Several new diagnoses will appear in the soon to-be-released Diagnostic and Statistical Manual of Mental Disorders – Fifth Edition (DSM-V). In fact, quite a bit of controversy surrounds the inclusion of several of these new “disorders” in what is considered to be the mental health world’s diagnostic “bible,” as many question their validity and appropriateness for inclusion.
Among the new DSM-V disorders is Excoriation (Skin Picking) Disorder, classified within the Obsessive Compulsive and Related Disorders. It is understandable that the initial public reaction to this release of information has been skeptical (at best). News outlets have begun to question the validity of the diagnosis. Readers have begun to leave comments such as, “Great, now we’re all mentally ill.”
Yes, everyone picks at his or her skin at some point; however, Excoriation Disorder far exceeds “normal” grooming behavior. Think of grooming behavior as occurring on a continuum, with normal, washing and exfoliating on one end of the continuum, extending to picking, scraping, or gouging that results in scarring or disfigurement on the other end.
Below, is a nice summary regarding this exciting avenue of treatment by principal investigator and Trichotillomania Learning Center (TLC) Scientific Advisory Board member, Dr. Jon Grant:
N-Acetyl Cysteine (NAC), a dietary supplement and amino acid that affects glutamate levels in the brain, has been studied in the treatment of a number of conditions across medicine and psychiatry. In recent years, NAC has been thought to have the potential to improve symptoms of Trichotillomania (hair pulling). As no medication or other substance to date has shown effectiveness in the treatment of TTM, this finding is one of promise and one that warrants consideration and further investigation.
Sara pulls the woven, green hat from her head to show her nearly bald scalp, with only a few tufts of long, thin hair surrounding her crown. Sara has trichotillomania. She pulls her own hair out.
This is not the first time I met with Sara. In fact, we’d been working together for months, but this is the first time she felt comfortable enough to show me what she’s done to herself.“This is where I pull from, Dr. Deibler,” she explains. I nod and say nothing, not because it’s unimportant, but because it’s important to react as if this discussion is like any other discussion, even though she has never before revealed her trichotillomania to anyone.It hadn’t always been this way for Sara.
She began pulling her eyelashes and eyebrows at age 7. Now, at age 14, she’s pulled nearly all of the hair from her head and wears a cap so that no one can see. It’s not that she’s never sought help. She’d been to therapist after therapist, each one helping her cope with her parents’ divorce and family problems, but none of whom knew how to help Sara with her hair.