Jerome Goddard, PhD, University of Mississippi School of Medicine

Delusions of parasitosis is a complex disorder that requires a multidisciplinary approach to treatment. Pimozide, an antipsychotic, appears to be the most effective agent.

Introduction

Regardless of specialty, most physicians who have long been in practice have encountered patients who claim that invisible insects or mites are on or in their skin. For proof, these afflicted patients may bring in tiny bottles, bags, or envelopes containing specks of dusts, hair, lint, or skin that they claim contain the offending specimens. In response, these patients are usually examined for actual arthropod infestations, evaluated for organic causes of the crawling sensations, and (frequently) given scabicidal creams or lotions. However, more often than not, the patient, experiencing no relief, becomes discouraged about a particular doctor or specialist and moves on to another. Such wandering among physicians, entomologists, and public health personnel may last for years without the patient ever receiving the help he or she really needs.

This condition, called delusions of parasitosis (DOP), is a psychiatric disorder characterized by an unshakable belief that tiny, almost invisible insects or mites are living on or in the body. Apparently, DOP is a true delusion, and no argument or scientific evidence can convince the patient that there is no infestation.^[1] A condition consistent with DOP was first recognized by Thibierge^[2] in the late 1800s, but appropriate definition and terminology were not applied until later. It has also been called Ekbom's syndrome, delusionary parasitosis, and delusory parasitosis. Wilson and Miller^[3] designated the condition as "delusions of parasitosis," which seems to be most accurate. Adverse health effects from DOP include radical efforts by patients to rid themselves of the "bugs," such as quitting jobs, burning furniture, abandoning homes, and using powerful pesticides in a dangerous manner. One man I knew piled all his household furniture in the backyard and burned it. His comment at that time: "The house is next if this doesn't get 'em."