Diagnosis  

There has been controversy over the creation of a separate category in the 
DSM-5  for excoriation (skin picking) disorder.  [13]
Two of the main reasons for objecting to the inclusion of excoriation disorder
in the DSM-5 are: that excoriation disorder may just be a symptom of a
different underlying disorder, e.g. OCD or BDD, and excoriation disorder is
merely a bad habit and that by allowing this disorder to obtain its own
separate category it would force the DSM to include a wide array of bad habits
as separate syndromes, e.g., nail-biting, nose-picking, hair pulling, etc.
[9]  Stein has argued that excoriation disorder does qualify as a separate
syndrome and should be classified as its own category because:  [14]

* Excoriation disorder occurs as the primary disorder and not as a subset of a larger disorder.
* Excoriation disorder has well-defined clinical features.
* There is gathering data on the clinical features and diagnostic criteria for this condition.
* There is sufficient data to create this as a separate category for excoriation disorder.
* The incidence rate for excoriation disorder is high within the population.
* Diagnostic criteria for the disease have already been proposed.
* The classification of excoriation disorder as a separate condition would lead to better studies and better treatment outcomes.
* Classification as a separate condition would lead to more awareness of the disorder and encourage more people to obtain treatment.  [9]

A new scale used to diagnosis excoriation was used in a recent study, and the
results published in the International Journal of Environmental Research and
Public Health, in May 2022. The scale is titled: Diagnostic Interview for Skin
Picking Problems (DISP). The DISP is designed to confirm DSM-5 criteria for
the diagnosis, combined with a clinical interview to determine frequency of
skin picking, and the body areas impacted.  [15]  Initial results from the
study (n = 120) participants show clinical confirmation at a satisfactory
level with 88% of participants identified through the DISP as meeting DSM-5
criteria. Additionally, researchers conducted a 5-month period of validity to
determine consistency with the scale. The data shows clinicians can expect to
yield consistent data with administration of the scale ranging from
satisfactory to perfect levels of diagnosis.  [16]

However, a review of the scientific literature by Jenkins et al. on
excoriation disorder as a separate category in the DSM-5 concluded that such a
distinction requires more evidence.  [13]  Because excoriation disorder is
different from other conditions and disorders that cause picking of the skin,
any diagnosis of excoriation disorder must take into account various other
medical conditions as possible causes before diagnosing the patient with
excoriation disorder.  [3]  There are a variety of conditions that cause
itching and skin picking including:  eczema  , 
psoriasis  ,  diabetes  ,  liver disease  , 
Hodgkin's disease  , 
polycythemia vera  ,  systemic
lupus  , and  Prader–Willi syndrome
 .  [3]

In order to better understand excoriation disorder, researchers have developed
a variety of scales to categorize skin-picking behavior. These include the
Skin-Picking Impact Scale (SPIS), and The Milwaukee Inventory for the
Dimensions of Adult Skin-picking.  [8]  The SPIS was created to measure how
skin picking affects the individual socially, behaviorally, and emotionally.
[17]

As of the release of the fifth  _Diagnostic and Statistical Manual of Mental
Disorders_  (DSM-5) in May 2013, this disorder is
classified as its own separate condition under "Obsessive Compulsive and
Related Disorders" and is termed "excoriation (skin-picking) disorder". The
diagnostic material is as follows:  [18]

1. Repeated picking of the skin, resulting in injuries
2. Recurring attempts to stop picking while relapses continually occur
3. Picking causes a substantial amount of distress and substantially impairs everyday functioning
4. The picking is not caused or cannot be better explained by physiological effects of a substance or a medical disorder
5. The picking is not more accurately attributed to another mental disorder