intense helplessness, guilt, shame, and embarrassment in individuals, and this greatly increases the risk of self-harm. Studies have shown that excoriation disorder presented suicidal ideation in 12% of individuals with this condition, suicide attempts in 11.5% of individuals with this condition, and psychiatric hospitalizations in 15% of individuals with this condition. Causes There have been many different theories regarding the causes of excoriation disorder, including biological and environmental factors. A common hypothesis is that excoriation disorder is often a coping mechanism to deal with elevated levels of turmoil, boredom, anxiety, or stress within the individual, and that the individual has an impaired stress response. A review of behavioral studies found support in this hypothesis, in that skin-picking appears to be maintained by automatic reinforcement within the individual. In contrast to neurological theories, there are some psychologists who believe that picking behavior can be a result of repressed rage felt toward authoritarian parents. A similar theory holds that overbearing parents can cause the behavior to develop in their children. Neurological There is limited knowledge regarding the neurobiology that drives excoriation disorder, and there have been few neuroimaging studies of those with excoriation disorder. Those individuals that have excoriation disorder along with other diagnosed conditions report differing motivations for their picking. Those with both OCD and excoriation disorder report that they will pick their skin due to perceived contamination of the skin, while those with both body dysmorphic disorder (BDD) and excoriation disorder reportedly pick to fix perceived imperfections in the skin. Studies have shown a linkage between dopamine and the urge to pick. Drugs such as cocaine and methamphetamine, which increase the pharmacological effects of dopamine, have been shown to cause uncontrollable picking in users. These drugs can create the sensation of formication, which feels like something is crawling on or under the skin. Thus, excoriation disorder could result from a dysfunction in the dopamine reward functions. There may be another neurological explanation for excoriation disorder: individuals with the condition have less motor-inhibitory control, but show no sign of a difference in cognitive flexibility when compared to individuals without the condition. Motor-inhibitory control is a function of the right-lateralized frontostriatal circuit, which includes the right inferior frontal and bilateral anterior cingulate cortices. The impairment of motor-inhibitory control is similar to the neurological conditions of those who have problems suppressing inappropriate behaviors, such as using methamphetamine. Genetic components There is significant evidence