Rethinking Delusion of Parasitosis

by Joseph Keleher

In 1946, Wilson and Miller introduced the term Delusion of Parasitosis to “…attempt to suggest a better name” describing medical conditions previously labeled acaraphobia, parasitophobia, and dermatophobia (Wilson and Miller 1946:39). The term Morgellons Disease was recently reintroduced (originally coined by Sir Thomas Browne in 1674) by Mary Leitao in 2002 as a “practical ‘place holder’ because of its dermal similarities to The Morgellons described by Browne” (Harvey et. al. 2009: 1). This paper compares Delusion of Parasitosis (DOP) with Morgellons Disease (MD) to establish if they appear as the same symptom set. The findings of this comparison along with repercussions are discussed. Finally, shifts in associated medical protocol are suggested.

Comparison of Delusion of Parasitosis and Morgellons Disease

The medical conditions of Delusion of Parasitosis and Morgellons Disease can be compared by viewing patient descriptions, medical descriptions, physical evidence, and other variables. The comparison is not meant to be exhaustive of the sources of these medical diagnoses; instead, it is hoped to represent the general documentation.

Patient Descriptions

The primary source of information for DOP and MD is the descriptions given by individual sufferers. A difference between the generally earlier accounts of DOP and later accounts of MD is the medical trend to move from individual accounts (found frequently in DOP related articles) to discussions of general trends (accepted mode for much of MD).

In reviewing numerous cases of DOP patients, “Predominant symptoms (include)…pruritis…(as well as)…creeping, crawling, movements, biting, scratching, sticking, digging, burning, clicking, irritation and…aggravation” (Wilson and Miller 1946:55). Over sixty years later, the DOP patients, “frequently describe cutaneous symptoms of crawling, biting, and stinging sensations as the first evidence of infestation” (Lee 2008: 2). One patient described it as, “Worms have spread all over the body and are causing itchy black specks to appear” (Tullett 1965: 451).

Patient descriptions for MD, “…report disturbing crawling, stinging, and biting sensations, as well as non-healing skin lesions, which are associated with highly unusual structures” (http://www.morgellons.org/symptoms.htm).

The patient descriptions of symptoms associated with the medical diagnosis of Delusion of Parasitosis and often self-diagnosed Morgellons Disease are nearly identically.

Medical Descriptions

Tullett describes Delusion of Parasitosis as, “…the favoured diagnosis being a monosymptomatic hypochondriasis arising in an obsessional personality” (Tullett 1965:455). He further shares with medical peers, “Particularly characteristic is the production of specks of matter which are thought to be the insect or material derived from its activities” (Tullett 1965:448). A presently accepted clinical definition is, “…a psychiatric disorder in which the patients have a fixed, false belief of being infested with parasites” (Lee 2008: 2).

For Morgellons Disease, medically accepted parameters and variability may be found in the recent study by Morgellons Research Foundation (Harvey et al., 2009). This study presents measurable physiologic effects and patterns associated with Morgellons Disease confirming that the condition is not delusional. The study describes DOP and MD as truncations of the same. The concluding remarks suggest the symptoms of this condition eventually lead to the effect of delusion (however, lack of sleep and stress are known factors effecting thought processes). The study reflects on an accepted medical approach, while lacking the benefit of patient input.

The medical descriptions of each appear as the same. In fact, “Most dermatologists, psychiatrists, and other medical professionals view Morgellons as a new name for a well established condition, delusional parasitosis, also known as ‘delusions of parasitosis’ (DP and DOP) and Ekbom’s Syndrome: Morgellons is ‘a pattern of dermatologic symptoms very similar, if not identical, to those of delusions of parasitosis’” (wikipedia citing Accordino, et. al. 2008).

It appears that the majority of the medical community considers Delusion of Parasitosis and Morgellons Diseases as the same phenomena.

