Excoriation Disorder Definition/description • • Skin picking disorder Involves the conscious creation of neurotic excoriations by means of repetitive scratching Epidemiology • More common in females? Aetiology • Opoid neurotransmitter system and central nervous system is the neurologic basis for neurotic excoriations - Thus why anti-psychotics may help Diagnosis DSM V A. Recurrent skin picking resulting in skin lesions. B. Repeated attempts to decrease or stop skin picking. C. The skin picking causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. D. The skin picking is not attributable to the physiological effects of a substance (e.g., cocaine) or another medical condition (e.g., scabies). E. The skin picking is not better explained by symptoms of another mental disorder (e.g., delusions or tactile hallucinations in a psychotic disorder, attempts to improve a perceived defect or flaw in appearance in body dysmorphic disorder, stereotypies in self-injury Treatment and Management • • • • Attempt to treat with: - Antipsychotic medications ➔Usually atypical - Anti-anxiety medications - Antidepressant medications - Topical cortisone medications - Antiepileptic medications Glutamate - N-acetylcysteine – ➔Restores extracellular glutamate concentration in the nucleus accumbens SSRIs Olanzapine – may be used as an adjunctive • • • • • • Lithium - Further study is needed Hypnosis CBT Habit reversal training Mindfulness and stress reduction techniques Understanding lifestyle triggers