Delusory Parasitosis and

Other Mind Myths About

Bugs

Nancy C. Hinkle, Ph.D.

Dept. of Entomology

Univ. of Georgia

Athens, Georgia

Morgellons Research Foundation Researching an emerging infectious skin disease

Image 1: Lip of 3 year old boy, 10x

Image 2: Object from same lip, 60x

THE „FIBER DISEASE‟

CDC Investigating Morgellons Illness CDC investigates whether bizarre Morgellons condition is real or imagined CDC Funds Morgellons Study

(AP) Imagine your body pocked by erupting sores. The sensation of little

bugs crawling all over you. And worst of all, mysterious red and blue fibers

sprouting from your skin.

It may sound like a macabre science fiction movie, but a growing legion of

Americans say they suffer from this condition. And now the U.S. Centers

for Disease Control and Prevention is investigating.

Some doctors dismiss these patients as delusional. But the condition -

called Morgellons - has caused a small frenzy on the Internet, with

hundreds of people pleading for help.

"Sometimes the government doesn't want to panic people until they can

figure out a definitive cause," said Pat Boddie, a 62-year-old Alabama

woman who said she's had Morgellons for 14 years.

"They're trying to figure out if this is going to be an epidemic. I hate to tell

them, but it already is," she said.

The CDC has been receiving as many as 20 calls a day from self-

diagnosed Morgellons patients. The agency has been urged to investigate

by, among others, U.S. Sen. Dianne Feinstein of California.

"We're going into this with an open mind," said Dan Rutz, spokesman for a

CDC Morgellons task force.

EKBOM SYNDROME

-- A CONDITION IN

WHICH THE

INDIVIDUAL

CONSIDERS

HIMSELF

INFESTED BY

INVISIBLE BUGS

(DELUSORY PARASITOSIS)

Infestation – population of

organisms lives in (or on), feeding,

reproducing, and sustaining itself

“Delusory Parasitosis”

Ekbom Syndrome

an erroneous, unshakable belief that the

skin is infested with a parasite

“A delusion is a false belief that is not consistent

with the patient‟s intelligence, educational level,

or cultural background, and that cannot be

corrected by reasoning” (Koblenzer 1993)

EKBOM SYNDROME

K.A. EKBOM (1907-1977) –

Swedish neurologist who described

“Delusion of Infestation in the

Elderly”

Acta Psychiatrica et Neurologica Scandinavica (1938)

History of Psychiatry (Classic Text No. 54) 14(2): 232-256

Demographics

Symptoms

Management Behaviors

Medical History

Comorbidities

Dr. Hinkle-

I have been suffering from what feels like insect bites at night, but

can't ever see any insects where affected. Every so often I think i

see something flying past me but have still never found one. I

used a fogger for my apartment and while it seemed to work for a

few days, the culprit is back in full force. I also just recently

returned from being out of town for 4 days thinking the lack of a

blood source would starve whatever it is, but only seemed to make

them hungrier.

I feel like they are crawling on me, followed by an intense sting /

bite, then a little welt forms that when scratched turns into a scab

that doesn't heal quickly, as in 1-2 weeks before they finally go

away (the scabs). Nothing I've found on the web has been helpful

in pinpointing what I'm dealing with, and I was hoping you might

be able to steer me in the right direction for relief.

Help!!

I am being bitten alive by invisible bugs! When I'm being bitten I feel a

sharp sensation, like a tiny pinprick, but when I look at where I am being

bitten I cant see a darn thing. I have tiny red dots all over my body under

my skin (where I believe the bugs have bitten me), but my doctor says

they are probably nothing. (Whatever, doc) There is no welt or noticeable

bite mark. I feel itchy all over my body, my feet, my belly, my hair,

especially when I am in the basement and at night. I know this isn't in my

head b/c when ppl come over to the basement, they are itchy too. Also, I

believe its a bug that jumps because when I am around someone else,

they start to feel itchy as well (without me saying a WORD about the

bugs). I have sprayed the place enough times, vaccuumed and scrubbed

for hours, washed my sheets and clothes in hot water twice and bagged

them, then froze them, and have now just resorted to spraying OFF on

myself and when I'm really desperate - RAID - before and after bed

because this is the only way I get relief.

Does anyone battle this same mysterious bug? Any advice????

Please HELP!

PEOPLE BLAME

• SPIDER BITES

• BED BUGS

• SCABIES

• CHIGGERS

• THRIPS

• SPRINGTAILS

• BIRD OR RODENT MITES

SPIDERS DO NOT BITE HUMANS

BED BUGS ARE NOT INVISIBLE

Scabies = Sarcoptes scabiei infestation

CHIGGER

BITING MIDGE

THRIPS

(THYSANOPTERA)

Springtails

(Collembola)

BIRD MITES (FEED ONLY ON BIRDS)

Some DP Background:

• DP is the most commonly

reported delusional disorder

More than 250,000 cases in U.S.

• Often affects people in pairs

or groups in a shared

delusion, called folie-a-deux.