Physical Evidence

In both DOP and MD accounts, the patient often provides physical evidence associated with their medical condition. The materials, especially fibers found by MD sufferers, have been the focus of several studies (see “research” on Morgellons.org).

A DOP document shared that, “Early in consultation she produces…fragments of skin…keratin, crust, or miscellaneous debris” (“Delusion of Parasitosis” British Medical Journal, March 1977- no author listed). Another study states, “Often they bring to the physician a container holding bits of debris or crust from their skin lesions” (Aleshire 1954: 15). In one particular case it is described as, “When the patient pulled them off they left fine threads, at the end of which there was a tiny egg” (Wilson and Miller 1946:51).

Fibers found in association with MD have been a major focus for research. Randy S. Wymore of OSU-CHS Center for the Investigation of Morgellons Disease states that, “100% of the patients, that were felt to genuinely have Morgellons Disease, have large microscopic to small microscopic fibers visible under the outer layer of skin” (http://www.healthsciences.okstate.edu/morgellons/docs/Wymore-position-statement-2-19-07.pfd). Mogellons.org describes the physical evidence as, “These structures can be described as fiber-like or filamentous, and are the most striking feature of this disease. In addition, patients report the presence of seed-like granules and black speck-like material associated with their skin” (http://www.morgellons.org/symptoms.htm). In checking Morgellons fibers against known fibers contained in the FBI National database, Mark Boese concluded, “These cannot be manmade and do not come from a plant. This could be a byproduct of a biological organism” (http://morgellons.org/docs/Tulsa_Police_Crime_Lab.pdf).

The physical evidence presented by DOP patients and Morgellons sufferers as described in numerous accounts sounds identical.

Other

For both DOP and MD there is additional information falling outside of the categories of patient description, medical description, and physical evidence.

DOP cases are, due to a diagnosis including “delusional” as an accepted label, typically referred for psychiatric evaluation. The patient is often prescribed antidepressants or their kin. In a recent publication, Lee acknowledges, “…certain drugs such as cocaine and amphetamines can induce…a delusional state clinically identical to that of idiopathic delusion of parasitosis”; ironically, she presents another drug, Pimozide, as the “treatment of choice” (Lee 2008: 3).

MD symptoms appear to be ever expanding. Morgellons.org outlines “Morgellons Disease Characterization”; besides fibers or filaments and movement sensation, the list includes: Skin Lesions, Musculoskeletal Effects and Pain, Aerobic Limitation, Cognitive Dysfunction, Emotional Effects, Shifting Visual Acuity, Numerous Neurological Symptoms, Gastrointestinal Symptoms, Acute Changes in Skin Texture and Pigment, Arthralgias, as well as many Laboratory Abnormalities. Associated physiological symptoms have recently been documented (see Harvey, et. al. 2009).

Discussion

The overlap and similarities between DOP and MD are undeniable.

The descriptions documented for DOP from 1946 until the present appear to fit within the variable parameters of Morgellons Disease. Given they appear as the same set of symptoms, Morgellons Disease described as a recent phenomena is false (see Harvey et al 2009 for justification of reintroduction as a “placeholder”). As DOP was itself described as replacing other medical terms, it follows that the symptoms existed pre-1946. As reviewed in Kellett 1935 and expanded on in Keleher 2008, it is possible this syndrome has been documented as early as the mid-1500s. This possibility should be further explored (as should a possible mercury connection found in reviewed DOP accounts).

Necessary Shifts in Medical Perspectives

Having experienced many of the symptoms myself, along with thousands of others, the willingness of medical professionals to use the word “Delusional” in describing a serious medical condition is disturbing. Please end the use of Delusion of Parasitosis for this set of symptoms and replace it with a more appropriate label such as Morgellons Syndrome.

As it appears most in the medical profession accept DOP and MD as the same phenomena, it is remarkable that most in this profession would intentionally ignore over 60 years of physical evidence! Some answers from fiber studies have proven fruitful and analysis of specks may prove very informative. This evidence must be treated as such.

