Grant have recognized the following similarities between individuals with dermatillomania and patients with addictions: Compulsion to engage in the negative behavior despite knowledge of the harm. Lack of control over the problematic behavior. Strong urge to engage in the behavior before engagement. Feeling of pleasure while engaging in the behavior or a feeling of relief or reduced anxiety after engaging in the behavior. One study that supported the addiction theory of picking found that 79% of patients with excoriation disorder reported a pleasurable feeling when picking. Odlaug and Grant also argue that dermatillomania could have several different psychological causes, which would explain why some patients seem more likely to have symptoms of OCD, and others, of an addiction. They suggest that treating certain cases of excoriation as an addiction may yield more success than treating them as a form of OCD. Treatment Knowledge about effective treatments for excoriation disorder is sparse, despite the prevalence of the condition. There are two major classes of therapy for excoriation disorder: pharmacological and behavioral. Individuals with excoriation disorder often do not seek treatment for their condition, largely due to feelings of embarrassment, alienation, lack of awareness, or belief that the condition cannot be treated. One study found that only 45% of individuals with excoriation disorder ever sought treatment, and only 19% ever received dermatological treatment. Another study found that only 30% of individuals with this disorder sought treatment. Medication There are several different classes of pharmacological treatment agents that have some support for treating excoriation disorder: SSRIs; opioid antagonists; anti-epileptic agents; and glutamatergic agents. In addition to these classes of drugs, some other pharmacological products have been tested in small trials as well. Antipsychotic, antianxiety, antidepressant, and antiepileptic medications have all been used to treat skin picking, with varying degrees of success. SSRIs have shown to be effective in the treatment of OCD, which serves as an argument in favor of treating excoriation disorder with the same therapy. Unfortunately, clinical studies have not provided clear support for this, because there have not been large double-blind placebo-controlled trials of SSRI therapy for excoriation disorder. In fact, in a meta-analysis of pharmacological treatments of excoriation disorders, it was found that selective serotonin reuptake inhibitors (SSRIs) and lamotrigine were no more effective than a placebo for longterm effects. Reviews of treatment of excoriation disorder have shown that the following medications may be effective in reducing picking behavior: