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Skin picking disorder — SCE Dermatology MCQ

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HardPsychodermatologySkin picking disorderSCE Dermatology

A patient repeatedly picks minor facial irregularities for hours, believing they make her hideously deformed. She checks mirrors, camouflages the areas and avoids work. Which formulation should guide treatment?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: C — Body dysmorphic disorder managed with CBT and/or an SSRI

Explanation lettering: D = shown as B · E = shown as C · B = shown as D · C = shown as E

E is correct. The core problem is a disabling preoccupation with a perceived appearance defect, accompanied by mirror checking, camouflage, avoidance and skin picking; this is body dysmorphic disorder rather than isolated skin-picking disorder. NICE uses stepped care with CBT including exposure and response prevention and/or an SSRI according to functional impairment and patient preference, with explicit assessment of depression and suicide risk. Dermatological care can address genuine lesions, but escalating topical treatment does not treat the maintaining beliefs and rituals. Confrontation and empirical antiparasitic treatment are inappropriate.

Reference: NICE CG31: OCD and body dysmorphic disorder treatment: https://www.nice.org.uk/guidance/cg31/chapter/Recommendations