MHM Magazine

Issue 61 | 2022 | MENTAL HEALTH MATTERS | 31 MHM Everybody picks their skin, right? Yes indeed, most people would probably admit to engaging in some form of picking behaviour every now and then, whether it’s scratching an insect bite, picking at a scab or pimple, or pulling dry skin from their lips. In one study, it was reported that almost 80% of college students engaged in skin-picking at some point in their lives. However, sometimes people engage in picking behaviour that is excessive, and clearly beyond the occasional scratch. Picking can become problematic because of the time it consumes, the scarring, or even sepsis, as well as having an emotional impact (shame or embarrassment). When the behaviour and its sequalae become clinically significant, i.e., distressing, or functionally impairing, a diagnosis of excoriation (skin-picking) disorder (SPD) may be warranted. WHAT IS EXCORIATION (SKIN-PICKING) DISORDER (SPD)? Pathological skin-picking or SPD is not a new phenomenon. Also known as neurotic excoriation, psychogenic excoriation, or dermatillomania, SPD has been documented in medical literature since the 19th century. But it was relatively recently that it was included as a distinct entity in the main psychiatric classification systems. In the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders , SPD is described as a condition that has many overlapping features with obsessive-compulsive disorder (OCD), and is classified among several other obsessive-compulsive related disorders (OCRDs), which include trichotillomania (hair- pulling disorder), body dysmorphic disorder and hoarding disorder. This inclusion recognised the increasing scientific evidence for the diagnostic validity and clinical utility of this entity, as well as the voice of patients and patient advocates. SPD, as well as trichotillomania, are also labelled as grooming disorders or body-focused repetitive behaviour disorders (BFRBDs). The question as to whether these disorders can By Professor Christine Lochner SA MRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry, Stellenbosch University SKIN-PICKING (EXCORIATION) DISORDER