This Morgellons Research Foundation photograph shows a skin lesion on
the lip of a 3-year-old boy believed to have morgellons disease. Individuals
with the illness often report nonhealing skin lesions and fibers associated
with the lesions. Courtesy:
Amysterious skin illness whose victims complain of insects invading their
skin; crawling, stinging, and biting sensations; and fibers protruding from
nonhealing skin lesions is making its way across the United States as well as
into other countries. "I would be in bed, and it felt like an army of
ants crawling over my body," one sufferer said.
The illness first came to public attention in 2002, when a woman whose son
had the condition named it "morgellons" (after a disease with
similar symptoms mentioned in a 16th-century medical text) and created a
foundation devoted to finding its cause and cure. Since then, more than 5,000
households have registered at the foundation's Web site. The malady has also
received a lot of media coverage, such as from the ABC show "Good
Morning America" to the Dallas Observer, Los Angeles Times, San
Francisco Chronicle, and New York Times.
Moreover, virtually "every dermatologist in the country" has
had contact with morgellons patients, Caroline Koblenzer, M.D., a clinical
professor of dermatology at the University of Pennsylvania, told
Psychiatric News. For example, she has treated dozens of patients
with the condition.
The federal Centers for Disease Control and Prevention in Atlanta is so
concerned about the numbers of people said to be suffering from the illness
that in June it set up a task force to look for its cause. The task force
includes experts in infectious diseases, environmental toxicity, pathology,
and psychiatry, said Dan Rutz, the CDC spokesperson for the task force, in an
interview. The task force had expected to be up and running by now, Rutz
admitted, "but we're just not.... It is just taking a long time to agree
on the protocol with this many disciplines represented."
When can the public expect some results from the task force? "I
wouldn't want to hazard a guess," said Rutz. Meanwhile, various
psychiatrists are speculating about the malady's cause or causes.
Lyme disease might be the culprit, Nanette Orman, M.D., an adjunct clinical
professor in Stanford University's Department of Psychiatry, theorized during
"Lyme disease is one of these illnesses that has multiple
symptoms—fatigue, depression....[Lyme patients] can have a skin rash,
they can have crawling sensations... .So Lyme disease can mimic a lot of other
diseases. And it cannot always be confirmed by blood tests."
However, Tomas Hajek, M.D., Ph.D., an assistant professor of psychiatry at
Dalhousie University in Canada, doubts that Lyme disease is the cause of
morgellons. He conducted a study in his native Czech Republic that linked Lyme
disease to a number of psychiatric illnesses (Psychiatric News, March
"Until I see carefully controlled, unbiased data, I remain skeptical
[about] its infectious etiology or association with Lyme disease," Hajek
told Psychiatric News.
Hajek believes it is more likely that morgellons is delusional
parasitosis—a psychiatric disorder that has traditionally been rare and
about which not much is known apart from case histories. Katharine Phillips,
M.D., a professor of psychiatry at Brown University who has seen a number of
patients with delusional parasitosis, concurred.
"My sense is that it seems to overlap a lot with delusional
parasitosis. How complete that overlap is, we don't know," she said.
Another reason to suspect that morgellons is delusional parasitosis is that
it often occurs with other psychiatric disorders or with illnesses that have a
strong psychological component.
"A past or family history of depression or bipolar disorder is not
uncommon," Koblenzer pointed out. "Chronic fatigue syndrome,
fibromyalgia, irritable bowel syndrome, and other somatization disorders crop
Jonathan Fleming, M.D., an associate professor of psychiatry at the
University of British Columbia in Canada, also believes that morgellons could
be delusional parasitosis, he said in an interview at the recent annual
meeting of the Canadian Psychiatric Association (CPA) in Toronto. But he
stressed that morgellons is not restless legs syndrome. Fleming, who is also
co-director of the Sleep Disorders Program at the University of British
Columbia Hospital, is an authority on the syndrome.
People sometimes confuse delusional parasitosis with restless legs syndrome
because the two conditions sometimes go by the same name—Ekbom's
syndrome. Also, they have similar symptoms—say, the sensation of worms
crawling under the skin of the legs. An easy way to distinguish whether the
crawling sensation is due to delusional parasitosis or restless legs syndrome
is to move the leg and see if the sensation goes away, he pointed out at a CPA
meeting workshop on the syndrome. If it does go away, it's restless legs
syndrome, not delusional parasitosis.
