Excoriation: Definition & Treatment

Instructor: Danielle Haak

Danielle has a PhD in Natural Resource Sciences and a MSc in Biological Sciences

Excoriation is a difficult condition to diagnose and treat because it is a type of mental disorder. Read through this lesson to learn what excoriation is, how it develops, what it causes a person to do, and how it is treated.

What is Excoriation?

Excoriation is a condition that leads to a person obsessively picking, digging into, rubbing, touching, or scratching their skin. It's believed this happens because the person is trying to physical remove imperfections they see on their skin. This constant irritation of the skin can lead to bleeding, open sores that don't heal, and scars. If it becomes severe, it can lead to tissue damage and permanent disfigurement, so excoriation is a serious mental disorder.

Excoriation causes a person to compulsively pick at their skin.

Excoriation is sometimes classified as a form of obsessive compulsive disorder (OCD) because the person feels like they have to keep picking, even if they know they shouldn't and wish they could stop. Any condition that causes a person to do harm to themselves or their appearance is also classified as a body-focused repetitive behavior (BFRB). (Other example include pulling out hair or excessive nail biting.)

Excoriation vs. Bad Habit

There is a fine line between a nervous habit and a serious medical condition that requires intervention. So where is that line drawn? As with most mental disorders, it varies with each individual. We are all guilty of peeling off a scab once or twice, but a person with excoriation will continue to de-scab a wound so that it never heals.

Why would someone do this? Well, there are two common 'triggers' to developing excoriation. The first is experiencing a minor skin infection, injury, or rash that the person repeatedly picks at, preventing the spot from healing. The second is high-stress situations. An action that starts as a nervous tic develops into a habit that one can't break. The person continues to pick at their skin because it helps them deal with their emotions, which can include excitement, fear, anxiety, or even boredom.

Diagnosing Excoriation

So how is excoriation diagnosed? Due to the complexity of mental disorders, a doctor conducts clinical screening to find the five conditions that must be met before a diagnosis of excoriation can be determined. According to the Diagnostic and Statistical Manual of Mental Disorders, the standard source for classifying mental disorders, these five conditions are:

  1. There is recurrent picking that causes lesions (wounds).
  2. The person has tried to stop but hasn't been successful, possibly multiple times.
  3. The person feels mentally distressed by their actions and that it's disrupting their life.
  4. The picking is not believed to be caused by any other medical condition.
  5. The picking is not believed to be caused by any other mental disorder.

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