depressive disorder and excoriation (skin- picking) disorder. Repetitive body-focused
symptoms other than hair pulling or skin picking (e.g. nail biting) occur in the majority of
individuals with trichotillomania and may dese rve an additional diagnosis of other spec-
ified obsessive-compulsive and related disorder (i.e., body-focused repetitive behavior
disorder).
Excoriation (Skin-Picking) Disorder
Diagnostic Criteria 698.4 (L98.1)
A. Recurrent skin picking resulting in skin lesions.
B. Repeated attempts to decrease or stop skin picking.
C. The skin picking causes clinically significant distress or impairment in social, occupa-
tional, or other important areas of functioning. 
D. The skin picking is not attributable to the physiological effects of a substance (e.g., co-
caine) or another medical condition (e.g., scabies). 
E. The skin picking is not better explained by symptoms of another mental disorder (e.g.,
delusions or tactile hallucinations in a psychotic disorder, attempts to improve a per-
ceived defect or flaw in appearance in body dysmorphic disorder, stereotypies in ste-
reotypic movement disorder, or intention to harm oneself in nonsuicidal self-injury).
Diagnostic Features
The essential feature of excori ation (skin-picking) disorder is recurrent picking at one’s
own skin (Criterion A). The mo st commonly picked sites are the face, arms, and hands, but
many individuals pick from multiple body sit es. Individuals may pick at healthy skin, at
minor skin irregularities, at le sions such as pimples or calluse s, or at scabs from previous
picking. Most individuals pick with their fi ngernails, although many use tweezers, pins,