A 28-year-old woman repeatedly picks at her skin, causing lesions on her arms and face. She describes tension before picking and relief afterward. She has tried to stop multiple times but cannot. According to DSM-5, what is a REQUIRED diagnostic criterion for excoriation (skin-picking) disorder?

• A The picking is triggered by a dermatological condition
• B The patient has co-occurring body dysmorphic disorder
• C The picking occurs only during periods of high stress
• D The picking causes clinically significant distress or impairment ✓

Explanation

DSM-5 requires that skin-picking cause clinically significant distress or impairment in functioning for diagnosis. The picking must not be attributable to a substance or medical condition. It need not occur only during stress. Co-occurring BDD is not required. A dermatological trigger would suggest another explanation.

Reference: Diagnostic and Statistical Manual of Mental Disorders, 5th ed.

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