Medical Terminology for OCD-Related Skin and Hair Picking
The medical terms for picking at skin and hair are excoriation disorder (also called skin-picking disorder or dermatillomania) for skin picking, and trichotillomania (also called hair-pulling disorder) for hair pulling. 1
Important Diagnostic Distinction
These conditions are not actually forms of OCD, despite their superficial similarities. According to DSM-5 criteria, they are classified as separate obsessive-compulsive and related disorders (OCRDs), and the diagnostic criteria explicitly state that OCD should not be diagnosed when the disturbance is better explained by hair pulling (trichotillomania) or skin picking (excoriation disorder). 1
Key Differentiating Features from OCD:
Excoriation disorder involves recurrent skin picking leading to skin lesions, with repeated unsuccessful attempts to stop, causing significant distress or functional impairment, but is not primarily motivated by appearance concerns (which would indicate body dysmorphic disorder instead). 2
Trichotillomania involves repetitive hair pulling that is not driven by an attempt to improve appearance, whereas hair pulling in body dysmorphic disorder is intended to improve appearance (e.g., by removing facial or body hair perceived as unattractive). 1
In contrast, grooming rituals in true OCD are driven by contamination fears, 'just right' urges, or needs for symmetry—not by appearance concerns or the texture/feel of skin or hair. 1
Clinical Characteristics
Excoriation Disorder (Skin-Picking Disorder):
- Peak age of onset is approximately 12.9 years, with over 90% having symptom onset before age 20. 3
- Most commonly affects the face, though individuals typically pick from multiple body sites. 3
- Most frequent triggers are stress and the texture/feel of the skin. 3
- Approximately 87% female predominance. 3
Trichotillomania (Hair-Pulling Disorder):
- Point prevalence of approximately 2% in the general population. 4
- Frequently co-occurs with skin-picking disorder. 4, 5
Common Comorbidities
Both disorders commonly present with: 4, 3
- Depression
- Generalized anxiety disorder
- Attention-deficit hyperactivity disorder
- Obsessive-compulsive disorder (as a comorbid condition, not the primary diagnosis)
- Each other (trichotillomania and excoriation disorder frequently co-occur)
Critical Clinical Pitfall
The majority of people with these disorders (87.1%) have never received treatment, despite the fact that 87% of those who did receive treatment found it helpful. 3 These conditions are severely under-recognized in clinical practice, leading to significant untreated morbidity. 1, 4