Skin picking as a symptom of body dysmorphic disorder

Skin picking, traditionally considered a type of "neurotic excoriation," has received little investigation. In particular, its association with body dysmorphic disorder (BDD) has not been studied. A total of 123 subjects with DSM-IV BDD were assessed with a variety of instruments; the descriptive characteristics of the 33 subjects who picked their skin were assessed and compared with those of the 90 subjects who did not pick. Of the 14 men and 19 women who engaged in picking behavior, 97 percent had preoccupations involving the skin. Nearly all had experienced impairment in social (97%) or occupational (82%) functioning, 33 percent had attempted suicide, and 67 percent had received dermatologic treatment, which was generally ineffective. Of 35 trials with a serotonin reuptake inhibitor (SRI), 17 (49%) resulted in significant improvement, in contrast to only 4 of 40 (10%) trials with other psychotropics. Subjects who picked were more likely than those who did not pick to have skin preoccupations, to have actual physical defects, to excessively groom and camouflage, and to have received dermatologic treatment. These preliminary findings suggest that compulsive skin picking is an under-recognized problem that commonly occurs as a symptom of BDD, is associated with significant morbidity, and may respond to psychiatric rather than dermatologic treatment.