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Self -injurious behavior is a symptom that has been associated with numerous psychiatric conditions. There are many different terms and forms described in the literature because the conceptualization of self-injurious behavior often differs according to the social and functional roles of the behavior. For example, "self-mutilation" and "deliberate self-harm" are terms often used when describing intentional infliction of bodily injuries to oneself without intent to die. Traditionally these behaviors were sometimes misidentified by terms such as "suicide attempts" or "parasuicidal acts."
Favazza1 reviewed the different types of selfinjurious behaviors and their classification into categories based on severity, frequency, and the pattern of behavior. There are three broad types of self-injurious behavior according to his classification. Major self-mutilation refers to severe but infrequent acts (generally associated with psychosis), such as enucleation or amputation. Stereotypic self-mutilation refers to repetitive, rhythmic acts that appear to function as self-stimulation, such as head banging or self-biting. Superficial or moderate self-mutilation is divided into episodic (eg, seH-rjutting) and compulsive (eg, trichotillomania and skin picking) types. For the purposes of this article, the primary focus is on skin picking, although at times general data on self-injurious behavior are provided because the literature on skin picking is extremely scarce.
Pathological skin picking has been described as "neurotic excoriation," "self-inflicted dermatoses," and "dermatillomania." Until recently, skin picking was not referred to as a symptom of psychiatric conditions, but was instead mentioned more in the dermatology literature. Skin picking continues to be an understudied phenomenon that plagues individuals and results in substantial occupational and social impairment2 and physical complications.
CLINICAL CHARACTERISTICS
Patients who skin pick often are too embarrassed to discuss this symptom during the initial psychiatric consultation. Patients may also hide the damage caused by self-injurious behavior underneath clothing or apply cosmetics to cover lesions. A few studies have examined the clinical characteristics of patients who skin pick.
Wilhelm et al.3 assessed 31 individuals recruited through advertisements for skin picking. They found that the most common part of the body to be targeted by patients who skin pick is the face.3 Other areas that may also be targeted are the lips, scalp, arms, hands, and legs. Many individuals may simply use their fingernails to scratch, pick, dig, or bruise their skin, but some may...