Delusional Parasitosis; The Ekbom Syndrome

_{(License: CC0]: pixabay}

She was then examined first by a dermatologist and a then a psychiatrist. Results from the dermatologist showed that she wasn’t indeed infested by any worms or some kind of threadlike objects that she described while the test results from the psychiatrist showed that restlessness, anxiousness, sleeplessness and the delusions that she was infested by threadlike objects was on in the increase which made them conclude that she was a victim of delusional parasitosis.

Another case is that of a 66-year-old woman who felt that her body was being infested by spiders and that her blood was no longer pure because of the infestation of these bugs. She claimed to have treated her skin with several insecticides and had rinsed her mouth with vinegar to cleanses her mouth from these bugs. She also claimed that these insects are her clothes and were all over her mattress that she had to change her mattress three times in the last months also had to change her wardrobe and burned the previous clothes but the insects and itching were still around. She had just moved into this new apartment before these things started happening to her and to her surprise her neighbours never complained of such issues. She also was examined by a dermatologist to check for ectoparasitism but it showed that she was clean and wasn’t indeed infested with spiders. She was also examined by a psychiatrist and results showed that she could be suffering from delusional parasitosis.

Just like in the two cases above of women who are above 60, it is believed that this condition is more prevalent in women who are past menopause. A study was carried out on a 77-year-old lady was presented with a case of delusional parasitosis associated with a recurrent depressive disorder.
She had different episodes of hallucination of bugs living and moving under her skin. In her case this hallucinations became more severe as the year went by and also the hallucination increased as her depression increased. She was also examined by a dermatologist and a psychiatrist before she was diagnosed with the condition.

Now let’s picture or try to imagine what Ekbom’s sufferer experiences; Have you ever felt a sensation on your skin as though an insect or bug is crawling on it and try to smack it out but find out that nothing was really on your skin but your senses were just playing with you? I bet the most of us have and that feeling we get is called Formication. Now imagine you have these sensations almost consistently, you’d feel super uncomfortable, I know. This is what victims of ekbom syndrome experience almost every minute; it feels so real that they do crazy things like peeling their skin to uncover the bugs they believe are buried beneath their skin. Some go as far as using insecticides on their skin, just like the case of the woman I mentioned above.

The behavioural manifestation of Ekbom syndrome; Patients first have hallucinations that make them believe that their bodies are indeed infested by bugs then they go ahead to use sharp objects to excavate these so-called imaginary bugs out of their skins. The patients may go as far as treating their skins with different insecticides which of course would be harsh on their skin but they could only care less because nothing could be more discomforting than having these imaginary bugs beneath their skin, that the only thing they would want to do is cleanse their skin of these bugs.

_{I don't have a psychotic disorder, I just have bug problems. [Remember convincing them is the hardest part] (License: CC0]: Pixabay}

Patients may also believe that not only their bodies are infested with bugs but also their houses and their immediate environment. These then forces them to clean and decontaminate their homes, destroy their clothes, mattress and even go as far as burning all their belonging and eventually moving out of their homes. This syndrome can change an individual’s behavior and life in a really depressing manner. Some cases reported, made mention of Ekbom syndrome patient who abandoned family, quit his or her job, became socially isolated and was so obsessed about getting these imaginary bugs out of his skin. These are the significant ways in which victims behave.

These symptoms are diagnosed according to their level of progression; the primary, secondary functional and secondary organic units. The primary form of this syndrome comprises of just hallucination and delusion, the secondary functional type, comprises of delusions accompanied with psychiatric conditions and the secondary operational type is that which is caused by another medical condition or substance use. We are able to diagnose it, study its symptoms but the hardest part of this syndrome is trying to convince victims that they are not infested with bugs. There’s a popular saying that states that you can only take a donkey or horse to the river but you can’t force it to drink water. This shows how hard it is to convince an ekbom syndrome patient that he or she is not infested with bugs, which is basically where the problem lies. For this diagnosis to be complete, the patient must be examined by a dermatologist, entomologist and a psychiatrist.

_{How can this mental but not so menatl problem be fixed? (License: CC0]: Pixabay}

This syndrome can be treated using different medications according to its level of progression. Antipsychotic drugs are usually suggested to victims but most of the time they reject this treatment as they believe that these bugs are really beneath their skin and what they experience is not just some psychotic delusion. They could refuse treatment and carry on with these condition for years, hurting themselves in the process, some even make a suicidal statement and threatening statements like “I’d just go ahead and excavate these bugs out of my skinn, my own way since you can’t help me”. Studies have shown that ekbom syndrome sufferers are more accepting to treatment if it’s introduced to them by a dermatologist and conducted in the dermatology department, as about 99 per cent of them that what they suffer is a mental condition, not a skin condition.
In the cases I mentioned above antipsychotic drugs like olanzapine and also antidepressant was used in the treatment of this condition. Pimozide can also be used in the treatment of this condition but from all the cases I’ve read regarding this syndrome, olanzapine or risperidone has been the most successful antipsychotic agent that is used in the treatment of the delusional parasitosis condition. Also, it’s been the safest antipsychotic agent that could be used in the treatment of this syndrome owing to its good side effect history and the fact that they would be no need for electrocardiographic monitoring.

In Conclusion, delusional parasitosis can make an individual’s life totally miserable and this individual could stay longer in this misery if he’s not given medical attention from the right medical personnel. The condition is most of the time very disturbing to the victim’s family and friends and sometimes, as most people are ignorant of this condition because of its rarity. This could even be worse if the victims are in remote villages, surrounded by religious and uneducated folks; because these religious people who are not learned may take this condition as a demonic possession and may be forced to conduct exorcism against the victim's will. The medical sector has not done much research on this condition because people who are affected with this condition are rarely seen by the researcher making it even more challenging to fully understand the condition and how it arises. This condition is more prevalent amongst postmenopausal women and the most of them who are unmarried, divorced or widowed, so this basically means that lonely and postmenopausal women are the most prone to this life-wrecking and disturbing condition.

Further Reading

Bellanger AP, Crouzet J, Boussard M, et al. Ectoparasites or Ekbom Syndrome? Can Fam Physician. 2009;55:1089–90. 26. Bewley AP, Lepping P, Freudenmann RW, Taylor R. Delusional parasitosis: time to call it dela usional infestation. Br J Dermatol. 2010;163:1–2

Bhatia MS, Shome S, Choudhary S, Gautam. Delusional parasitosis: a series of 25 cases. Indian J Dermatol 1996; 41 : 5-8.

Bhatia MS, Gaurav. Delusional parasitosis. Delhi Psychiatry Journal, 2007; 10 : 147.

Ekbom KA. Der präsenile dermatozoenwahn. Acta Psychiatr Neurol Scand. 1938;33:227–59 [reprinted as “The Pre-senile Delusion of Infestation,” Classic Text No. 54, History of Psychiatry 2003, 14:232–56]