bodily sensation. Pain is not routinely reported to accompany skin picking. Some individuals
engage in skin picking that is more focused (i .e., with preceding tens ion and subsequent re-
lief), whereas others engage in more automatic picking (i.e., when skin picking occurs with-
out preceding tension and without full awarene ss), and many have a mix of both behavioral
styles. Skin picking does not usually occur in the presence of other individuals, except im-
mediate family members. Some individual s report picking the skin of others.
Prevalence
In the general population, the lifetime prevalence  for excoriation disorder in adults is 1.4%
or somewhat higher. Three-quarters or more of individuals with the disorder are female.
This likely reflects the true gender ratio of the condition, although it may also reflect dif-
ferential treatment seeking based on gender or cultural attitudes regarding appearance.
Development and Course
Although individuals with excoriation disorder may present at various ages, the skin pick-
ing most often has onset during adolescence, commonly coinciding wi th or following the
onset of puberty. The disorder frequently begins with a dermatological condition, such
as acne. Sites of skin picking may vary over time. The usual course is chronic, with some
waxing and waning if untreated. For some in dividuals, the disorder may come and go for
weeks, months, or years at a time.
Risk and Prognostic Factors
Genetic and physiological. Excoriation disorder is more  common in individuals with
obsessive-compulsive disorder (OCD) and thei r first-degree family members than in the
general population.
Diagnostic Markers
Most individuals with excoriation disorder admit to skin picking; therefore, dermato-
pathological diagnosis is rarely required. Ho wever, the disorder ma y have characteristic