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7 TPC Digest Excoriation Disorder Assessment, Diagnosis and Treatment Nicole A. Stargell, Victoria E. Kress, Matthew J. Paylo, Alison Zins Milwaukee Inventory for the Dimensions of Adult Skin Picking. A functional analysis that includes a behavioral scale and multiple interviews with a client’s loved ones can also be used to identify the antecedents and rewards associated with skin picking behaviors. Cognitive behavioral therapy (CBT) has been identified as an effective strategy for working with clients who have ED. CBT is used to restructure and reframe dysfunctional thoughts while integrating behavioral interventions such as homework, preventative measures, activity replacement and relapse prevention. Habit reversal training can also be used to foster awareness, identify triggers for picking behaviors and integrate alternative behaviors (e.g., clenching fists rather than picking). Acceptance and commitment therapy can be used in conjunction with habit reversal training to incorporate mindfulness techniques, values clarification and goal setting. Medication also can be helpful when indicated. Continued research on ED is required to expand upon our current understanding of the etiology and treatment of skin-picking behaviors. ED should be distinguished from non-suicidal self-injury (which also involves physical harm to the body in order to regulate emotions) and general OCD. Professional counselors should maintain an awareness of the diagnostic criteria associated with ED and assess for this new disorder when appropriate. Nicole A. Stargell, NCC, is an Assistant Professor at the University of North Carolina at Pembroke. Victoria E. Kress, NCC, is a Professor at Youngstown State University. Matthew J. Paylo is an Associate Professor at Youngstown State University. Alison Zins is a graduate student at Youngstown State University. Correspondence can be addressed to Nicole Stargell, UNC Pembroke, P.O. Box 1510, Department of Educational Leadership and Counseling, 341 Education Building, Pembroke, NC 28372, nicole.stargell@uncp.edu . E xcoriation disorder (ED) is also called skin picking disorder. Affecting up to 5.4% of the general population, ED is a newly added mental disorder in the most recent version of the Diagnostic and Statistical Manual of Mental Disorders ( DSM-5 ). Diagnostic features of ED include a preoccupation with picking behaviors (e.g., ripping skin from the hands, face or scalp), difficulty controlling skin picking behaviors and distress as the result of the behaviors. Because ED is a new diagnosis, it is often overlooked by clinicians or addressed as a symptom of obsessive-compulsive disorder (OCD). However, ED is now listed as a unique diagnosis under the general category of obsessive-compulsive and related disorders in the DSM-5 . Skin picking is a body-focused repetitive behavior similar to trichotillomania (hair pulling) and is rooted in biological and psychological factors. Individuals with ED often have first-degree relatives who also have this disorder as well as generally high levels of impulsivity and sensation-seeking behaviors. Skin picking behaviors are associated with obsessions regarding the way the skin feels and looks. Individuals with ED are compelled to pick their skin in order to make it smooth or otherwise altered. Skin picking behaviors are often ritualistic, involving focused examination of the skin, strategic picking habits and disposal of the skin in a customary way (e.g., playing with or eating). Related to the obsessions and compulsions associated with ED, skin picking behaviors are often reinforced as an effective way to minimize unwanted emotions that accompany obsessive thoughts. However, individuals often feel a sense of shame or guilt after picking. Skin picking creates physical damage to the body, which leads to regret and further contributes to preexisting feelings of anxiety, stress and irritability. Skin picking behaviors can develop during early adolescence through middle age. Many formal assessments for ED exist, such as the Skin Picking Scale, the Skin Picking Impact Survey and The Read full article and references: Stargell, N. A., Kress, V. E., Paylo, M. J., & Zins, A. (2016). Excoriation disorder: Assessment, diagnosis and treatment. The Professional Counselor , 6, 50–60. doi : 10.15241/nas.6.1.50 7 TPC Digest