DELUSIONAL PARASITOSIS

It feels like bugs, worms, or mites are biting, crawling over or burrowing into, under or out of your skin. They must be there, because you can feel them and maybe you can even see them. They may also infest your home or furniture. You may be the only one that knows they are there. No one seems to believe they exist except you. Nothing seems to get rid of them. So what are they?

Obviously, they are not easily seen like mosquitoes, ticks, fleas, or other large insects that bite people and cause itchy bumps to develop. Barely visible mites can also bite people and leave itchy tracks or rash-like splotches in the skin. Usually, we can prevent bites from common biting insects by excluding them from our homes with window and door screens. Insect repellents will keep them off our bodies, and they can be killed with appropriate applications of pesticides labeled specifically for use against particular insects.

But what if none of these normal approaches work? What if, after trying every reasonable approach and with helpful hints from friends or medical professionals, the individual's problem persists? What if the condition seems to be spreading to other family members or to your friends? Then it is time to seek the proper type of professional help.

Who can assist with this sort of problem? Actually, quite a few different types of specialists can. Most entomologists recognize various life stages of insects or mites, or can use references to discover what they are. Medical entomologists, in particular, spend their careers working with insect and mite parasites. Parasitologists study these and other groups of organisms like worms, protozoans, and other invertebrates that live at the expense of their host animals. Samples should be sent to entomologists, parasitologists, or other biologists for verification or identification of any organisms present. Local Public Health Offices or laboratories often have experts that may be able to assist with such identifications. Dermatologists are trained to deal most effectively with skin disorders.

If you have visited any or perhaps several of these professionals and no one is able to find the offending organism, it is very unlikely that they are all incompetent. It is time to reassess your situation, particularly if you have no itchy lumps (papules) or rashes. Parasites nearly always leave an itchy lump or rash. Not all itching or sensations of crawling or burrowing are caused by arthropods or other parasites infesting your skin. Itching and the sensation of things crawling on or under the skin may be associated with many seemingly unrelated medical conditions and have more to do with the nerve pathway between the skin and the brain than with the skin. These skin sensations could be due to the following conditions among others (see Table 1):

• Contact irritation to nonliving substances in your environment; paper dust and fiberglass insulation residue are well known examples
• Use of amphetamines or opiates, particularly methamphetamine and cocaine abuse
• Skin cancer
• Vitamin, protein or other deficiencies in your diet
• Diabetes
• Cerebrovascular disease
• Hyper- or hypothyroidism
• Menopause
• Liver disease
• Delusional parasitosis

Thorough testing by a competent physician should lead to a diagnosis and understanding, if not a cure, for most sensations of infestation caused by metabolic disorders or other medical problems listed above. Certainly stopping drug abuse will greatly diminish, if not abolish, symptoms of drug-induced feelings of parasitosis. But if thorough allergy and medical testing leaves you with a "perfect bill of health" and the symptoms still persist, then you have to seriously consider the possibility that you are suffering from delusional parasitosis. Recognition of a mistaken belief in parasite infestation is extremely hard if not impossible for the sufferer, even with adequate medical advice. 

Delusional Parasitosis is defined as a medical disorder in which the patient has a mistaken belief of being infested by parasites such as mites, lice, fleas, spiders, worms, bacteria, or other organisms. The basis of this belief is sensations in the skin that are very real to the sufferer. These sensations of irritation, itching or of crawling organisms are so real that the victim is rightfully driven to believe that something is there. Usually, the sufferer scratches the itches, but they don't go away. More scratching leads to rashes, open wounds and sores, then infections. Failure to obtain relief from over-the-counter or prescribed medications often drives the sufferer to apply unconventional and sometimes highly toxic compounds to his or her body in a desperate attempt to alleviate symptoms. Skin conditions become worse or much more complicated and so do the symptoms.

In a desperate attempt to find the causative agent, some people mutilate themselves externally and internally. Sometimes the parasites appear to be visible to the afflicted person, but they cannot be caught. The person sometimes will submit pieces of their own tissues to medical or other professionals, in a desperate effort to demonstrate the pests. When no parasites are discovered, the patient's frustration level reaches incredible heights. 

The presence or absence of a rash should determine what kind of physician you go to seek help. If is a rash or itchy lumps then a dermatologist would be most appropriate. If there are no obvious skin signs, except what is caused by scratching, then an internal medicine specialist might be the place to start.

There are strong correlations with age and delusional parasitosis. The majority of sufferers appear to be postmenopausal women, particularly Caucasians. Partly this appears to be due to hormonal changes and partly skin thinning and sun damage (solar elastosis) causing crawling, itching, pinching sensations in the skin.

Very often there is a corollary problem associated with delusional parasitosis - stress. Stress often manifests itself in people as a nervous habit or "nervous tic" but these conditions usually are not overwhelming. Delusional parasitosis however can become overwhelming, because it tends to amplify the stress level and, in turn be increased by stress.

Stress seems to be associated with numerous factors causing poor health in Americans, similar to poor diet. Stress may result from numerous experiences including job related pressure, personal relationships, divorce, loneliness, financial problems, and loss of friends, relatives, or pets. Frequently, reducing stress coincides with the rapid reduction or elimination of delusional parasitosis. 

Finding ways to reduce your level of stress can often greatly be assisted by your doctor. When delusional parasitosis occurs and is persistent, there are drug treatments available that can alleviate symptoms, at least temporarily. If a physician determines that further therapy or advice is needed, the patient may be referred to a psychiatrist. Very clearly, there is no need for anyone to become a chronic prisoner of delusional parasitosis, when relief may be relatively simple to obtain.