My Professional, Scientific Opinion

Delusional parasitosis or Ekbom's Syndrome is a rare disorder in which sufferers hold a delusional belief they are infested with parasites. A related symptom involving a tactile hallucination of insects, snakes, or other vermin crawling over the skin is known as formication. The origin of this word is from the Latin formica, "ant".

It is not to be confused with Wittmaack-Ekbom or restless legs syndrome. Unfortunately, this is also referred to in short as "Ekbom's Syndrome" leaving the audience having to infer the particular meaning from the context. It is named after a Swedish neurologist, Karl Axel Ekbom, who published seminal accounts of the disease in 1937 and 1938.

The sufferer typically reports parasites to exist under the skin, around or inside body openings, in the stomach or bowels and may include a belief that the parasites infest the sufferer's home, surroundings or clothing.

Delusional parasitosis was described in medical literature as early as the 1800's. Up until the 1960's a variety of terms were used including: acaraphobia, dermatophobia, parasitophobia and entomophobia. Confusion caused by the use of all of these very different terms led to the syndrome .

The exact prevalence of this syndrome is unknown, although it is apparently rare to uncommon. It was renamed delusions of parasitosis, delusional infestation or delusions of infestation, following development of precise definitions of "phobia" = fear, and "delusion" = mistaken belief. It may occur in individuals of any age. However, there is a strong correlation with drug abuse.

The typical patient is a middle-aged or elderly woman. The female to male ratio is 2:1. Whether this frequency of women reported is a real number or the consequence of women being more likely to seek professional help is unknown. Younger patients tend to be white males, whose symptoms are usually caused by drug abuse, particularly methamphetamine and cocaine.


In younger women there are correlations between delusional parasitosis and:

• divorce with children
• drug abuse
• low or no income
• low self-esteem and feelings of social rejection
• alternate life styles
• stress, loneliness

Individuals suffering from delusional parasitosis:

• come from a variety of occupational and socioeconomic backgrounds
• are generally of average or above average intelligence
• hold reasonable views or reality
• generally lack a fear of insects

A person holding such a belief may approach doctors or dermatologists asking for treatment for the supposed infestation, and will often bring small particles, dust, skin flakes and other material for the doctor to inspect. Since the material may be carried in an envelope or matchbox, this presentation is known as the "matchbox sign."

Stimulant drug abuse (particularly amphetamine and cocaine) can lead to delusional parasitosis. For example, excessive cocaine use can lead to an effect nicknamed "cocaine bugs" where the affected person believes he has, or feels parasites crawling under his skin. These conditions are also associated with high fevers and extreme alcohol withdrawal, often associated with visual hallucinations of insects.

People suffering from these conditions may scratch themselves to the extent of serious skin damage and bleeding, especially if they are delirious or intoxicated.

The description above is from the University of California, Davis' website. Check it out for more detailed info such as diagnostic criteria, the sufferer's viewpoint, treatments, causes, etc. It's a great resource for information on this strange disorder.
UCDavis Delusional Parasitosis Website

Another great synopsis of the disorder:
Mayo Clinic Proceedings: Delusional Parasitosis

Professionally, I see this disorder on a regular basis. My supervisor, and Parasitology Lab Lead before me, assures me it is not as prevalent as it seems to be to us. Because of the nature of the disorder, patients often make their way up the "food-chain," if you will, from general practitioner, to regional hospital, to regional specialist, and eventually on to the Big Dogs (that's us,) looking for confirmation of their delusion. I have seen all sorts of "parasitic" junk: crumbs, every type and color of fiber imaginable, fingernail clippings, dirt, scabs, dried skin, entire jars filled with fresh skin peelings, mushrooms caps, julienned carrots, bean sprouts, jars filled with hair ripped out by the roots, whole grapes, and...,and...I could go on for pages listing the strange things that have passed under my dissecting microscope. It is puzzling and humorous, and sad and tragic. There was even a nuclear physicist once who tracked down our lab and begged to buy a textbook off of my very desk. I have a couple of letters from a desperate woman who watched "just opened" cake mix line up and march across her kitchen counter. These are intelligent people with very elaborate and detailed chronicles of the various organisms that they are "infested" with.

After web-researching Morgellon's Disease, it sounds exactly like Delusional Parasitosis as I know it with a new name. There are even names for this disorder when two or more people are involved in the delusional state. Mass hysteria in Texas? Hmmmm...

FYI: All of the organisms pictured above are REAL parasites (but the jury's still out on the last one from the X-Files.)