|Classification and external resources|
Delusional parasitosis, or delusory parasitosis, also known as Ekbom's syndrome, is a form of psychosis. Victims acquire a strong delusional belief that they are infested with parasites, whereas in reality no such parasites are present. Often, exposure to household cleaning products can result in a sensation known as formication. This irritation combined with underlying psychiatric or psycho-pharmacological issues can cause delusional parasitosis.
The alternative name of Ekbom's syndrome derives from Swedish neurologist Karl Axel Ekbom, who published seminal accounts of the disease in 1937 and 1938. It is important not to confuse or interchange this with Willis-Ekbom Disease (or WED), another name for restless legs syndrome (RLS).
Signs and symptoms
Details of delusional parasitosis vary among sufferers, but it is most commonly described as involving perceived parasites crawling upon or burrowing into the skin, sometimes accompanied by an actual physical sensation (known as formication). Sufferers may injure themselves in attempts to be rid of the "parasites". Some are able to induce the condition in others through suggestion, in which case the term folie à deux may be applicable.
Nearly any marking upon the skin, or small object or particle found on the person or his clothing, can be interpreted as evidence for the parasitic infestation, and sufferers commonly compulsively gather such "evidence" and then present it to medical professionals when seeking help. This presenting of "evidence" is known as "the matchbox sign" because the "evidence" is frequently presented in a small container, such as a matchbox.
A study conducted of 108 patients at the Mayo Clinic was published in Archives of Dermatology on May 16, 2011. The study failed to find evidence of skin infestation despite doing skin biopsies and examining specimens provided by the patients. The study, which was conducted between 2001 and 2007, concluded that the feeling of skin infestation was delusional parasitosis.
Delusional parasitosis is divided into primary, secondary functional and secondary organic groups.
In primary delusional parasitosis, the delusions comprise the entire disease entity: there is no additional deterioration of basic mental functioning or idiosyncratic thought processes. The parasitic delusions consist of a single delusional belief regarding some aspect of health. This is also referred to as "monosymptomatic hypochondriacal psychosis",:389 and sometimes as "true" delusional parasitosis. In the DSM-IV, this corresponds with "delusional disorder, somatic type".
Secondary organic delusional parasitosis occurs when the state of the patient is caused by a medical illness or substance (medical or recreational) use. In the DSM-IV this corresponds with "psychotic disorder due to general medical condition". Physical illnesses that can underlie secondary organic delusional parasitosis include: hypothyroidism, cancer, cerebrovascular disease, tuberculosis, neurological disorders, vitamin B12 deficiency, and diabetes mellitus. Any illness or medication for which formication is a symptom or side effect can become a trigger or underlying cause of delusional parasitosis.
Other physiological factors which can cause formication and thus can sometimes lead to this condition include: menopause (i.e. hormone withdrawal); allergies, and drug abuse, including but not limited to cocaine and methamphetamine (as in amphetamine psychosis). It appears that many of these physiological factors, as well as environmental factors such as airborne irritants, are capable of inducing a "crawling" sensation in otherwise healthy individuals; however, some people become fixated on the sensation and its possible meaning, and this fixation may then develop into delusional parasitosis.
Treatment of secondary forms of delusional parasitosis are addressed by treating the primary associated psychological or physical condition. The primary form is treated much as other delusional disorders and schizophrenia. In the past, pimozide was the drug of choice when selecting from the typical antipsychotics. Currently, atypical antipsychotics such as olanzapine or risperidone are used as first line treatment.
However, it is also characteristic that sufferers will reject the diagnosis of delusional parasitosis by medical professionals, and very few are willing to be treated, despite demonstrable efficacy of treatment.
In season 3 episode 12 of the television show The X-Files, Scully mentions this condition in conversation with Mulder.
In season 5 episode 7 of the television show House, Dr. Wilson diagnoses Dr. House as having delusional parasitosis.
