Most morgellon patients are flocking to dermatologists or family doctors
rather than to psychiatrists because they believe that their condition is a
skin disease, not of psychological origin. Yet if a patient should appear in
your office asking for help, what should you do?
Some psychiatrists who have had contact with morgellons patients,
delusional parasitosis patients, or both offer some suggestions.
"You know, it is a difficult topic because we have no absolute proof
of what is going on," Caroline Koblenzer, M.D., told Psychiatric
News. Koblenzer, a clinical professor of dermatology at the University of
Pennsylvania and a psychoanalyst, has treated dozens of delusional parasitosis
patients over the years and several dozen morgellons patients during the past
"We do biopsies, we do blood tests, all those things that would rule
out the extrusion of any foreign material, whether it be living or nonliving.
So what I try to say to patients is, `We have no evidence... however, we do
have medications [that can help].'"
She added, "I think it is heartless to tell the patients that it is
all in their head because I have no question that something is going
"If a patient came to me, I would make sure that he or she had an
evaluation by a dermatologist to make sure that there wasn't any..
.infestation by an organism," Gerard Gallucci, M.D., said. Gallucci,
medical director of the Delaware Health and Social Services' Division of
Substance Abuse and Mental Health, has treated few patients with delusional
parasitosis. "And if it was clear that there wasn't any
organism—indeed, that it might be a delusional belief—I would
probably use one of the atypical agents to treat him or her and would engage
him or her in therapy as well. A number of factors might be driving this
belief or perpetuating it, and anxiety might be one of them."
"I would recommend [doing] some testing to make sure that the patient
does not have a skin infection," said William Meehan, M.D., Ph.D., a
University of Massachusetts psychiatry resident who co-wrote a paper about
delusional parasitosis in the March Archives of Dermatology. "I
would also want to rule out any other problem that might lead to a sensation
of bugs crawling on the skin—for example.. .using cocaine or.. .certain
endocrine problems, such as thyroid and liver disease."
Once he had eliminated medical explanations, he continued, he would most
likely consider it a case of delusional parasitosis, but he would not call the
patient's morgellons a delusion. He would tell the patient, "This does
not seem to be an infectious process." And then he would suggest,"
We have found that certain psychiatric medications at low doses have
been beneficial for many people."
Finally, Annette Matthews, M.D., an assistant professor of psychiatry at
Oregon Health and Science University, has had contact with patients with
delusional parasitosis, including a couple who shared it. She believes that
morgellons lies on the spectrum of delusional parasitosis and would thus
respond to patients with morgellons in essentially the same way that she would
to patients with delusional parasitosis.
"It turns out that a lot of times, the disease is situationally
predisposed," she explained. "Patients tend to kind of isolate
themselves, to develop an environment around themselves that feeds the
process. So very frequently if you just get one or both people out of the
environment feeding the problem, [the illness] will evaporate. But if it
doesn't go away, often there is an underlying problem, for instance, substance
abuse... .Depression is [also] highly comorbid with this disorder, so treating
someone's depression could be important." ▪