The PMHNP has just diagnosed a patient with excoriation disorder. To fulfill diagnostic criteria for excoriation disorder, the skin-picking must be severe enough to result in which of the following?

Choice A reason: Permanent deformity is not required for diagnosis, although it can occur in severe cases. Choice B reason: Infection may occur but is not a necessary diagnostic criterion. Choice C reason: Correct. The skin-picking must result in lesions, indicating that the behavior is causing physical damage and distress. Choice D reason: Medical attention may be sought but is not required for the diagnosis.