The animated series The Simpsons makes reference to delusional parasitosis in the motto of the Springfield Psychiatric Center: "Because There May Not Be Bugs On You".
The Philip K. Dick novel A Scanner Darkly contains a character named Jerry Fabin who suffers from intense delusional parasitosis. This detail forms the partly humorous plot of the opening segment of the film adaptation of the story.
In the first issue of the comic book Hellblazer, John Constantine's friend believes he is experiencing delusional parasitosis as a result of being a junkie. (As it turns out, he really is covered in insects.)
In Neil Gaiman's The Sandman, Delirium inflicts a curse on a policeman, giving him delusional parasitosis.
In the Dark Skies episode “The Last Wave,” two characters hallucinate insects under their skin as a result of actually having alien bacteria in their bodies.
The sound novel Higurashi no Naku Koro Ni features a character who experienced delusional parasitosis and was driven to self-mutilation, believing maggots were mixed in with her blood and would try to crawl back inside her through the open wounds.
In the fantasy roleplaying game Dungeons and Dragons characters who come into contact with a type of demon called an 'Ekolid' develop this delusion.
In Season 10, Episode 4 ("The Itch") of the television show Criminal Minds (2014), the unsub has delusional parasitosis, and kills his victims when they don't support his delusion.
The term "Morgellons" was introduced by Mary Leitao in 2004 to describe a skin condition characterized by a range of cutaneous (skin) symptoms including crawling, biting, and stinging sensations; finding fibers on or under the skin; and persistent skin lesions (e.g., rashes or sores). A majority of health professionals, including most dermatologists, regard Morgellons as a manifestation of other known medical conditions, including delusional parasitosis and believe any fibers found are from textiles such as clothing. Large-scale studies into the proposed diagnosis by the Centers for Disease Control and Prevention (CDC) and the Mayo Clinic failed to find an infectious cause of the symptoms and confirmed that Morgellons is a variant of delusional parasitosis.
- Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology: 2-Volume Set. St. Louis: Mosby. ISBN 1-4160-2999-0.
- Hinkle, N.C. (2011). "Ekbom Syndrome: a delusional condition of "bugs in the skin"". Curr Psychiatry Rep 13 (3): 178–86. doi:10.1007/s11920-011-0188-0. PMID 21344286.
- Webb, J.P., Jr. (1993). "Case histories of individuals with delusions of parasitosis in southern California and a proposed protocol for initiating effective medical assistance". Bulletin of the Society of Vector Ecologists 18 (1): 16–24.
- Kligman, Albert M (2011). "Demodex folliculorum: Requirements for Understanding Its Role in Human Skin Disease". Journal of Investigative Dermatology 131 (1): 8–10. doi:10.1038/jid.2010.335. PMID 21157421.
- Jing, X., Shuling, G. and Ying, L. (2005). "Environmental scanning electron microscopy observation of the ultrastructure of Demodex.". Microsc. Res. Tech. 68: 284–289. doi:10.1002/jemt.20253.
- Ekbom's syndrome II at Who Named It?
- Koblenzer, C.S. (1993). "The clinical presentation, diagnosis and treatment of delusions of parasitosis--a dermatologic perspective". Bulletin of the Society of Vector Ecologists 18 (1): 6–10.
- Hylwa SA, Bury JE, Davis MD, Pittelkow M, Bostwick JM; Sara A. Hylwa, BS; Jessica E. Bury, MD; Mark D. P. Davis, MD; Mark Pittelkow, MD; J. Michael Bostwick, MD (May 16, 2011). "Delusional Infestation, Including Delusions of Parasitosis: Results of Histologic Examination of Skin Biopsy and Patient-Provided Skin Specimens". Arch Dermatol 147 (9): 1041–5. doi:10.1001/archdermatol.2011.114. PMID 21576554.
- Walsh, Nancy; Zalman S. Agus (May 16, 2011). "Bugs and Worms in Patients' Heads, Not the Skin". MedPage Today. Retrieved 16 May 2011.
