skin picking disorder
An impulse control disorder characterised by repetitive and compulsive picking of skin resulting in tissue damage any place within reach of the hands–especially the face, but also the arms, shoulders, chest, fingers and hands. It has features of obsessive-compulsive and abuse disorders. .
Clinical findings Episodic picking sessions are often temporally linked to tension, anxiety, or stress. It may be accompanied by intense guilt, shame, and embarrassment in individuals, an increased risk of self-harm, suicidal ideation and attempts in 12% of those with skin picking disorder.
Triggers Stress, anxiety, tension
Common sites Face, arms, legs, back, gums, lips, shoulders, scalp,chest, and extremities–e.g., fingernails, cuticles, toenails
Complications Local tissue damage, infection and, in extreme cases, septicaemia and disfigurement.
Differential diagnosis Intense itching and picking at the skin may be secondary to other conditions including eczema, psoriasis, diabetes, liver disease, Hodgkin lymphoma, polycythemia vera, systemic lupus, and Prader-Willi syndrome
• Behavioural Habit reversal training, cognitive-behavioural therapy
– SSRIs Clomipramine, doxepin, fluoxetine, naltrexone, olanzapine,pimozide
– Opioid antagonists–e.g., naloxone and naltrexone
– Glutamatergic agents–e.g., N-acetyl cysteine.
Skin picking disorder is included in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders–DSM 5 (2013).
Synonyms Compulsive skin picking, CSP, neurotic excoriation, pathologic skin picking, PSP, psychogenic excoriation