Excoriation disorder: Difference between revisions
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{{SI}} | {{SI}} | ||
{{CMG}} {{AE}} {{KS}} | {{CMG}} {{AE}} {{KS}} {{Y.A}} | ||
{{SK}} Compulsive skin picking; CSP; dermatillomania; neurotic excoriation; psychogenic excoriation | |||
==Overview== | ==Overview== | ||
'''Excoriation disorder''' (also known as '''dermatillomania,''' '''compulsive skin picking,''' '''neurotic excoriation,''' '''psychogenic excoriation,''' or '''CSP''') is an [[impulse control disorder]] and form of [[self-injury]] characterized by the repeated urge to pick at one's own [[skin]], often to the extent that damage is caused. Excoriation disorder may be related to [[body dysmorphic disorder]] (BDD).<ref name="pmid12080906">{{cite journal| author=Deckersbach T, Wilhelm S, Keuthen NJ, Baer L, Jenike MA| title=Cognitive-behavior therapy for self-injurious skin picking. A case series. | journal=Behav Modif | year= 2002 | volume= 26 | issue= 3 | pages= 361-77 | pmid=12080906 | doi=10.1177/0145445502026003004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12080906 }} </ref> | |||
[[Image:Dermatillomania fingers.JPG|thumb|left|Compulsive picking of the knuckles (via mouth) illustrating disfiguration of the [[interphalangeal articulations of hand|distal and proximal joints]] of the [[middle finger|middle]] and [[little finger|little]] fingers.]] | |||
Sufferers of dermatillomania find skin picking to be stress relieving or gratifying, though it can still be as physically painful as it would be for a non-skin picker. | |||
==Historical Perspective== | |||
*Lous-Anne-Jean Brocq was the first person to mention excoriation disorder on paper. She used the term in 1898 to describe a patient who uncontrollably picked their [[acne]]. | |||
==Classification== | |||
*The DSM-5 changed excoriation disorder's classification from "[[impulse control disorder]]" to "excoriation (skin-picking) disorder.<ref>{{cite book | last = Black | first = Donald | title = DSM-5 guidebook : the essential companion to the Diagnostic and statistical manual of mental disorders, fifth edition | publisher = American Psychiatric Publishing | location = Washington, DC | year = 2014 | isbn = 978-1585624652 }}</ref> | |||
*Excoriation disorder was originally known as "[[dermatillomania]]" before the DSM-5.<ref name="pmid20575652">{{cite journal| author=Odlaug BL, Grant JE| title=Pathologic skin picking. | journal=Am J Drug Alcohol Abuse | year= 2010 | volume= 36 | issue= 5 | pages= 296-303 | pmid=20575652 | doi=10.3109/00952991003747543 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20575652 }} </ref> | |||
*The inability to control the urge to pick is similar to [[trichotillomania]].<ref>http://www3.interscience.wiley.com/cgi-bin/abstract/90513484/ABSTRACT?CRETRY=1&SRETRY=0</ref> Recent research suggests that, like trichotillomania, dermatillomania may be an [[impulse control disorder]]. This is part of the [[Obsessive-Compulsive Spectrum Disorder|obsessive compulsive disorder spectrum]].<ref>[http://www.brainexplorer.org/ocd/OCD_Related_%20Spectrum_%20Disorders.shtml Brain Explorer - Focus on Brain Disorders - OCD - Related Spectrum Disorders<!-- Bot generated title -->]</ref> | |||
*In some animal models, it has been shown that animals that who excessively pull their hairs have more [[endorphin]] [[receptor]]s in their [[brain]] than animals who do not. Endorphin receptors enable endorphins to have an effect on the brain. If this is true for humans, people who are particularly compulsive about their repetitive habits may have more endorphin receptors in their brain as well. This may explain why sufferers get more enjoyment out of picking their scabs than others. | |||
==Pathophysiology== | |||
*Those suffering from excoriation disorder have very damaged skin, as a result of picking at it constantly. | |||
[[Image:Derma_me.JPG|thumb|left|Skin Picking results on arms, shoulders and chest are visible. | |||
While this look can be a social disturbance, it is also a time-consuming habit.]] | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
Excoriation disorder must be differentiated from: | |||
*Neurodevelopmental disorders | *Neurodevelopmental disorders | ||
:*[[Prader-Willi syndrome]] | :*[[Prader-Willi syndrome]] | ||
| Line 15: | Line 39: | ||
:*[[Acne]] | :*[[Acne]] | ||
:*[[Scabies]] | :*[[Scabies]] | ||
*Psychotic disorder | *[[Psychotic disorder]] | ||
:*[[Delusion]] | :*[[Delusion]] | ||
:*Tactile [[hallucination]] | :*Tactile [[hallucination]] | ||
| Line 22: | Line 46: | ||
*Substance/medication-induced disorders | *Substance/medication-induced disorders | ||
