Diagnosis of Excoriation Disorder Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) criteria To meet diagnostic criteria for excoriation disorder, patients must typically Cause visible skin lesions by picking (although some patients try to camouflage lesions with clothing or makeup) Make repeated attempts to decrease or stop the picking Experience significant distress or impairment in functioning from the activity The distress can include feelings of embarrassment or shame (eg, due to loss of control of one's behavior or the cosmetic consequences of the skin lesions).