Excoriation Disorder

Excoriation could be associated with anxiety, depression, trauma, ADHD or several other underlying mental health issues. For many people, this action gives them the illusion of temporarily having control, even if it’s only during that moment emotionally. These emotional factors are consistent with the excoriation disorder definition as outlined in DSM-5.

Bug bites, acne, eczema or dry skin are all examples of irritants that can result in the urge to pick. Some users have also reported facing discomfort due to uneven patches or imperfections on the skin. These are direct contributors to skin excoriation disorder and are commonly reported during clinical assessments.

Newer studies have started focusing on obsessive compulsive disorder and body-focused repetitive behaviours within family history, along with serotonin and problem-forming habits, suggesting these factors of genetics and neurobiology have a larger impact on the disorder.

This type occurs without conscious control, usually while a person is focused on another task such as reading or watching television. The picking starts with a mindless scanning and picking of skin and can escalate to skin tearing in the absence of awareness. In such cases, excoriation disorder symptoms may go unnoticed for a long time.

This kind of skin picking is purposeful and sustained, often sparked by stress, anxiety, or perceived irregularities of the skin. Some individuals may use mirrors or tweezer-like tools, and sessions can stretch from minutes to hours.

Most people will experience a mix of both automatic and focused picking. A person may start doing it mindlessly, and at some point, they will become aware of it, especially after some emotional stress or discomfort in their physical body. These mixed behaviours often highlight the complexity involved in the excoriation disorder definition and its diagnosis.

Therapies involve:

1. Cognitive Behaviour Therapy (CBT) is used to change the cognitive processes responsible for the behaviours.

2. Habit Reversal Training (HRT)

3. Acceptance and Commitment Therapy (ACT)

4. Exposure and Response Prevention (ERP)

Depending on severity and other concomitant conditions (comorbidity), a psychiatrist may recommend:

1. SSRIs such as fluoxetine or escitalopram

2. Mood stabiliser: Lamotrigine

3. N-acetylcysteine (NAC) to aid in decreasing the urges.

4. Antipsychotics, at lower doses, are used in resistant cases.

Recovery may be supplemented with:

1. Barrier aids (like gloves and bandages)

2. Fidget tools

3. Grounding objects

4. Share story group therapy.

5. Peer-led motivational recovery circles.