Excoriation disorder: Difference between revisions
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==Classification== | ==Classification== | ||
The | *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> | ||
In some animal models, it has been shown that animals that who excessively pull their hairs have more endorphin | *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== | ==Pathophysiology== | ||
Revision as of 15:48, 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
- Episodes of skin picking are often preceded or accompanied by tension, anxiety, stress, or paranoia. During these moments, there is commonly a compulsive urge to pick, bite, or scratch at a surface or region of the body, often at the location of a perceived skin defect. Sufferers may experience relief from upsetting emotions by engaging in skin picking.
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.
- The regions most commonly affected by this are the face, back, scalp, stomach, chest, and extremities such as the hands, feet, and arms. Physical indicators of dermatillomania most commonly expressed in these areas are swelling, scarring, and callusing due to damage to the affected region's epidermis.
- Aware of the damage they are inflicting, many sufferers feel and recognize a need to stop the behavior but are physically and mentally unable to do so without aid. Additionally, the behavior's addict-like characteristics are very similar to the expression of trichotillomania, or the compulsive pulling of hair from the body.
- Many dermatillomania sufferers find that the disorder interferes with daily life. Plagued by shame, embarrassment, and humiliation, they may take measures to hide their disorder by not leaving the home, wearing long sleeves and pants in summer, or covering visible damage to skin with cosmetics and/or bandages. The disorder is typically found among females more than males.
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
Diagnostic Criteria
DSM-V Diagnostic Criteria for Excoriation (Skin-Picking) Disorder [6]
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History and Symptoms
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 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.