Symposia
Assessment
Margaret Andover, Ph.D.
Associate Professor
Fordham University
Bronx, New York
Hae-Joon kim, MA
Doctoral Candidate
Fordham University
Bronx, New York
Brianna Pastro, B.S.
Graduate Student
Fordham University
New York, New York
Joshua DeSon, MA
Doctoral Candidate
Fordham University
Bronx, New York
Excoriation disorder was included as a new diagnosis in the DSM-5 (APA, 2013), reflecting increasing recognition of the prevalence of skin picking behaviors and recognition of the potential for significant functional impairment and distress (Stein & Phillips, 2013). Criteria for diagnosis include recurrent skin picking resulting in physical damage, repeated attempts to decrease or stop the behavior, and clinically significant distress or functional impairment as a result of picking; the behavior must not be attributable to or better explained by other psychological or medical conditions, including non-suicidal self-injury (NSSI). However, skin picking is a commonly reported method of NSSI. NSSI Disorder was proposed for DSM-5; criteria included self-inflicted injury on 5+ days in the past year and endorsement of specific empirically-identified functions and antecedents of the behavior. Inter-rater reliability of NSSI Disorder was low in field trials (Regier et al., 2013), and it was ultimately included as a Disorder Requiring Further Research (APA, 2013). However, because of common behaviors, functions, and antecedents, diagnoses of Excoriation Disorder and NSSI Disorder are likely to overlap.
The purpose of this study was to investigate NSSI Disorder among adults who engage in excoriation only (EO) or other NSSI behaviors. Participants (N = 548) completed an online assessment of NSSI behaviors and NSSI Disorder diagnostic criteria. Nearly 20% of the sample (n = 107) reported self-injurious behaviors in the past year. Of those, 25.2% reported EO (n = 27). Those with EO were compared to those whose behaviors also included other forms of NSSI on NSSI Disorder criteria. Those with EO were significantly less likely to meet Criterion A (number of episodes of self-injury; < ![if !msEquation] >< ![if !vml] >< ![endif] >< ![endif] >2(1) = 5.93, p = .02, < ![if !msEquation] >< ![if !vml] >< ![endif] >< ![endif] > = .28), as the EO group reported a low number of behaviors in the past year (M = 1.17, SD = 1.40). There were no significant differences on any of the other NSSI Disorder criteria (all ps > .12). When considering only Criteria B, C, and E, there was no difference between groups in meeting NSSI Disorder criteria (EO = 50%, NSSI = 48.5%; < ![if !msEquation] >< ![if !vml] >< ![endif] >< ![endif] >2(1) = 0.01, p = .92, < ![if !msEquation] >< ![if !vml] >< ![endif] >< ![endif] > = .01). These findings suggest that Excoriation Disorder and NSSI Disorder may overlap significantly and may not represent distinct populations. Clinical constructs (e.g., BPD symptoms, coping strategy use) that may differentiate those with excoriation only and NSSI will also be presented. Implications for patient diagnosis will be discussed, as well as future research and implications for revisions to the disorders.