I am pleased to see that in the December 15, 2006, issue, Psychiatric
News drew attention to Morgellons disease and that the excellent article
gave sound advice on communicating with delusional parasitosis patients.
However, I would like to add comments about the distinction between Morgellons
disease and delusional parasitosis.
I've evaluated and treated Morgellons patients, spoken with researchers and
other clinicians who work with these patients, read the limited literature on
the subject, and reviewed a database of 3,000 Morgellons patients. The
Morgellons patients I have seen had surprisingly similar symptoms, with an
abrupt onset, often following a toxic exposure. Before the onset of their
illness, these patients' mental status appeared to be quite representative of
the general population, and some (including physicians) were high-functioning
professionals. The condition appears more common in nurses, teachers, and in
family members in the same household, which suggests a contagious
After the onset of the illness, these patients report surprisingly similar
symptoms. They have a combination of bizarre dermatological sy mptoms, cognit
ive impairments, mood disturbances, and sometimes paranoia and suicide
attempts in later stages of the illness.
Their symptoms are not compatible with schizophrenia, bipolar illness,
substance abuse, or other recognized causes of delusions. When patients
complain of fibers protruding from their skin, examination with a low-power
digital microscope can visualize and photograph the presence or absence of
these fibers. In addition, many Morgellons patients test positive for Lyme
disease. The mental symptoms seen in Morgellons are similar to those of other
chronic general medical illnesses with psychiatric manifestations, since the
mental symptoms fluctuate in a pattern similar to that of the general medical
symptoms; and this suggests that the mental symptoms are probably associated
with immune and/or toxic effects upon the brain.
When these patients are treated with modest courses of antibiotics, their
dermatological and psychiatric symptoms often show significant improvement.
Without a thorough assessment, Morgellons patients are commonly given a
diagnosis of delusional parasitosis, resulting in a delay in proper treatment.
Whatever Morgellons is, it is something very different and unique and should
be considered as a condition needing further study and possibly listed in the
next edition of the DSM.
In summary, Morgellons disease and delusional parasitosis are two distinct
clinical entities. Morgellons does not appear to be an imaginary or delusional
illness and merits the research effort that we see with any other emerging and