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Excoriation disorder : Introduction , Sign and Symptoms , Cause , Diagnosis



Excoriation disorder is an obsessive-compulsive spectrum mental disturbance that's characterized by the repeated urge or impulse to select at one's own skin to the extent that either psychological or physical damage is caused.


Signs and symptoms

The region most ordinarily 
picked is that the face, but other frequent locations include the arms, legs, back, gums, neck, shoulders, scalp, abdomen, chest, and extremities like the fingernails, cuticles, and toenails. Most patients with excoriation disorder report having a primary area of the body that they focus their picking on, but they're going to often move to other areas of the body to permit their primary picking area to heal.


Individuals with excoriation disorder vary in their picking behavior; some roll in the hay briefly multiple times each day while others can do one picking session which will last for hours. The foremost common thanks to pick is to use the fingers although a big minority of individuals uses tools like tweezers or needles.

Skin picking often occurs as a results of 
another triggering cause.[5] Some common triggers are feeling or examining irregularities on the skin and feeling anxious or other negative feelings.

Complications arising from excoriation disorder include: infection at the location 
of picking, tissue damage, and sepsis. Damage from picking are often so severe on require skin grafting. Severe picking can cause epidermal abscesses. Severe cases of excoriation disorder can cause life-threatening injuries. for instance , in one reported case a female picked a hole through the bridge of her nose, which required surgery to repair , and a 48-year-old female picked through the skin on her neck exposing the arteria carotis . Pain within the neck or back can arise thanks to prolonged bent-over positions while engaging within the behavior. Besides physical injuries, excoriation disorder can cause severe physical scarring and disfigurement.

Excoriation disorder can cause feelings of intense helplessness, guilt, shame, and embarrassment in individuals, and this greatly increases the danger 
of self-harm. Studies have shown that excoriation disorder presented suicidal ideation in 12% of people with this condition, suicide attempts in 11.5% of people with this condition, and psychiatric hospitalizations in 15% of people with this condition.


There are 
many various theories regarding the causes of excoriation disorder including biological and environmental factors.

A common hypothesis is that excoriation disorder is usually 
a coping mechanism to affect elevated levels of turmoil, arousal or stress within the individual, which the individual has an impaired stress response. A review of behavioral studies found support during this hypothesis therein skin-picking appears to be maintained by automatic reinforcement within the individual.

In contrast to neurological theories, there are some psychologists who believe that picking behavior are often 
a results of repressed rage felt toward authoritarian parents. An identical theory holds that overbearing parents can cause the behavior to develop in their children.

Clinical studies have posited that there's 
a robust link between traumatic childhood events and excoriation disorder. Those with self-injurious disorders of the skin are found to also frequently report childhood sexual assault . While attempting to supply diagnostic criteria for excoriation disorder, researchers conversed with 10 patients with the disorder and located that a majority reported personal problems before the picking began, and 4 reported on abuses they suffered in childhood or adolescence.



There has been controversy over the creation of a separate category within the 
DSM-5 for excoriation (skin picking) disorder. Two of the most reasons for objecting to the inclusion of excoriation disorder within the DSM-5 are: that excoriation disorder may be a symbol of a special underlying disorder, e.g. OCD or BDD, and excoriation disorder is simply a nasty habit which by allowing this disorder to get its own separate category it might force the DSM to incorporate a good array of bad habits as separate syndromes, e.g., nail biting and nose-picking. Stein has argued that excoriation disorder does qualify as a separate syndrome and will be classified as its own category because:


Ø  Excoriation disorder occurs because the primary disorder and not as a subset of a bigger disorder.

Ø  Excoriation disorder has well-defined clinical features.

Ø  There is gathering data on the clinical features and diagnostic criteria for this condition.

Ø  There is sufficient data to make this as a separate category for excoriation disorder.

Ø  The incidence rate for excoriation disorder is high within the population.

Ø  Diagnostic criteria for the disease have already been proposed.

Ø  The classification of excoriation disorder as a separate condition would cause better studies and better treatment outcomes.

Ø  Classification as a separate condition would cause more awareness of the disorder and encourage more people to get treatment


Knowledge about effective treatments for excoriation disorder is sparse, despite the prevalence of the condition. There are two major classes of therapy for excoriation disorder: pharmacological and behavioral.
Individuals with excoriation disorder often don't 
seek treatment for his or her 
condition, largely thanks to feelings of embarrassment, alienation, lack of awareness, or belief that the condition can't be treated. One study found that only 45% of people with excoriation disorder ever sought treatment, and only 19% ever received dermalogical treatment. Another study found that only 30% of people with this disorder sought treatment.


Ø  Medication

Ø  Counseling

Ø  Developmentally disabled



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