DSM-5 field survey: Skin picking disorder

BACKGROUND: Pathologic skin picking (skin picking disorder [SPD]) is a prevalent and disabling condition, which has received increasing study. It is timely to consider including SPD in DSM-5. The aim of this field survey was to investigate possible diagnostic criteria for SPD. METHODS: Patients age >10 with skin-picking symptoms were recruited. Patients were assessed with 2 modules based on the Structured Clinical Interview for DSM, which addressed proposed DSM-5 diagnostic criteria for SPD. Additional questions were included to test other possible diagnostic criteria. RESULTS: Thirty-eight patients had SPD. All had recurrent skin picking that resulted in skin lesions. Skin picking persisted despite repeated attempts to decrease or stop. "Urges" or "needs" to pull were not endorsed by all patients, but did correlate with severity of skin picking. "Resistance" to picking also was not universally endorsed. CONCLUSIONS: These data support the proposed DSM-5 diagnostic criteria for SPD. Although most patients have urges to pick or a sense of relief when picking, such phenomena are not universal and should not be included in the diagnostic criteria set. An additional criterion of repeated attempts to decrease or stop skin picking seems warranted.