TPC-Journal-V6-Issue1

50 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. Nicole A. Stargell, Victoria E. Kress, Matthew J. Paylo, Alison Zins Excoriation Disorder: Assessment, Diagnosis and Treatment Excoriation disorder (also called skin picking disorder) is a newly added, often overlooked mental disorder in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (APA, 2013) . The purpose of this article is to increase professional counselors’ abilities to recognize and effectively address the symptoms of excoriation disorder. In this article, the etiologies, diagnostic criteria and assessment strategies for excoriation disorder are described. Excoriation disorder develops as the result of biological and physical contributors and might serve to regulate emotions. A review is provided of specific interventions and treatments, such as cognitive behavioral therapy and acceptance and commitment therapy, which have demonstrated success in treating those who have excoriation disorder. Keywords: excoriation disorder, skin picking, assessment, diagnosis, DSM-5 Excoriation disorder, sometimes colloquially referred to as skin picking disorder, is a newly added disorder in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5 ; American Psychiatric Association [APA], 2013). Despite being a newly-classified DSM disorder, excoriation disorder is relatively common and affects between 1.4 and 5.4% of the general population (Grant et al., 2012). The purpose of this article is to provide professional counselors with a general understanding of how to assess, diagnose and treat excoriation disorder. The prevalence of excoriation disorder may be underestimated, as it is sometimes overlooked, particularly because of comorbidity with other mental disorders (e.g., depression, anxiety, obsessive- compulsive disorder; Hayes, Storch, & Berlanga, 2009). Previously underestimated numbers of its prevalence also may be due to the covertness often associated with this disorder (Grant & Odlaug, 2009). Many people with excoriation disorder go to great lengths to hide their behavior from others (e.g., significant others, family members, health professionals) due to fear or embarassment. Historically, excoriation disorder has been associated with obsessive-compulsive disorder (OCD), and it is now listed as a unique diagnosis in the obsessive-compulsive and related disorders section in the DSM-5 (Ravindran, da Silva, Ravindran, Richter, & Rector, 2009). According to the APA (2013), excoriation disorder involves the recurrent, excessive and often impulsive scratching, rubbing and picking of skin which leads to tissue damage and lesions. Those who have excoriation disorder frequently initiate attempts to eradicate these destructive behaviors, yet have difficulty doing so. In order for the diagnosis of excoriation disorder to be applied, individuals must experience clinically- significant distress or impairment in social, occupational or other important areas of functioning due to the routine nature of the skin picking behaviors (APA, 2013). Because of its physical manifestation, this phenomenon has frequently been discussed in medical research, but it is now receiving attention in mental health circles. The Professional Counselor Volume 6, Issue 1, Pages 50–60 61http://tpcjournal.nbcc.org © 2016 NBCC, Inc. and Affiliates doi:10.15241/nas.6.1.50