The sufferers of compulsive picking behaviors may call their activities merely picking, or pulling in the case of hair, but the exacting nature of medical terminology applies some very specific terms to some very specific behaviors that fall under the “umbrella” of picking.
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Dermatillomania is the medical diagnostic term used to describe skin picking disorders. Quite often the habitual picking begins with understandable circumstances. Perhaps a blemish of some sort – ingrown hair, insect bite, or some other minor and often temporary imperfection – is the target of the picking. For some reason, the subject develops an irresistible urge to pick this minor imperfection to the point of pain and destruction. The original picking creates a bigger target area on which to focus attention, thus picking, so the habit becomes self-perpetuating.
Neurotic excoriation involves incessant scratching. Someone compelled to scratch to the point of damage may be unaware of his or her activities. Sometimes a previous injury or skin condition triggers the onset of the behavior but the destructive urge to scratch continues long after the condition or injury has healed. Signs of neurotic excoriation include fresh wounds, scabs, and scars that are clean around the edges, linear, and relatively uniform in size and shape, evidence of excessive scratching motions. The targeted sites are usually those exposed in a normal setting – the face, back of the neck, shoulders, and lower arms and legs. Patients diagnosed with neurotic excoriation are most often female and usually have accompanying diagnoses of an anxiety or mood disorder.
Psychogenic excoriation appears, on the surface, to be similar to dermatillomania but the difference lies at the reason(s) behind the development of the habit of skin picking. Dermatillomania often gets started as a realistic desire to alleviate the presence of an actual dermatological condition, such as a blemish, ingrown hair, or similar fleeting imperfection. The relief, or satisfaction, derived from tending the blemish leads to more picking, the search for more imperfections to correct, and the habitual picking cycle escalates beyond control. In psychogenic excoriation, there is no blemish apparent that starts the skin picking cycle. Instead, the compulsion is considered to be of psychological nature only but it, too, spirals rapidly out of control and becomes a very difficult habit to break. One very graphic and tragic example of psychogenic excoriation is that of a 52-year-old woman who felt a compulsion to clean her left ear. She began by using her finger and other blunt objects to clean the opening of her ear canal but soon progressed to using sharp objects, such as pins and needles, poking them ever deeper into her ear. The habit caused repeated infections in the ear canal. Years of invasive cleaning and the infection it generated eventually led to a fatal and extremely rare case of squamous cell carcinoma. Psychogenic excoriation is diagnosed in about 2% of dermatology patients. The patient is usually female and onset of the disorder most often begins between the ages of 30 and 40. Within the medical specialties of both psychology and dermatology, there are many sub-classifications of the obsessive-compulsive urge to pick at skin, scalp, and nails uncontrollably and to the point of danger. The three descriptions here are but a brief overview of these disorders thought to be associated with mood and obsessive-compulsive disorders.
Update: as of 2013, the official name of the disorder is Excoriation Disorder (as listed in the DSM-5) For more information about Dermatillomania, causes and treatment, get the Complete Guide to Picking Disorders today.