256 Obsessive-Compulsive and Related Disorders
Functional Consequences of 
Excoriation (Skin-Picking) Disorder 
Excoriation disorder is associated  with distress as well as with social and occupational im-
pairment. The majority of indi viduals with this condition spend at least 1 hour per day
picking, thinking about picking, and resist ing urges to pick. Many individuals report
avoiding social or entertainment events as well as going out in public. A majority of indi-
viduals with the disorder also report experien cing work interference from skin picking on
at least a daily or weekly basi s. A significant proportion of students with excoriation disor-
der report having missed school, having expe rienced difficulties managing responsibilities
at school, or having had diffi culties studying because of skin picking. Medical complica-
tions of skin picking include ti ssue damage, scarring, and infe ction and can be life-threaten-
ing. Rarely, synovitis of the wrists due to ch ronic picking has been reported. Skin picking
often results in significant tissue damage and sc arring. It frequently requires antibiotic treat-
ment for infection, and on o ccasion it may require surgery.
Differential Diagnosis
Psychotic disorder. Skin picking may occur in response to a delusion (i.e., parasitosis)
or tactile hallucination (i.e., fo rmication) in a psychotic disorder. In such cases, excoriation
disorder should not be diagnosed. 
Other obsessive-compulsive and related disorders. Excessive washing compulsions
in response to contamination obsessions in in dividuals with OCD may lead to skin lesions,
and skin picking may occur in individuals with body dysmorphic disorder who pick their