– Entire families, entire offices, are susceptible

A. MOST COMMON IN ELDERLY

B. DISPROPORTIONATELY FEMALE

C. EXHIBIT SELF-DESTRUCTIVE BEHAVIORS

1. QUIT JOBS

2. BURN/DESTROY FURNITURE

3. ABANDON HOME

4. OBSESSIVE LAUDERING/CLEANING

5. REPEATED PESTICIDE MISUSE

6. USE HOME REMEDIES

7. SELF-MUTILATION/EXCORIATION

D. PROVIDE „SPECIMENS‟- GOBBETS OF TISSUE, OTHER

DEBRIS

E. ELABORATE DESCRIPTIONS OF PEST & LIFE CYCLE

F. SOCIAL ISOLATION

G. MAJOR LIFE EVENT (DIVORCE, BEREAVEMENT,

JOB LOSS)

H. CONSULTED SEVERAL PHYSICIANS

I. MEAN DURATION OF DELUSION > 3 YR.

J. COMPLAIN OF ITCHING, CRAWLING, STINGING,

BITING

K. ADAMANT THAT IT IS AN „INFESTATION‟

L. EXPRESSES DESPERATION

M. DELUSION EVENTUALLY SHARED BY ANOTHER

When the sensation is felt

Apply tape

Gently fold tape on itself

Box and ship

SENSATIONS ARE REAL

PHYSICAL

PHYSIOLOGICAL

PSYCHOLOGICAL

PHYSICAL CAUSES OF

SKIN DISCOMFORT

PHYSIOLOGICAL CAUSES OF SKIN DISCOMFORT

DERMATOGRAPHIA

(DERMNET.COM)

RINGWORM

DIABETIC NEUROPATHY IS A SERIOUS COMPLICATION OF

DIABETES, AFFECTING HALF OF DIABETICS.

NERVES DAMAGED BY DIABETIC NEUROPATHY CAN CAUSE

STINGING OR BURNING SENSATIONS, TINGLING, PAIN,

NUMBNESS OR A CRAWLING SENSATION ON THE SKIN.

FORMICATION

SOME DISEASES CHARACTERIZED

BY PARESTHESIA OR PRURITUS

SYMPTOMS

AUTOIMMUNE DISEASES (LUPUS)

CARDIOVASCULAR DISEASE

CIRRHOSIS

DIABETES

HEPATITIS

HIV INFECTION

HODGKIN‟S DISEASE

HYPERTHYROIDISM

HYPOTHYROIDISM

HEAVY-METAL POISONING

LYME DISEASE

MALIGNANCIES/NEOPLASMS

MULTIPLE SCLEROSIS

PARKINSON‟S DISEASE

RENAL FAILURE

STROKE

SYPHILIS

VITAMIN DEFICIENCIES

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DRUG

POSSIBLE SIDE EFFECTS

1

Rash, paresthesia, pruritus

2

Urticaria, pruritus, rash, erythema

3

Erythema, urticaria

4

Paresthesia, pruritus, rash, urticaria, erythema

5

Erythema, rash, urticaria

6

Erythema, rash

7

Dermatitis, pruritus, paresthesia, rash, urticaria

8

Paresthesia, dermatitis, pruritus, rash, urticaria

9

Paresthesia, pruritus, rash

10

Paresthesia, pruritus, urticaria

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“COCAINE BUGS” AND “METH MITES”

“COCAINE BUGS”

AND

“METH MITES”

COCAINE

The patient

complained of a

worm infestation in

his neck. He used a

pair of scissors to

excise the imagined

worms.

The toxicology screening of this patient was

positive for cocaine, opiates, and tranquilizers.

STRESS

ANXIETY

DEPRESSION

PSYCHOLOGICAL CAUSES

DISPLACEMENT ACTIVITY

an unconscious defense mechanism whereby the

mind redirects from situations producing

internal conflict (uncertainty or anxiety) and felt

to be dangerous or unacceptable to a focus felt to

be safe or acceptable.

Scratching and autogrooming („picking‟) are the

most commonly reported displacement activities

among primates.

FIRST –

IDENTIFY THE PEST

What does your

agreement to treat

obligate you to?

THEY ARE STRICTLY MEDICAL CONDITIONS.

THE ONLY ARTHROPODS THAT INFEST HUMAN

BODIES ARE SCABIES MITES AND HUMAN LICE.

BECAUSE THESE LIVE EXCLUSIVELY ON

HUMAN BODIES, THERE IS NO ROLE FOR A PMP

IN CONTROLLING THEM.

SCABIES MITE

HUMAN LOUSE

No insect or mite can live in the environment and

switch to infesting the human body.

No insect or mite can feed on inorganic materials, so

cannot survive on furniture or carpeting.

No winged insects infest human bodies.

No invisible mites or insects infest human bodies.

No external animal parasites can infest humans.

Bird mites cannot infest humans.

Human body infestation is a medical condition and

must be treated by a physician.

EKBOM SYNDROME IS A MEDICAL CONDITION

Refer cases to UGA (Insects@uga.edu) 706-542-9033