Delusional parasitosis is a psychological condition where patients believe they have a parasitic infestation, often described as insects crawling on or under the skin. It can be divided into three categories, with primary being without accompanying disorders, secondary functional having another psychiatric condition, and secondary organic being caused by a medical illness or drug use. It is often misdiagnosed and difficult to treat as patients refuse psychological explanations.
Delusional parasitosis, or delirium of parasitosis, is a form of psychosis in which the patient believes that he or she is suffering from a parasitic infestation, when in fact there is no such infestation. Often the patient describes the imagined parasites as insects crawling on or under the skin. Tingling, the medical term for a crawling sensation on the skin, like the “pins and needles” that can arise when circulation to an extremity is temporarily cut off, may be the basis for some cases of parasitic delusions.
Delusional parasitosis is sometimes referred to as Ekbom syndrome, after the 20th century Swedish neurologist Karl Axel Ekbom. However, Ekbom has worked on both delusions of parasitosis and restless legs syndrome, and both conditions can be referred to as Ekbom syndrome. The two disorders are very different, however, as restless legs syndrome has physical causes and delusional parasitosis is a psychological condition.
Patients with delusional parasitosis often pick up what they believe is evidence of their infestation, such as small marks on their bodies or clothing. They are capable of injuring themselves, such as by scratching excessively, and sometimes convince others, such as those they live with, that they are also haunted. A variety of the delusion, illusory kleptoparasitosis, is characterized by the belief that one’s home is infested with parasites, rather than oneself.
Delusional parasitosis can be divided into three categories. These are primary, functional secondary or organic secondary. In primary delusional parasitosis, psychosis occurs by itself, without accompanying disorders or causes. In the secondary functional variety, another psychiatric condition, such as schizophrenia or depression, is present.
In secondary organic delusions of parasitosis, the psychosis is caused by a medical illness, medication, or recreational drug use. Some medical conditions that can cause delusional parasitosis include diabetes mellitus, tuberculosis, cancer, and neurological disorders. Menopause, allergies, poor diet, and drug abuse can also be underlying causes of parasitic delusions.
Patients with delusions of parasitosis are often misdiagnosed or misunderstood, as they typically do not realize that their condition is psychological. They are more likely to seek help from a dermatologist than a psychiatrist and may refuse psychiatric treatment. If delusional parasitosis is a secondary condition, it is treated by treating the primary condition, or cause. Whether primary or secondary, delusions of parasitosis are often very difficult to treat because the patient refuses a psychological explanation for his symptoms.
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