Koblenzer, who is a psychoanalyst and a dermatologist, proposed another
possibility—that morgellons and delusional parasitosis are identical,
but that they are more than mere delusion.
"Unfortunately, since we do not know the cause of the symptoms..
.there are differences of opinion as to how to approach these unfortunate
patients," she said. "Many dermatologists feel that it is `all in
your head' or `imaginary' and tend to dismiss the patient. Others, of which I
am one, believe that there is indeed an altered sensation in the skin,
probably triggered by neuropeptide release, usually associated with stress of
some kind or depression, which the patient interprets in terms of parasitic
infestation; that is, the basic change is in the skin, and this must be
addressed appropriately, in addition to treating the thought
Yet another intriguing scenario is that morgellons is not only a delusional
parasitosis, but a delusional parasitosis that can be shared by more than one
person—or what the French back in the 19th century named
folie à deux (psychosis for two), folie à trois (psychosis for
three), or however many people are involved.
"I read one report where 12 percent of cases of delusions of
parasitosis have folie à deux," William Meehan, M.D., Ph.D., told
Psychiatric News. "So it seems to be pretty common."
Meehan, who is a second-year resident in adult psychiatry at the University
of Massachusetts, has had some exposure to delusional parasitosis
"There have been cases of delusional parasitosis in which several
people in the same family have sort of bought into the notion that there is an
infestation," Gerard Gallucci, M.D., said in an interview. "I
[also] remember reading about someone who appeared at the vet because they
believed that they and their pets were infested."
Gallucci, medical director of Delaware Health and Social Services' Division
of Substance Abuse and Mental Health, has treated a few patients with
delusional parasitotis. In fact, as of last month, some 200,000 Web sites were
devoted to morgellons disease. "The Internet might be a vehicle for
propagating" the illness, he speculated.
"Most of what I have read about morgellons disease suggests that it
is a disease that has been generated online," Meehan agreed.
Regardless of the origin or origins of morgellons, "these patients
really suffer," koblenzer asserted. "The symptoms
literally take over the life of the patient, consuming not only the patient's
time, but also the patient's financial resources. I have known patients who
have literally disposed of all upholstered furniture and much clothing (one
patient included a $10,000 mink coat, which she burned). Grandmothers will not
touch their grandchildren for fear of contamination and similar tragic
Also compounding the distress of these patients, Koblenzer pointed out, is
that most dermatologists do not feel comfortable treating them.
There is some good news for morgellons sufferers, however: Some treatments
have been found, on a case-by-case basis, to help them—steroid creams,
antibiotics, antidepressants, and, most crucially, low doses of antipsychotic
medications such as olanzapine and pimozide. Meehan and colleagues reported in
the March Archives of Dermatology, in an article titled"
Successful Treatment of Delusions of Parasitosis With
Olanzapine," that they favored olanzapine over pimozide because
olanzapine has a safer adverse-effect profile.
But in the October Archives of Dermatology, in a letter titled"
Pimozide at Least as Safe and Perhaps More Effective Than Olanzapine
for Treatment of Morgellons Disease," Koblenzer wrote that Meehan and
coworkers failed "to mention a very strong point in favor of
pimozide—its powerful antipruritic action, [which is] believed to be due
to its effect on opioid pathways." Also, "the adverse-effect
profile of olanzapine does not seem significantly more benign than that of
pimozide." Nonetheless, "because effective doses of both drugs are
low," she concluded, "significant adverse effects are unlikely in
either case, though the weight gain with olanzapine is unacceptable to many
More information is posted at<www.morgellons.org>
An abstract of "Successful Treatment of Delusions of Parasitosis With
Olanzapine" is posted at<http://archderm.ama-assn.org/cgi/content/abstract/142/3/352>.
An extract of "Pimozide at Least as Safe and Perhaps More Effective Than
Olanzapine for Treatment of Morgellons Disease" is posted at<http://archderm.ama-assn.org/cgi/content/extract/142/10/1364-a>.▪