It is important for the medical professional to understand the typical MD patient is exhausted from lack of solid sleep, has likely read there is little hope of recovery, and fears what they are experiencing could be passed onto others; they are not following an easy road. They may have been struggling with these horrifying symptoms for days, months or even years. If ever you needed to have empathy and an attentive ear, it is with these sufferers!

Conclusion

Recent studies have shown the MD sufferer has a long list of associated physiological symptoms (Harvey, et. al 2009). The physical evidence in the form of fibers, threads, plugs, specks and such appears to have consistently been presented in association with the symptom set since at least 1946. The documentation of these symptoms goes back far in time; an in depth review of these by a qualified medical professional could provide further information.

Given the current understanding of this medical condition, now is the time for the delusion of Delusion Of Parasitosis to end.

Sources:

Accordino, RE, Engler D, Ginsburg IH, Koo J. "Morgellons Disease?." Dermatology Theory 21, no. 1 (2008): 8-12.

Aleshire, Irma, MD. "Delusions of Parasitosis: Report of Successful Care with Antipellagrous Treatment." Journal of the American Medical Association 155 (1954): 15.

Boese, Mark. "Tulsa Police Crime Lab Report." morgellons.org. Available from http://www.morgellons.org Internet; accessed 27 October 2009.

"Delusions of Parasitosis." British Medical Journal 26, no. 1 (1977): 790-791.

Harvey, WT, Bransfield, RC, Mercer, DE, Wright, AJ, Ricchi, RM and Leitao, MM. "Morgellons Disease: Illuminating an Undefined Illness: A Case Series." Journal of Medical case Reports 1, no. 3 ( July,2009): 8243. http://www.morgellons.org/docs/Case_Series.pdf

Keleher, Joseph W.. "Patterns in Early Morgellons Disease Considered as Effect of Mercury Exposure." Explore! 17 no. 6 (December 2008):  http://joewritesslow.blogspot.com/2009/06/morgellons-mercury-article.html

Kellett, C.E.. "Sir Thomas Browne and the Disease Called The Morgellons." Annals of Medical History, n.s., VII 1935, 467-479.

Lee, Chai Sue. "Delusions of Parasitosis." Dermatologic Therapy 21 (2008): 2-7.

http://www.morgellons.org Internet: accessed 27 October 2009

Tullett, G.L.. "Delusions of Parasitosis." The British Journal of Dermatology 77 no. 8-9 (Aug- Sept): 448-455.

Wilson, J. Walter and Hiram E. Miller. "Delusions of Parasitosis." Archives of Dermatology and Syphilology 54, no. (1946):

Wikipedia.com accessed 27..October 2009.

Wymore, Randy. “Position Statement” okstate.edu Available from http://www.healthsciences.okstate.edu/morgellons/docs/Wymore-position-statement-2-19-07.pdf

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Comments on: "Morgellons – Rethinking Delusion of Parasitosis" (8)

  1. Thank you for this post.
    Since a delusion is, by definition, a false belief, the term needs to be ‘deleted’ in
    reference to MD, as proper study shows there is nothing false about this condition.

    Since the etiology of infection per se is still unknown, it is offensive for the medical community to focus on mental health/neuro symptoms –which are ‘secondary to the general medical conditon.’ ‘Normal’ people would find its bizarre symptoms disturbing, especially when dismissed by drs., family members.

    Wording in the Harvey et al study article I find misleading, though the findings clearly indicate that these subjects were not delusional:

    “Strikingly, most patients in this study (23 out
    of 25) had prior psychiatric diagnoses…In each case, medical records
    indicated that the dermal symptoms and signs preceded or
    occurred simultaneously with the onset of emotional
    signs, with an emotionally ‘normal’ time in each patient’s
    life prior to Morgellons disease…”

    If antiparasitic medications are still part of recommended treatment, then the
    term ‘delusional’ has no business in this discussion…
    The DOP moniker has even led to online ‘hate groups’ mocking MD. Yet we know
    it is only a matter of time before MD is more widely recognized and legitimized.

