CHARACTERISTICS OF 34 ADULTS WITH PSYCHOGENIC EXCORIATION

Background: Psychogenic excoriation, characterized by excessive scratc hing or picking of the skin, is not yet recognized as a symptom of a d istinct DSM-IV disorder. The purpose of this study was to provide data regarding the demographics, phenomenology, course of illness, associa ted psychiatric comorbidity, and family history of subjects with psych ogenic excoriation. Method: Thirty-four consecutive subjects were recr uited from an outpatient dermatology practice and by advertisement. Su bjects completed the Structured Clinical Interview for DSM-IV augmente d with impulse control disorder modules, the Yale-Brown Obsessive Comp ulsive Scale, and a semistructured interview for family history, demog raphic data, and clinical features. Results: Most subjects were women who described a mean age at onset of 38 years and a chronic course. Su bjects excoriated multiple sites, most frequently the face. The behavi or caused substantial distress and dysfunction. All 34 subjects met cr iteria for at least 1 comorbid psychiatric disorder, with a mood disor der the most common. Family histories were notable for depressive diso rders and psychoactive substance use disorders. Most subjects experien ced both mounting tension before excoriation and relief after excoriat ion as in impulse control disorders. A minority of subjects excoriated skin as part of obsessive-compulsive disorder. Body dysmorphic disord er with preoccupation about the skin's appearance precipitated excoria tion in about a third of subjects. Conclusion: Psychogenic excoriation is chronic, involves multiple sites, and is associated with a high ra te of psychiatric comorbidity. The behavior associated with the excori ation is heterogeneous and spans a compulsive-impulsive spectrum. Most subjects in this sample described features of an impulse control diso rder.