Excoriation (Skin-Picking) Disorder 255
endure for months or years. Cr iterion A requires that skin picking lead to skin lesions, al-
though individuals with this disorder often at tempt to conceal or camouflage such lesions
(e.g., with makeup or clothing). Individuals with excoriation disorder have made repeated
attempts to decrease or stop skin picking (Criterion B).
Criterion C indicates that skin picking causes clinically significant distress or impair-
ment in social, occupational, or other im portant areas of func tioning. The term distress  in-
cludes negative affects that may be experience d by individuals with skin picking, such as
feeling a loss of control, em barrassment, and shame. Significant impairment may occur in
several different areas of functioning (e.g., so cial, occupational, academic, and leisure), in
part because of avoidance of social situations. 
Associated Features Supporting Diagnosis
Skin picking may be accompanied by a range of behaviors or rituals involving skin or scabs.
Thus, individuals may search for a particular kind of scab to pull, and they may examine,
play with, or mouth or swallow th e skin after it has be en pulled. Skin picking may also be pre-
ceded or accompanied by various emotional stat es. Skin picking may be triggered by feelings
of anxiety or boredom, may be preceded by an  increasing sense of tension (either immedi-
ately before picking the skin or when attempting to resist the urge to pick), and may lead to
gratification, pleasure, or a sense of relief when the skin or scab has been picked. Some indi-
viduals report picking in response to a minor skin irregularity or to relieve an uncomfortable
bodily sensation. Pain is not routinely reported to accompany skin picking. Some individuals