Similarities with other conditions  

The inability to control the urge to pick is similar to the urge to
compulsively pull one's own hair, i.e.,  trichotillomania
 . Researchers have noted the
following similarities between trichotillomania and excoriation disorder: the
symptoms are ritualistic but there are no preceding obsessions; there are
similar triggers for the compulsive actions; both conditions appear to play a
role in modifying the arousal level of the subject; and the age of onset for
both conditions is similar.  [9]  There is also a high level of  comorbidity
 between those that have trichotillomania
and those that have excoriation disorder.  [9]  A notable difference between
these conditions is that skin picking seems to be dominated by females whereas
trichotillomania is more evenly distributed across genders.  [9]  The acronym
body focused repetitive behavior disorders (BFRB) is used to characterize
excoriation and trichotillomania behaviors.  [20]  One shared behavior is
continued picking as an emotional or reward sensation. This involves the
picking to resolve negative thoughts or emotions or a developed behavior of
automatic picking. This automatic picking becomes habitual and is a
comorbidity with ADHD.  [21]  In 2018, a new study on Tourette Syndrome (TS),
trichotillomania, and excoriation revealed cooccurrence of the same disorders.
[22]  Participants were screened by clinical staff in clinics supporting
patients with Tourette Syndrome. Those patients included then completed self-
report questionnaires. Of the total number of TS participants (n = 811), 13%
revealed diagnosis of trichotillomania and excoriation.  [23]  This
significance of results was reported with the recommendation of screening in
children with a diagnosis of TS. This will assist clinicians in screening for
trichotillomania and excoriation or the risk factors for both. As with the
adult population of women, girls are more impacted by the disorders than boys.

Research has also suggested that excoriation disorder may be thought of as a
type of  obsessive compulsive disorder  (OCD).  [6]  Excoriation disorder and OCD are
similar in that they both involve "repetitive engagement in behaviors with
diminished control" and also both generally decrease anxiety.  [3]

Nevertheless, Odlaug and Grant have suggested that excoriation disorder is
more akin to  substance use disorder  than OCD.  [3]  They argue that excoriation disorder
differs from OCD in the following fundamental ways:

* There is a much greater share of females with excoriation disorder.
* Excoriation disorder may be inherently pleasurable whereas OCD is not.
* The treatments that are generally effective for patients with OCD (i. e.,  SSRIs  and  exposure therapy  ) are not as successful in patients with excoriation disorder.
* Unlike OCD, picking the skin is rarely driven by obsessive thoughts.

Odlaug and Grant have recognized the following similarities between
individuals with dermatillomania and patients with addictions:

* Compulsion to engage in the negative behavior despite knowledge of the harm.
* Lack of control over the problematic behavior.
* Strong urge to engage in the behavior before engagement.
* Feeling of pleasure while engaging in the behavior or a feeling of relief or reduced anxiety after engaging in the behavior.  [3]

One study that supported the addiction theory of picking found that 79% of
patients with excoriation disorder reported a pleasurable feeling when
picking.  [3]

Odlaug and Grant also argue that dermatillomania could have several different
psychological causes, which would explain why some patients seem more likely
to have symptoms of OCD, and others, of an addiction. They suggest that
treating certain cases of excoriation as an addiction may yield more success
than treating them as a form of OCD.  [3]