- Hinkle, Nancy C (2000). "Delusory Parasitosis" (PDF). American Entomologist 46 (1): 17–25.
- Grace, Kenneth J (1987). "Delusory Cleptoparasitosis: Delusions of Arthropod Infestation in the Home". Pan-Pacific Entomologist (PDF) 63 (1): 1–4.
- Freinhar, Jack P (1984). "Delusions of parasitosis". Psychosomatics 25 (1): 47–53. doi:10.1016/S0033-3182(84)73096-9.
- Freedberg, et al. (2003). Fitzpatrick's Dermatology in General Medicine. (6th ed.). McGraw-Hill. ISBN 0-07-138076-0.
- Mysterious 'Morgellons disease' prompts US investigation, Emma Marris, Nature Medicine, 30 August 2006
- Delusions of Parasitosis Noah Scheinfeld, May 4, 2007
- Dunn, Jeffrey; Michael B. Murphy; Katherine M. Fox (August 2007). "Diffuse Pruritic Lesions in a 37-Year-Old Man After Sleeping in an Abandoned Building". The American Journal of Psychiatry 164 (8): 1166–1172. doi:10.1176/appi.ajp.2007.07030381. PMID 17671278. Retrieved 2007-08-04.
- Elaine Monaghan (May 19, 2006). "All in the head?". London: The Times. Retrieved 2007-08-14.
- Pearson, Michele L.; et al. (January 2012). Egles, Christophe, ed. "Clinical, Epidemiologic, Histopathologic and Molecular Features of an Unexplained Dermopathy". PLoS One 7 (1): e29908. doi:10.1371/journal.pone.0029908. Retrieved 2012-01-25.
- Aleccia, JoNel. "Mystery skin disease Morgellons has no clear cause, CDC study says". msnbc.com. Retrieved 26 January 2012.
- Harding, Anne (May 16, 2011). "Skin infestation a delusion, study says – CNN.com". Health.com (CNN). Retrieved 16 May 2011.
- Berrios GE (1985). "Delusional Parasitosis and Physical Disease". Comprehensive Psychiatry 26 (5): 395–403. doi:10.1016/0010-440X(85)90077-X. PMID 4028691.
- Frances A, Munro A (1989). "Treating a woman who believes she has bugs under her skin". Hospital and Community Psychiatry 40 (11): 1113–1114. PMID 2807218.
- Goddard J (1995). "Analysis of 11 cases of delusions of parasitosis reported to the Mississippi Department of Health". Southern Medical Journal 88 (8): 837–839. doi:10.1097/00007611-199508000-00008. PMID 7631209.
- Gould WM, Gragg TM (1976). "Delusions of parasitosis". Archives of Dermatology 112 (12): 1745–1748. doi:10.1001/archderm.1976.01630370033007. PMID 1008566.
- Morris M (1991). "Delusional Manifestation". The British Journal of Psychiatry 159: 83–87. doi:10.1192/bjp.159.1.83.
- Rasmussen JE; Voorhees, JJ (1990). "Psychosomatic Dermatology". Archives of Dermatology 126 (1): 90–93. doi:10.1001/archderm.1990.01670250096016. PMID 2404467.
- Schrut AH, Waldron WG (1963). "Psychiatric and entomological aspects of delusory parasitosis". JAMA 186 (4): 429–430. doi:10.1001/jama.1963.63710040008018b.
- Ekbom K, Yorston G, Miesch M, Pleasance S, Rubbert S (2003). "The pre-senile delusion of infestation". Hist Psychiatry 14 (54 Pt 2): 229–232. doi:10.1177/0957154X030142007. PMID 14521159.
- Slaughter, JR; Zanol, K; Rezvani, H; Flax, J (December 1998). "Psychogenic Parasitosis". Psychosomatics 39 (6): 491–500. doi:10.1016/S0033-3182(98)71281-2. PMID 9819949.