Excoriation Disorder in Children and Adolescents


ICD-10 code: F42.4

Excoriation (skin picking) disorder is part of a cluster of diagnoses called the obsessive-compulsive and related disorders.  Obsessive-compulsive and related disorders are a group of psychiatric conditions that include:

  • Obsessive-compulsive disorder
  • Body dysmorphic disorder
  • Hoarding disorder
  • Trichotillomania
  • Excoriation (skin picking) disorder

These disorders are characterized by the occurrence of repetitive behaviors, often called compulsions.  Individuals with obsessive-compulsive disorder might engage in compulsive behaviors such as excessive washing, checking, arranging, or counting.  Individuals with body dysmorphic disorder might engage in frequent checking of their appearance in the mirror, or excessive grooming-related behaviors.  Individuals with hoarding disorder may engage in excessive acquiring of objects, combined with a strong need to save items.  Individuals with trichotillomania engage in excessive hair pulling, and individuals with excoriation disorder engage in excessive skin picking.

In some cases, the obsessive-compulsive and related disorders are also characterized by intrusive, unwanted, or distressing thoughts, called obsessions, which come to mind again and again.  People with obsessive-compulsive disorder might have obsessive thoughts about dirt or germs, thoughts of harming others, fears of making mistakes, or distress about things being out of order.  People with body dysmorphic disorder have repetitive, negative thoughts about their own appearance.  However, people with certain other obsessive-compulsive and related disorders (such as trichotillomania or excoriation disorder) often do not experience obsessive thoughts.

 

What is excoriation (skin picking) disorder?

Excoriation (skin picking) disorder is a psychiatric disorder that can arise at any age, often after the onset of a dermatological condition. Estimates of the prevalence in young adults range from 2-9%. The prevalence among children remains largely unknown. Excoriation disorder is characterized by two main symptoms:

  • Recurrent skin picking resulting in injury to the skin (skin lesions)
  • The person has repeatedly and unsuccessfully tried to decrease or stop skin picking
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Understanding Excoriation (skin picking) Disorder

Excoriation disorder severity can range from mild to very severe. Most people with excoriation disorder spend at least an hour per day thinking about or engaging in skin picking.  In severe cases, picking and picking-related thoughts can last many hours per day. Youth with the disorder may try to avoid social events or peer interactions. Interference at school is also common.

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How is excoriation (skin picking) disorder treated?

Excoriation (skin picking) disorder is treatable.  The Trichotillomania Learning Center(TLC) and the Society of Clinical Child and Adolescent Psychology has published guidelines on the treatment of excoriation.

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