Excoriation disorder (ED) is a condition which portrays a behaviour in which an individual continuously picks at their skin which can be ensued with skin lesions and major disturbances in one’s daily life. Excoriation is also known as neurotic excoriation, psychogenic excoriation or dermatillomania and can be associated with obsessive-compulsive disorder. Although chronic skin picking has been documented in medical literature long since the 19th century, there has been its recent entry as an individual entity in the psychiatric classification systems.
These individuals may pick at healthy skin, lesions, or scabs. ED is commonly chronic with periods of reduction in the behaviour alternating with periods with great symptom intensity. They might also spend considerable amounts of time, fortime for instance in some cases, several hours, to pick their skin which can lead to them missing school, work, or social activities.
If not paid attention to or if left untreated, the skin-picking can go on for months or even years. Skin-picking is typically a common phenomenon, and although it may occur at any age it does have a typical onset in adolescence, usually corresponding with the onset of puberty. It is also experienced more often by women than by men.
This is basically a Body Focused Repetitive Behavior Disorder (BFRB) which begins in adolescence. It occurs with puberty around 13-15 years of age but also occur in children under 10 and adults who are between the age of 30 and 45 years of age. Skin excoriation disorder occurs more in women than in men.
Dermatological issues like acne or eczema might often trigger the onset of skin-picking. ED can have multiple triggers and may differ across various individuals. Yet, it will include emotions namely stress, anxiety, anger, or stationary activities like watching television, reading, feeling bored or tired. When the individual is unable to stop picking at their skin, they are likely to feel shame, anger, anxiety, or depression. Due to the feeling of shame, individuals may often feel consequently, social embarrassment or they might avoid situations or environments in which their skin lesions can be shown.
ED is often analogous with other body-focused recurrent behaviour disorders out of which Trichotillomania is the most common, it means repetitive or irresistible urges to pull out body hair. Obsessive-compulsive disorder (OCD) and Body dysmorphic disorder (BDD) are also more common in people with ED than in the general population. Mood and anxiety disorders can also be very common in ED.
Symptoms of skin excoriation disorder
The symptoms may help you recognize what kind of skin picking is normal and what kind of handpicking is abnormal in nature. Some people scratch normally like that when it feels like itching. But many of them scratch to such a point that it starts to bleed or may become inflamed. They scratch it again to get it corrected and again it starts to bleed and then inflamed. In turn this is converted to a habit and the cycle continues.
The signs and symptoms of skin excoriation disorder are as follows:
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There is continuous skin picking which is converted to a skin lesion.
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There are some recurring steps so that they can stop that behavior.
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The symptoms are causing distress to the person experiencing them.
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People with this disorder are trying to remove the imperfections and because of that they keep on scratching their skin.
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They are spending a large amount of time skin picking. They may also keep on scratching their skin many times a day.
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The skin picked area may leave with scars, lesions and infections. Sometimes these infections may require treatment of antibiotics also.
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Because of this they may also avoid all the social events.
Causes of skin picking disorder
Skin picking disorder may occur in response to the following:
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Any kind of skin infection, injury or when a wound heals it will leave a scab. When it heals, it starts to itch and because of that iching people scratch it to such an extent that another wound is formed. And with this forms a habit.
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This behavior may also occur as a part of stress relieving strategy by some. In the conditions and situations in which it cannot be controlled, skin picking can give them a sort of comfort.
Co occurring illness with skin picking
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Obsessive Compulsive Disorder
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Body Dysmorphic Disorder
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Major Depressive Disorder
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Trichotillomania (hair-pulling)
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Other BFRB,s which include: nail biting, lip biting, chewing the inside of the cheeks
Treatment of Skin excoriation:
The treatment of this disorder basically includes medication and therapy. Talking therapy and Habit reversal training are used frequently in the treatment to Skin Excoriation Disorder.
According to the severity of the skin-picking it can be decided if intervention is required or not. However, individuals do not commonly seek help due to many factors namely embarrassment or thinking it is just a “bad habit” to get rid of. Currently in the field of psychology, psychiatric examinations are done, behavioural therapy and meditation are also crucial for its treatment.
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