Delusional Parasitosis (Ekbom’s Syndrome)

Delusional parasitosis, also known as Ekbom’s Syndrome, refers to a patient who mistakenly believes that his body is infested with parasites. These delusions can include an individual’s erroneous belief that he is inhabited by mites, fleas, lice, worms, bugs, bacteria and other various parasitic organisms. Typically a rare and uncommon syndrome, delusional parasitosis is becoming increasingly more relevant, especially with the rise of methamphetamine drug abuse, nicknamed “meth mites” or “cocaine bugs.”

Definition

Delusional parasitosis is quite often a misunderstood disorder and can be difficult to diagnose. It is named “delusional” because the infestation of parasites is not real; it is mistakenly believed to be true by whoever is suffering from the condition. A person with delusional parasitosis will likely go to several doctors hoping to get treatment for this imaginary infestation and may even bring collections of skin particles or dust to show the doctors.

Symptoms

People suffering from delusional parasitosis often become upset and strongly dispute any findings by their doctor that do not corroborate their mistaken belief of infestation. Characteristics of individuals with delusional parasitosis include:

  • May claim to have had this condition for an extended period of time.
  • Have been evaluated by several doctors.
  • May have employed the services of several exterminators, entomologists, parasitologists or hygienists.
  • May bring collections of human tissue, scabs, toilet paper, dust, lint, etc. to their appointments, known as the “matchbox sign.”
  • May have wounds as a result of self-mutilation in an attempt to extract the parasites from their skin or body.
  • May steer away from prescription drugs and rely instead on their own home remedies.
  • May expose themselves to toxic levels of pesticides.

People suffering from delusional parasitosis may describe the parasite infestations as being in various locations, including:

  • Under the skin
  • On or in the skin
  • In or around the body openings
  • Within sputum
  • Within the stomach and intestines
  • Inside their home

Causes

There is no single definitive cause for delusional parasitosis. Researchers believe that there is some correlation to primary brain chemistry. Generally, delusional parasitosis is categorized into three major types based upon the presence of an underlying condition. The three subtypes are:

Primary Psychotic Delusional Parasitosis – the only psychological disturbance is delusional parasitosis. Persons typically act in an otherwise normal fashion and have the ability to reason in a rational way.

Secondary Functional Delusional Parasitosis – there is a concurrent underlying psychiatric disorder such as:

  • Schizophrenia
  • Paranoia
  • Depression
  • Anxiety
  • Obsessive compulsive disorder

Secondary Organic Delusional Parasitosis – there is a concurrent underlying non-psychiatric medical condition such as:

  • Cancer
  • Hypothyroidism
  • Tuberculosis
  • Drug abuse
  • Diabetes
  • Neurological impairment
  • B12 vitamin deficiency
  • Side effects of prescription drugs

Risk Factors

Delusional parasitosis can occur in people of any age, but instances are higher among middle-aged or elderly women and young men with a history of abuse of methamphetamines or cocaine. There are other risk factors that may increase a person’s chances of suffering from delusional parasitosis, including:

  • Young females who are divorced and have children
  • Young women with a history of drug abuse
  • Young women suffering with stress
  • Low income or unemployment
  • Drug abuse typically that of cocaine or methamphetamines
  • Compulsive cleaning
  • Being a female
  • Another family member or members shares in this mistaken belief of infestation

Diagnostic Tests

Being diagnosed with delusional parasitosis will likely be a long process. Many sufferers are so insistent that their infestations are real, they will likely go to several doctors before accepting a diagnosis. The diagnosis of delusional parasitosis involves:

  • Detailed and carefully constructed case history
  • Complete physical exam
  • Laboratory testing including: thyroid function tests, blood count, skin scraping and biopsies, B12 levels, chemistry profile.
  • Diagnostic tests to rule out any underlying medical conditions that may present with skin problems
  • Rule out real parasite infestations
  • Rule out allergies or skin conditions
  • Identify any history of drug abuse

Treatment Options

The most successful treatment plan for a person suffering from delusional parasitosis will likely include a variety of doctors and specialists. The person’s primary medical doctor should work in conjunction with all other professionals and must be careful about referring the patient to a psychiatrist.

If the patient feels like he is not being taken seriously, he will likely refuse to see a psychiatrist. The patient believes the infestations are real and sending him to a psychiatrist makes it a fabrication. It may be better for the patient to believe the psychiatrist can help rid him of the infestation to ensure initial contact. These professionals may include:

  • Medical doctors
  • Dermatologists
  • Parasitologists
  • Entomologists
  • Psychiatrists

It is essential for the individual with delusional parasitosis to see a psychiatrist in order to confirm a diagnosis and identify or rule out any secondary psychiatric disorders. A patient may be able to live with the mistaken belief of infestation without the use of prescription drugs or psychiatric counseling if that person has been reassured upon close examination that the infestation is under control and engages in regular visits to their primary medical doctor. However, some individuals will require psychiatric intervention consisting of:

  • Long term therapy
  • Antipsychotic medications

Considerations

An individual with delusional parasitosis needs to receive some kind of treatment. It is important to identify the underlying cause of the problem, be it physical or psychological. The sensations associated with the mistaken belief of infestation are very real to the person who has delusional parasitosis and may cause that person to scratch or wound his skin in an attempt to rid himself of bugs. This excessive scratching can lead to open wounds and sores and later infection.

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