A 32-year-old female presents with multiple excoriated lesions on her arms and face. She reports spending 1-2 hours daily picking at perceived skin imperfections, often entering a 'trance-like' state while doing so. She has tried to stop many times but cannot resist the urge. She denies that the picking is driven by concerns about her appearance or fears of contamination. She reports a history of trichotillomania in adolescence that has since resolved. Dermatological examination confirms the lesions are self-inflicted with no primary skin pathology.