Characteristics of 34 Adults With Psychogenic Excoriation
J Clin Psychiatry 1998;59(10):509-514
© Copyright 2015 Physicians Postgraduate Press, Inc.
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Background: Psychogenic excoriation, characterized by excessive
scratching or picking of the skin, is not yet recognized as a symptom of a distinct DSM-IV
disorder. The purpose of this study was to provide data regarding the demographics,
phenomenology, course of illness, associated psychiatric comorbidity, and family history
of subjects with psychogenic excoriation.
Method: Thirty-four consecutive subjects were recruited from an
outpatient dermatology practice and by advertisement. Subjects completed the Structured
Clinical Interview for DSM-IV augmented with impulse control disorder modules, the
Yale-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 38
years and a chronic course. Subjects excoriated multiple sites, most frequently the face.
The behavior caused substantial distress and dysfunction. All 34 subjects met criteria for
at least 1 comorbid psychiatric disorder, with a mood disorder the most common. Family
histories were notable for depressive disorders and psychoactive substance use disorders.
Most subjects experienced both mounting tension before excoriation and relief after
excoriation as in impulse control disorders. A minority of subjects excoriated skin as
part of obsessive-compulsive disorder. Body dysmorphic disorder with preoccupation about
the 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 associated
with the excoriation is heterogeneous and spans a compulsive-impulsive spectrum. Most
subjects in this sample described features of an impulse control disorder.