Dermatillomania by any other name

Tasneem Abrahams
Feb 24th, 2016

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The very first clinically recognized case of skin picking was documented by French dermatologist Brocq in 1898, in the Journal of Practitioners, Clinique Generale and Therapy Review. Brocq identified the disorder in a young girl who compulsively picked her acne. Since then the disorder has been referred to by many different names: Skin Picking Disorder, Chronic Skin Picking, Compulsive Skin Picking, Neurotic Excoriation, Acne Excoriee, Pathological Skin Picking and even Pyschogenic Excoriation. But for many years the most recognized name has been Dermatillomania. The term Dermatillomania is from Greek origin meaning:

Derma – skin | Till - pull | Mania – madness

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Dermatillomania becomes an official disorder

However, up until 2013, dermatillomania was not considered an ‘official’ disorder! As the fifth revision of the Diagnostic and Statistical Manual (DSM) was approaching, there was a massive drive from those involved in the advocacy of skin picking disorder to have it recognized and included. The DSM-5 publication is considered an event of huge importance in the mental health field. The last major revision was the fourth edition (DSM-4), published in 1994. It’s inclusion in the DSM was important because it would have a huge impact on the awareness of the disorder among mental health professionals and researchers, and therefore greater access to funding toward the advancement of diagnosis and treatment for the millions who suffer in silence. This great milestone was achieved in 2013, when it was indeed included in the DSM5, but was classified as excoriation (skin-picking) disorder and was no longer considered an impulse control disorder, but is rather classified as its own separate condition under "Obsessive Compulsive and Related Disorders (OCDR)". So thrown among all these different names for one disorder, we now have yet another.

It is important to note though, that inclusion in the DSM is no easy feat. New diagnoses are included in the DSM only after a comprehensive review of the scientific literature; full discussion by Work Group members; review by the DSM-5 Task Force, Scientific Review Committee, and Clinical and Public Health Committee; and, finally, evaluation by the American Psychiatric Association’s Board of Trustees. After this rigorous process, the Trustees approved the final diagnostic criteria for excoriation disorder in the DSM-5. Studies show that the prevalence of excoriation is estimated at approximately two to four percent of the population. Resulting problems may include medical issues such as infections, skin lesions, scarring and physical disfigurement.

You say dermatillomania, I say excoriation disorder

It was in the famous love story Romeo and Juliet by William Shakespeare that we heard the well-known quote:

“What's in a name? That which we call a rose by any other name would smell as sweet”

Of course in the case of dermatillomania there is nothing sweet about this disorder. And while excoriation disorder and dermatillomania both describe the same compulsive skin picking, to the those unaware of the condition or have the condition but do not know it is a clinical disorder, both these terms can sound like nothing more than gibberish science speak. When we here at first set out to spread awareness of this debilitating disorder we predominantly used the term dermatillomania interchangeably with compulsive skin picking disorder. Readers of our blog and many other awareness group blogs used the same and as such readers became familiar with the term. It also helped that the other, more well-known body-focused repetitive behavior (BFRB) – trichotillomania, or compulsive hair pulling, that had already been receiving mainstream media coverage, is a very similar sounding term. One has to wonder then, what was the motivation behind formerly naming this disorder differently when trichotillomania is to remain the same?

What does excoriation mean anyway?

Excoriation disorder is defined as "repetitive and compulsive picking of skin which results in tissue damage". According to the English Oxford Dictionary, the word excoriation has its origins from Latin:

excoriat- 'skinned', from the verb excoriare, from ex- 'out, from' + corium 'skin, hide'

So one can see that the term really does speak to the act of removing surfaces of the skin, whether it be by picking, scratching, or even using implements. Just as the idiom goes, “there are many ways to skin a cat”, so too is it true that there are many ways that excoriation disorder presents itself in each individual. I guess it is difficult to then to encapsulate the true essence of how this disorder really affects one in just one word. The problem is that we are dealing with a condition that is not very well known. Excoriation disorder, like trichotillomania and many other BFRBs are of the most un-diagnosed psychological conditions. Millions of people across the globe suffer from it, but only few of those who suffer from it know that it is a clinically recognized disorder. This coupled with the overwhelming shame, guilt and even disgust at one’s own behavior leads to skin pickers often suffering in silence and never seeking help. Over recent years the BFRB advocacy community had started making tremendous strides in creating awareness about compulsive skin picking, but under the term dermatillomania! As a result the name change has not been pervasively adopted yet. Even here on our own blog, we tend to still refer to dermatillomania because we know that people looking for information on this disorder will not necessarily be searching for the term excoriation disorder. However we do have a responsibility to raise awareness of the correct terminology as this ill only benefit us all in the long run as more we will gain greater traction within the medical research community toward improved clinical knowledge and awareness about the plight of skin pickers world wide.








Tasneem Abrahams

Tasneem is an Occupational Therapist, and a graduate of the TLC foundation for BFRBs professional training institute. Her experience in mental health includes working at Lentegeur Psychiatric hospital forensic unit (South Africa), Kingston Community Adult Learning Disability team (UK), Clinical Specialist for the Oasis Project Spelthorne Community Mental Health team (UK). Tasneem is a member of both the editorial team and the clinical staff on Skinpick, providing online therapy for people who suffer from excoriation (skin picking) disorder.

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