Characteristics of 34 Adults With Psychogenic Excoriation

Background: Psychogenic excoriation, characterized by excessivescratching or picking of the skin, is not yet recognized as a symptom of a distinct DSM-IVdisorder. The purpose of this study was to provide data regarding the demographics,phenomenology, course of illness, associated psychiatric comorbidity, and family historyof subjects with psychogenic excoriation.

Method: Thirty-four consecutive subjects were recruited from anoutpatient dermatology practice and by advertisement. Subjects completed the StructuredClinical Interview for DSM-IV augmented with impulse control disorder modules, theYale-Brown Obsessive Compulsive Scale, and a semistructured interview for family history,demographic data, and clinical features.

Results: Most subjects were women who described a mean age at onset of 38years and a chronic course. Subjects excoriated multiple sites, most frequently the face.The behavior caused substantial distress and dysfunction. All 34 subjects met criteria forat least 1 comorbid psychiatric disorder, with a mood disorder the most common. Familyhistories were notable for depressive disorders and psychoactive substance use disorders.Most subjects experienced both mounting tension before excoriation and relief afterexcoriation as in impulse control disorders. A minority of subjects excoriated skin aspart of obsessive-compulsive disorder. Body dysmorphic disorder with preoccupation aboutthe skin’s appearance precipitated excoriation in about a third of subjects.

Conclusion: Psychogenic excoriation is chronic, involves multiple sites,and is associated with a high rate of psychiatric comorbidity. The behavior associatedwith the excoriation is heterogeneous and spans a compulsive-impulsive spectrum. Mostsubjects in this sample described features of an impulse control disorder.