:*[[Cocaine]]<ref name=DSMV>{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref> | :*[[Cocaine]]<ref name=DSMV>{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref> | ||
==Epidemiology and Demographics== | ==Epidemiology and Demographics== | ||
===Prevalence=== | ===Prevalence=== | ||
The prevalence of excoriation ( | *The prevalence of excoriation (skin-picking) disorder is approximately 1,400 per 100,000 (1.4%) individuals worldwide.<ref name=DSMV>{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref> | ||
*About 2% of [[dermatology]] patients suffer from excoriation disorder.<ref name="pmid20575652">{{cite journal| author=Odlaug BL, Grant JE| title=Pathologic skin picking. | journal=Am J Drug Alcohol Abuse | year= 2010 | volume= 36 | issue= 5 | pages= 296-303 | pmid=20575652 | doi=10.3109/00952991003747543 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20575652 }} </ref> | |||
===Age=== | |||
*The age of onset for excoriation disorder is likely either under 10 years old or between 30 and 45 years old.<ref name="pmid20575652">{{cite journal| author=Odlaug BL, Grant JE| title=Pathologic skin picking. | journal=Am J Drug Alcohol Abuse | year= 2010 | volume= 36 | issue= 5 | pages= 296-303 | pmid=20575652 | doi=10.3109/00952991003747543 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20575652 }} </ref> | |||
==Risk Factors== | ==Risk Factors== | ||
Common risk factors in the development of excoriation disorder include: | |||
*Genetic predisposition | *Genetic predisposition | ||
*[[ | *[[Obsessive-compulsive disorder]]([[OCD]])<ref name=DSMV>{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref> | ||
==Natural History, complications, and prognosis== | |||
===Natural History=== | |||
*The symptoms of excoriation disorder usually develop either under 10 years of age or between 30 and 45 years old.<ref name="pmid20575652">{{cite journal| author=Odlaug BL, Grant JE| title=Pathologic skin picking. | journal=Am J Drug Alcohol Abuse | year= 2010 | volume= 36 | issue= 5 | pages= 296-303 | pmid=20575652 | doi=10.3109/00952991003747543 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20575652 }} </ref> | |||
===Complications=== | |||
*There are no known complications associated with excoriation disorder. | |||
===Prognosis=== | |||
*Those who suffer from this disorder tend to wear long sleeved clothing, even in warm weather, to hide any damaged skin. They are hindered by embarrassment when going out in public. If excoriation disorder is left untreated, it can last as long as 21 years. | |||
==Diagnostic Criteria== | ==Diagnostic Criteria== | ||
| Line 36: | Line 73: | ||
{{cquote| | {{cquote| | ||
*A.Recurrent skin picking resulting in skin lesions. | *A. Recurrent skin picking resulting in skin lesions. | ||
'''''AND''''' | '''''AND''''' | ||
*B.Repeated attempts to decrease or stop skin picking. | *B. Repeated attempts to decrease or stop skin picking. | ||
'''''AND''''' | '''''AND''''' | ||
*C.The skin picking causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. | *C. The skin picking causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. | ||
'''''AND''''' | '''''AND''''' | ||
*D.The skin picking is not attributable to the physiological effects of a substance (e.g.,[[cocaine]]) or another medical condition (e.g., [[scabies]]). | *D. The skin picking is not attributable to the physiological effects of a substance (e.g.,[[cocaine]]) or another medical condition (e.g., [[scabies]]). | ||
'''''AND''''' | '''''AND''''' | ||
*E.The skin picking is not better explained by symptoms of another mental disorder (e.g., [[delusions]] or tactile [[hallucinations]] in a psychotic disorder, attempts to improve a perceived defect or flaw in appearance in [[body dysmorphic disorder]], stereotypies in [[stereotypic movement disorder]], or intention to harm oneself in non suicidal self-injury). | *E. The skin picking is not better explained by symptoms of another mental disorder (e.g., [[delusions]] or tactile [[hallucinations]] in a [[psychotic disorder]], attempts to improve a perceived defect or flaw in appearance in [[body dysmorphic disorder]], stereotypies in [[stereotypic movement disorder]], or intention to harm oneself in non suicidal self-injury). | ||
}} | }} | ||
==History and Symptoms== | |||
*History of picking at the the skin | |||
*History of personal issues such as abuse that may lead to these behaviors. | |||
*Acne already preexisting on the body. | |||
==Laboratory Findings== | |||
*There are no diagnostic laboratory findings associated with excoriation disorder. | |||
==Other Imaging Studies== | |||
*There are no other imaging findings associated with excoriation disorder. | |||
==Other Diagnostic Studies== | |||
