This excoriation of skin can be voluntary; this picking of skin relieves stress and anxiety faced by the individual or when they suffer from obsessive-compulsive disorder (OCD) or can be an involuntary action that has been ingrained inside the individual. But, on the other hand, this constant picking of skin hinders one’s social and personal life.

Skin picking is a body-focused repetitive behavior (BFRB); in simpler terms, it is an activity performed unconsciously by the body. Unfortunately, individuals suffering from this order become so habitual that they do not even realize that they are participating in the said activity. That is one of the main reasons behind their shut-eye towards the signs of excoriation disorder.

Excoriation disorder is often accompanied by other physical and mental health disorders, such as skin conditions (pimples or acne problems), mental retardation, substance abuse disorder, withdrawal (alcohol or drug) symptoms, or anxiety disorders. These disorders do not necessarily cause an individual to pick at their skin, but picking skin is often seen as these disorders cause stress and anxiety, leading to an imbalance or freakish behavior of the individuals, hence picking at their skin.

Does Skin Picking Associated With This Disorder Cause Pain?

Individuals picking at their skin ordinarily do not seem to mind the pain accompanied by the attack; they relish it as it distracts them individually, making them less anxious and stressed, which is the desired state for an anxiety-ridden individual. Common skin parts involved in the disorder are the face, head, back, arms and legs, hands and feet, and the most common site are the cuticles. The most commonly picked site is cuticle because it is easier to pick at the location with the help of their nails and, in rare cases, teeth.

What Causes Excoriation Disorder?

The cause as to why an individual picks at their skin is yet not known. However, it has been established that excoriation disorder is closely related to obsessive-compulsive disorder (OCD). Obsessive-compulsive disorder is a mental disorder where an individual becomes obsessed (with constant thoughts of the idea of doing something) with an activity or a thought. Individuals with OCD might develop excoriation disorder and continuously pick at their skin. Theories have also suggested other factors which can trigger skin picking or excoriation of the skin. Some of them are listed below:

1. Tendency to get bored quickly.

2. Stress.

3. Anxiety.

4. Negative emotions such as remorse or guilt (over something).

5. Skin irregularities an individual wants to get rid of.

6. Body-focused repetitive behavioral activities include nail-biting, hair-pulling (repeatedly), or skin-picking.

7. Positive signs of body dysmorphic disorder.

8. Scab wound (this is one of the most common reasons behind picking skins).

Co-occurring Diseases: Excoriation disorder is often accompanied by other mental health disorders. These conditions either have excoriation as their symptoms or may motivate an individual to pick skin as a result of suffering from these disorders. Some of the common co-occurring diseases are:

1. Obsessive-compulsive disorder.

2. Major depressive disorder.

3. Trichotillomania (pulling one’s hair out of habit or repetitively).

4. Infectious diseases cause skin lesions.

5. Body dysmorphic disorder.

6. Attention-deficit hyperactivity disorder (ADHD).

7. Autism spectrum disorder (AUS).

What Are the Symptoms of Excoriation Disorder?

The golden sign of skin-picking disorder or excoriation disorder is its namesake, picking at skin. Other signs and symptoms of excoriation disorder include:

  • Recurrent and continuous skin picking results in skin lesions.

  • Failed or half-hearted attempts to quit this habit.

  • Picking skin causes pain, discomfort, and shame to the individual.

  • Visible after marks of the trauma (skin picking) on the site.

  • The symptoms are not dictated or explained by other mental illnesses.

How to Self-Diagnose Excoriation Disorder?

Since the disorder does not affect life on a grand scale, the most common sign of this disorder, that is, skin picking, is also ordinarily observed. However, individuals often do not seek professional help for diagnosis. Hence, self-diagnosis or confirmation is necessary. So once confirmed, the individual can take precautionary steps and therapeutic action to resolve the disorder. In order to self-diagnose excoriation disorder, an individual must be willing to ask oneself the following questions:

  • Does picking at the skin provide a distraction?

  • Are there visible scars or scabs from picking at the skin?

  • Does skin picking consume or take up a significant amount of time?

  • Is picking at the skin a daily activity?

  • Does the pain after picking at the skin feel normal?

  • Does it affect the patient to pick at the skin?

  • Ever tried quitting this habit?

  • Does picking at skin cause trouble in personal and professional life?

What Is the Treatment of Excoriation Disorder?

Treatment of excoriation is similar to obsessive-compulsive disorder (OCD) and is an adjunct to provide symptomatic relief to the patient. The treatment plan for excoriation disorder includes psychotherapy.

Psychotherapy: Psychotherapy or talk therapy allows an individual to be able to talk to their therapists or counselor about their fear, feelings, emotions, and thought processes. Different types of psychotherapy prescribed to help an individual suffering from excoriation disorder are:

1. Cognitive-Behavioral Therapy (CBT): Cognitive-behavioral therapy provides insight into the patient’s psyche and cognitive mindfulness. They make the individual comfortable enough to discuss their anxiety which is often a direct cause of skin picking and peeling. After understanding the reason behind excoriating one’s skin, the counselor moves forward to the helping segment. The counselor then sits and discusses their issues so as to come to a point where they can avoid and help the situation. The standard type of cognitive-behavioral therapies suggested are:

  • Habit-Reversal Training (HRT): Like its namesake, this therapy is suggested to reverse the habit of skin peeling by talking to the patient about their thoughts and the processes leading to skin picking.

  • Comprehensive-Behavioral Model (ComB): This therapy tames and models the behavior of the individual, helping them avoid the triggers and talk about their habit.

2. Acceptance and Commitment Therapy (ACT): This therapy, like its namesake, helps the individual accept and then commit to the needed changes to change the behavior that may cause skin picking.

Conclusion:

Excoriation disorder is chronic and could be a potentially fatal mental disorder. It is a treatable condition that requires early diagnosis. Providing an individual with prompt diagnosis and appropriate treatment is a must as it is a further branch or complication of obsessive-compulsive disorder. Living with excoriation disorder can hinder the patient's psyche as it provides obstacles in an individual's personal and professional life. Excoriation disorder is a mellow symptom of obsessive-compulsive disorder, only when promptly taken care of.

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Dr. Ramchandra Lamba
Dr. Ramchandra Lamba

Psychiatry

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