Escitalopram for the Treatment of Self-Injurious Skin Picking

Inclusion Criteria: * Repetitive skin picking resulting in noticeable tissue damage and associated emotional distress and/or functional impairment. * Age 18-65 years old. * Duration of skin picking symptoms ≥ 6 months. * MGH Skin Picking Scale score ≥ 10. * Written informed consent. * Females of childbearing potential must have a negative serum or urinary beta-HCG test and be willing to use acceptable methods of birth control during study tenure. Exclusion Criteria: * Pregnant women or females of childbearing potential who do not consent to use of a medically acceptable method of contraception. * Women who are breastfeeding. * Subjects who pose a serious suicidal or homicidal risk in the judgment of study investigators. * Serious or unstable medical illness including cardiovascular, hepatic, renal, respiratory, endocrine, neurologic, or hematologic disease. * Subjects with a dermatologic disorder that causes pruritis. * Patients on anticoagulant therapy. * History of seizure disorder. * Comorbid bipolar disorder, psychosis, organic mental disorder, borderline personality disorder or developmental disorder. Subjects with obsessive compulsive disorder (with primary symptoms other than compulsive skin picking). * History of substance dependence. If there is a history of substance abuse, subjects should be in remission for ≥ 6 months. * Current treatment with cognitive behavioral therapy for skin picking. * Current use of another SSRI medication. * Other medications for medical disorders that might interfere with escitalopram. * Current major depression or prescribed an antidepressant for major depression within the past 12 months. * More than 1 adequate trial (at least 10 weeks at maximally tolerated dose) with another prior SSRI.