There are no other diagnostic studies associated with excoriation disorder. | |||
==Medical Therapy== | |||
*[[SSRI]]s, glutamateric agents, and [[opioid antagonist]]s can all help in treating excoriation disorder. | |||
**SSRIs are effective in treating [[obsessive-compulsive disorder]], which is closely related to excoriation disorder. | |||
*[[Skin picking]], which is the defining symptom of excoriation disorder, can be treated by using [[antidepressant]], [[anti-anxiety]], [[anti-epileptic]], and [[antipsychotic]] medications.<ref name="pmid20575652">{{cite journal| author=Odlaug BL, Grant JE| title=Pathologic skin picking. | journal=Am J Drug Alcohol Abuse | year= 2010 | volume= 36 | issue= 5 | pages= 296-303 | pmid=20575652 | doi=10.3109/00952991003747543 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20575652 }} </ref> | |||
==Psychotherapy== | |||
*[[Habit reversal training]], acceptance and commitment therapy, acceptance-enhanced behavioral therapy, and [[cognitive behavioral therapy]] were all used to help treat excoriation disorder. | |||
*These strategies help reduce skin picking behavior in individuals with excoriation disorder, but no psychological issues.<ref name="pmid20575652">{{cite journal| author=Odlaug BL, Grant JE| title=Pathologic skin picking. | journal=Am J Drug Alcohol Abuse | year= 2010 | volume= 36 | issue= 5 | pages= 296-303 | pmid=20575652 | doi=10.3109/00952991003747543 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20575652 }} </ref><ref name="pmid16960655">{{cite journal| author=Dell'Osso B, Altamura AC, Allen A, Marazziti D, Hollander E| title=Epidemiologic and clinical updates on impulse control disorders: a critical review. | journal=Eur Arch Psychiatry Clin Neurosci | year= 2006 | volume= 256 | issue= 8 | pages= 464-75 | pmid=16960655 | doi=10.1007/s00406-006-0668-0 | pmc=1705499 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16960655 }} </ref><ref name="pmid19963341">{{cite journal| author=Lang R, Didden R, Machalicek W, Rispoli M, Sigafoos J, Lancioni G et al.| title=Behavioral treatment of chronic skin-picking in individuals with developmental disabilities: a systematic review. | journal=Res Dev Disabil | year= 2010 | volume= 31 | issue= 2 | pages= 304-15 | pmid=19963341 | doi=10.1016/j.ridd.2009.10.017 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19963341 }} </ref> | |||
==Brain Stimulation Therapy== | |||
*There is no brain stimulation therapy associated with excoriation disorder. | |||
==Cost Effectiveness of Therapy== | |||
==Future or Investigational Therapies== | |||
==References== | ==References== | ||
{{Reflist|1}} | {{Reflist|1}} | ||
Latest revision as of 17:15, 16 January 2019
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Kiran Singh, M.D. [2] Yashasvi Aryaputra[3]
Synonyms and keywords: Compulsive skin picking; CSP; dermatillomania; neurotic excoriation; psychogenic excoriation
Overview
Excoriation disorder (also known as dermatillomania, compulsive skin picking, neurotic excoriation, psychogenic excoriation, or CSP) is an impulse control disorder and form of self-injury characterized by the repeated urge to pick at one's own skin, often to the extent that damage is caused. Excoriation disorder may be related to body dysmorphic disorder (BDD).[1]
Sufferers of dermatillomania find skin picking to be stress relieving or gratifying, though it can still be as physically painful as it would be for a non-skin picker.
Historical Perspective
- Lous-Anne-Jean Brocq was the first person to mention excoriation disorder on paper. She used the term in 1898 to describe a patient who uncontrollably picked their acne.
Classification
- The DSM-5 changed excoriation disorder's classification from "impulse control disorder" to "excoriation (skin-picking) disorder.[2]
- Excoriation disorder was originally known as "dermatillomania" before the DSM-5.[3]
- The inability to control the urge to pick is similar to trichotillomania.[4] Recent research suggests that, like trichotillomania, dermatillomania may be an impulse control disorder. This is part of the obsessive compulsive disorder spectrum.[5]
- In some animal models, it has been shown that animals that who excessively pull their hairs have more endorphin receptors in their brain than animals who do not. Endorphin receptors enable endorphins to have an effect on the brain. If this is true for humans, people who are particularly compulsive about their repetitive habits may have more endorphin receptors in their brain as well. This may explain why sufferers get more enjoyment out of picking their scabs than others.
Pathophysiology
- Those suffering from excoriation disorder have very damaged skin, as a result of picking at it constantly.
Differential Diagnosis
Excoriation disorder must be differentiated from:
- Neurodevelopmental disorders
- Other obsessive-compulsive and related disorders
- Other disorders
- Other medical conditions
- Delusion
- Tactile hallucination
- Somatic symptom and related disorders
- Substance/medication-induced disorders
Epidemiology and Demographics
Prevalence
- The prevalence of excoriation (skin-picking) disorder is approximately 1,400 per 100,000 (1.4%) individuals worldwide.[6]
- About 2% of dermatology patients suffer from excoriation disorder.[3]
Age
- The age of onset for excoriation disorder is likely either under 10 years old or between 30 and 45 years old.[3]
Risk Factors
Common risk factors in the development of excoriation disorder include:
- Genetic predisposition
- Obsessive-compulsive disorder(OCD)[6]
Natural History, complications, and prognosis
Natural History
- The symptoms of excoriation disorder usually develop either under 10 years of age or between 30 and 45 years old.[3]
Complications
- There are no known complications associated with excoriation disorder.
Prognosis
- Those who suffer from this disorder tend to wear long sleeved clothing, even in warm weather, to hide any damaged skin. They are hindered by embarrassment when going out in public. If excoriation disorder is left untreated, it can last as long as 21 years.
Diagnostic Criteria
DSM-V Diagnostic Criteria for Excoriation (Skin-Picking) Disorder [6]
| “ |
AND
AND
AND
AND
|
” |
History and Symptoms
- History of picking at the the skin
- History of personal issues such as abuse that may lead to these behaviors.
- Acne already preexisting on the body.
Laboratory Findings
- There are no diagnostic laboratory findings associated with excoriation disorder.
Other Imaging Studies
- There are no other imaging findings associated with excoriation disorder.
Other Diagnostic Studies
There are no other diagnostic studies associated with excoriation disorder.
Medical Therapy
- SSRIs, glutamateric agents, and opioid antagonists can all help in treating excoriation disorder.
- SSRIs are effective in treating obsessive-compulsive disorder, which is closely related to excoriation disorder.
- Skin picking, which is the defining symptom of excoriation disorder, can be treated by using antidepressant, anti-anxiety, anti-epileptic, and antipsychotic medications.[3]
Psychotherapy
- Habit reversal training, acceptance and commitment therapy, acceptance-enhanced behavioral therapy, and cognitive behavioral therapy were all used to help treat excoriation disorder.
- These strategies help reduce skin picking behavior in individuals with excoriation disorder, but no psychological issues.[3][7][8]
Brain Stimulation Therapy
- There is no brain stimulation therapy associated with excoriation disorder.
Cost Effectiveness of Therapy
Future or Investigational Therapies
References
- ↑ Deckersbach T, Wilhelm S, Keuthen NJ, Baer L, Jenike MA (2002). "Cognitive-behavior therapy for self-injurious skin picking. A case series". Behav Modif. 26 (3): 361–77. doi:10.1177/0145445502026003004. PMID 12080906.
- ↑ Black, Donald (2014). DSM-5 guidebook : the essential companion to the Diagnostic and statistical manual of mental disorders, fifth edition. Washington, DC: American Psychiatric Publishing. ISBN 978-1585624652.
- ↑ 3.0 3.1 3.2 3.3 3.4 3.5 Odlaug BL, Grant JE (2010). "Pathologic skin picking". Am J Drug Alcohol Abuse. 36 (5): 296–303. doi:10.3109/00952991003747543. PMID 20575652.
- ↑ http://www3.interscience.wiley.com/cgi-bin/abstract/90513484/ABSTRACT?CRETRY=1&SRETRY=0
- ↑ Brain Explorer - Focus on Brain Disorders - OCD - Related Spectrum Disorders
- ↑ 6.0 6.1 6.2 6.3 Diagnostic and statistical manual of mental disorders : DSM-5. Washington, D.C: American Psychiatric Association. 2013. ISBN 0890425558.
- ↑ Dell'Osso B, Altamura AC, Allen A, Marazziti D, Hollander E (2006). "Epidemiologic and clinical updates on impulse control disorders: a critical review". Eur Arch Psychiatry Clin Neurosci. 256 (8): 464–75. doi:10.1007/s00406-006-0668-0. PMC 1705499. PMID 16960655.
- ↑ Lang R, Didden R, Machalicek W, Rispoli M, Sigafoos J, Lancioni G; et al. (2010). "Behavioral treatment of chronic skin-picking in individuals with developmental disabilities: a systematic review". Res Dev Disabil. 31 (2): 304–15. doi:10.1016/j.ridd.2009.10.017. PMID 19963341.