From the Research
The recommended treatment approach for excoriation disorder in individuals with severe intellectual disability is a multimodal strategy combining behavioral interventions, environmental modifications, and pharmacological treatments, with a focus on habit reversal training, environmental modifications, and pharmacological interventions such as N-acetylcysteine (NAC) or selective serotonin reuptake inhibitors (SSRIs) 1, 2, 3, 4. The treatment of excoriation disorder in individuals with severe intellectual disability requires a comprehensive approach that addresses both the compulsive nature of the behavior and the sensory needs that may drive skin picking.
Key Components of Treatment
- Behavioral approaches: habit reversal training adapted to the individual's cognitive level, differential reinforcement of alternative behaviors, and consistent redirection when skin picking occurs
- Environmental modifications: keeping fingernails trimmed short, using protective clothing or gloves when necessary, and identifying and addressing environmental triggers that may precipitate picking behaviors
- Pharmacological interventions: N-acetylcysteine (NAC) at doses of 1200-2400 mg/day, SSRIs such as fluoxetine (20-80 mg/day) or sertraline (50-200 mg/day), or atypical antipsychotics like risperidone (0.5-2 mg/day) for severe cases with self-injury Treatment should be individualized based on the person's specific presentation, with careful monitoring for side effects, especially with antipsychotics 5.
Importance of Caregiver Training
Caregiver training is crucial for implementing behavioral strategies consistently across settings, and for ensuring that the individual with excoriation disorder receives the support and guidance they need to manage their symptoms effectively 1, 3.
Recent Studies
A recent study published in 2021 found that mirtazapine, a noradrenergic and specific serotonergic antidepressant, can be effective in treating excoriation disorder, particularly in cases with comorbid psychiatric conditions 5. However, the most recent and highest quality study, a systematic review and meta-analysis published in 2016, found that behavioral treatments, lamotrigine, and SSRIs have large effect sizes in reducing symptoms of excoriation disorder, and that treatment type, trial length, and trial methodological quality were not significant moderators 4.