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; while severe picking may cause scarring, the diagnostic criterion focuses on observable skin lesions. Choice B reason: Infections can occur secondary to skin-picking but are not necessary to fulfill diagnostic criteria. Choice C reason: Skin lesions resulting from recurrent and compulsive picking are the core diagnostic feature of excoriation disorder. The behavior must result in noticeable tissue damage. Choice D reason: Seeking medical attention is not a requirement for diagnosis; many individuals with excoriation disorder do not present for care despite the lesions.