Psychiatric Arsenal Has Weapons Against Morgellons Disease

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 six months.

“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 on....”

“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.” ▪