  2. Netmu, I agree the word is confusing there, it says prior psychiatric diagnoses but then goes on to say the the psychiatric issues started either after or simulataneously with the onset of Morgellons, which I believe is the case. Most people do experience psychiatric issues after Morgellons. I will be writing a pretty detailed blog post as to why.

    Also, I find this quote from the article very interesting …

    One patient described it as, “Worms have spread all over the body and are causing itchy black specks to appear” (Tullett 1965: 451).

    This is clear back to 1965 … Morgellons is an old condition IMHO.

  3. sistertocommonsense said:

    I have spoken and seen many patients who never had a delusional moment in their lives. Scared, Frustrated by the lack of attention to this issue, Yes.
    Lack of sleep as the symptoms seem to worsen at night and they are exausted.
    I spoke to the husband of a woman who had this toxic syndrome and he went to the Doctor with her. She had this….. but he did not have the symptoms.
    The Doctor said, “She has fibers and parasites and strange lint coming out of her skin and you believer her???” The Husband said, “Yes”.
    Here is the kicker….The Diagnosis….”Follie a deux”, The Delusions of Two.
    Sister to Common Sense

  4. There is a book published in 2008, “How Doctors Think,” by Jerome Groopman, M.D.
    He describes his own difficulty iwith a hand problem, getting 5 different diagnoses and treatment recommendations, then he authored this book to help physicians and their patients. “This is book is about what goes on in a doctor’s mind as he or she treats a patient.” He offers 3 questions to ask to help him/her think out of the box, and avoid “cognitive errors:”
    “What else could it be?”
    “Is there anything that doesn’t fit?”
    “Is it possible I have more than one problem?”

    He cites how many seconds it takes most drs. to make a provisional diagnosis.
    Using his own experience as a clinician (which led to the patient’s death), he gave this outline to an audience of physicians:
    “My misdiagnosis embodied three cardinal cognitive pitfalls. First was an anchoring error, seizing on her initial symptom and making the snap judgment of acid reflux; second, an attribution error, stereotyping the woman as a complainer and hypochondriac, so I kept attributing her persistent symptom to this benign condition; and last, an availability eror, since at the time my other patients with similar complaints had no serious problems.”

    He also faults the current medical system as not leaving time for physicians to deconstruct flaws in thinking. Perhaps if we ever get true healthcare reform (when treatment is driven by clinical considerations instead of fees for service), when drs. are salaried for caring for patients, there will be time to properly care for patients.

  5. [...] Morgellons. To top it off we get to go through the experience scorned and alone. You might end up labeled DOP or worse. What the doctors refuse to realize is what Amelia summed up so well in her response to [...]

  6. [...] wonder if Joseph Keleher’s "Rethinking Delusion of Parasitosis" article had any effect on this delay. Well, the good news is I won’t be eating crow for [...]

  7. I think we talked about DOP when there was that feud going on w/ PalMD.
    I just think it’s laughable that a diagnosis that dumps all these mystery skin symptoms into this “unknown but ppl are claiming it” bucket is this official medical diagnosis that is now treated like a factual base for a diagnosis of still, unknown, unexplained skin symptoms.

    The biggest problem w/ DOP is that it’s just a label of symptoms and it’s not an actual diagnosis of the cause like the flu. But it’s being misused as a diagnosis.

    Not that I can dismiss this frustration, BUT I can *understand* why they might think morgellons sufferers = delusional. Had I never come down with this, I’d probably never understood it either and empathizing would have been nearly impossible. Only fellow sufferers can truly understand.

  8. The concluding remarks suggest the symptoms of this condition eventually lead to the effect of delusion (however, lack of sleep and stress are known factors effecting thought processes). The study reflects on an accepted medical approach, while lacking the benefit of patient input

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