and skin picking may occur in individuals with body dysmorphic disorder who pick their
skin solely because of appearance concerns; in  such cases, excoriatio n disorder should not
be diagnosed. The description of body-focused repetitive behavior disorder in other spec-
ified obsessive-compulsive and related diso rder excludes individuals whose symptoms
meet diagnostic criteria for excoriation disorder.
Neurodevelopmental disorders. While stereotypic movement disorder may be charac-
terized by repetitive self-injurious behavior , onset is in the early developmental period.
For example, individuals with  the neurogenetic condition Prader-Willi syndrome may
have early onset of skin picking, and their symptoms may meet criteria for stereotypic
movement disorder. While tics in individuals with Tourette’s disorder may lead to self-
injury, the behavior is not ti c-like in excoriation disorder. 
Somatic symptom and related disorders. Excoriation disorder is not diagnosed if the
skin lesion is primarily attributable to de ceptive behaviors in factitious disorder.
Other disorders. Excoriation disorder is not diagnosed if the skin picking is primarily
attributable to the intention to harm oneself th at is characteristic of nonsuicidal self-injury.
Other medical conditions. Excoriation disorder is not di agnosed if the skin picking is
primarily attributable to another medical condition. For example, scabies is a dermatolog-
ical condition invariably associated with seve re itching and scratching. However, excori-
ation disorder may be precipitated or ex acerbated by an unde rlying dermatological
condition. For example, acne may lead to so me scratching and picking, which may also be
associated with comorbid excoriation diso rder. The differentiation between these two
clinical situations (acne with some scratching  and picking vs. acne with comorbid excori-