EKBOM`S SYNDROME

Delusory Parasitosis and
Other Mind Myths About
Bugs
Nancy C. Hinkle, Ph.D.
Dept. of Entomology
Univ. of Georgia
Athens, Georgia
Morgellons Research Foundation
Researching an emerging infectious skin disease
Image 1: Lip of 3 year old boy, 10x
Image 2: Object from same lip, 60x
THE „FIBER DISEASE‟
CDC Investigating Morgellons Illness
CDC investigates whether bizarre Morgellons condition is real or imagined
CDC Funds Morgellons Study
(AP) Imagine your body pocked by erupting sores. The sensation of little
bugs crawling all over you. And worst of all, mysterious red and blue fibers
sprouting from your skin.
It may sound like a macabre science fiction movie, but a growing legion of
Americans say they suffer from this condition. And now the U.S. Centers
for Disease Control and Prevention is investigating.
Some doctors dismiss these patients as delusional. But the condition called Morgellons - has caused a small frenzy on the Internet, with
hundreds of people pleading for help.
"Sometimes the government doesn't want to panic people until they can
figure out a definitive cause," said Pat Boddie, a 62-year-old Alabama
woman who said she's had Morgellons for 14 years.
"They're trying to figure out if this is going to be an epidemic. I hate to tell
them, but it already is," she said.
The CDC has been receiving as many as 20 calls a day from selfdiagnosed Morgellons patients. The agency has been urged to investigate
by, among others, U.S. Sen. Dianne Feinstein of California.
"We're going into this with an open mind," said Dan Rutz, spokesman for a
CDC Morgellons task force.
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EKBOM SYNDROME
(DELUSORY PARASITOSIS)
A CONDITION IN
WHICH THE
INDIVIDUAL
CONSIDERS
HIMSELF
INFESTED BY
INVISIBLE BUGS
Infestation – population of
organisms lives in (or on), feeding,
reproducing, and sustaining itself
“Delusory Parasitosis”
Ekbom Syndrome
an erroneous, unshakable belief that the
skin is infested with a parasite
“A delusion is a false belief that is not consistent
with the patient‟s intelligence, educational level,
or cultural background, and that cannot be
corrected by reasoning” (Koblenzer 1993)
EKBOM SYNDROME
K.A. EKBOM (1907-1977) –
Swedish neurologist who described
“Delusion of Infestation in the
Elderly”
Acta Psychiatrica et Neurologica Scandinavica (1938)
History of Psychiatry (Classic Text No. 54) 14(2): 232-256
Demographics
Symptoms
Management Behaviors
Medical History
Comorbidities
Dr. HinkleI have been suffering from what feels like insect bites at night, but
can't ever see any insects where affected. Every so often I think i
see something flying past me but have still never found one. I
used a fogger for my apartment and while it seemed to work for a
few days, the culprit is back in full force. I also just recently
returned from being out of town for 4 days thinking the lack of a
blood source would starve whatever it is, but only seemed to make
them hungrier.
I feel like they are crawling on me, followed by an intense sting /
bite, then a little welt forms that when scratched turns into a scab
that doesn't heal quickly, as in 1-2 weeks before they finally go
away (the scabs). Nothing I've found on the web has been helpful
in pinpointing what I'm dealing with, and I was hoping you might
be able to steer me in the right direction for relief.
Help!!
I am being bitten alive by invisible bugs! When I'm being bitten I feel a
sharp sensation, like a tiny pinprick, but when I look at where I am being
bitten I cant see a darn thing. I have tiny red dots all over my body under
my skin (where I believe the bugs have bitten me), but my doctor says
they are probably nothing. (Whatever, doc) There is no welt or noticeable
bite mark. I feel itchy all over my body, my feet, my belly, my hair,
especially when I am in the basement and at night. I know this isn't in my
head b/c when ppl come over to the basement, they are itchy too. Also, I
believe its a bug that jumps because when I am around someone else,
they start to feel itchy as well (without me saying a WORD about the
bugs). I have sprayed the place enough times, vaccuumed and scrubbed
for hours, washed my sheets and clothes in hot water twice and bagged
them, then froze them, and have now just resorted to spraying OFF on
myself and when I'm really desperate - RAID - before and after bed
because this is the only way I get relief.
Does anyone battle this same mysterious bug? Any advice????
Please HELP!
PEOPLE BLAME
•
•
•
•
•
•
•
SPIDER BITES
BED BUGS
SCABIES
CHIGGERS
THRIPS
SPRINGTAILS
BIRD OR RODENT MITES
SPIDERS DO NOT BITE HUMANS
BED BUGS ARE NOT INVISIBLE
Scabies = Sarcoptes scabiei infestation
CHIGGER
BITING MIDGE
THRIPS
(THYSANOPTERA)
Springtails
(Collembola)
BIRD MITES
(FEED ONLY ON BIRDS)
Some DP Background:
• DP is the most commonly
reported delusional disorder
More than 250,000 cases in U.S.
• Often affects people in pairs
or groups in a shared
delusion, called folie-a-deux.
– Entire families, entire offices, are susceptible
A. MOST COMMON IN ELDERLY
B. DISPROPORTIONATELY FEMALE
C. EXHIBIT SELF-DESTRUCTIVE BEHAVIORS
1. QUIT JOBS
2. BURN/DESTROY FURNITURE
3. ABANDON HOME
4. OBSESSIVE LAUDERING/CLEANING
5. REPEATED PESTICIDE MISUSE
6. USE HOME REMEDIES
7. SELF-MUTILATION/EXCORIATION
D. PROVIDE „SPECIMENS‟- GOBBETS OF TISSUE, OTHER
DEBRIS
E. ELABORATE DESCRIPTIONS OF PEST & LIFE CYCLE
F. SOCIAL ISOLATION
G. MAJOR LIFE EVENT (DIVORCE, BEREAVEMENT,
JOB LOSS)
H. CONSULTED SEVERAL PHYSICIANS
I. MEAN DURATION OF DELUSION > 3 YR.
J. COMPLAIN OF ITCHING, CRAWLING, STINGING,
BITING
K. ADAMANT THAT IT IS AN „INFESTATION‟
L. EXPRESSES DESPERATION
M. DELUSION EVENTUALLY SHARED BY ANOTHER
When the sensation is felt
Apply tape
Gently fold tape on itself
Box and ship
SENSATIONS ARE REAL
PHYSICAL
PHYSIOLOGICAL
PSYCHOLOGICAL
PHYSICAL CAUSES OF
SKIN DISCOMFORT
PHYSIOLOGICAL CAUSES OF SKIN DISCOMFORT
DERMATOGRAPHIA
RINGWORM
(DERMNET.COM)
DIABETIC NEUROPATHY IS A SERIOUS COMPLICATION OF
DIABETES, AFFECTING HALF OF DIABETICS.
NERVES DAMAGED BY DIABETIC NEUROPATHY CAN CAUSE
STINGING OR BURNING SENSATIONS, TINGLING, PAIN,
NUMBNESS OR A CRAWLING SENSATION ON THE SKIN.
FORMICATION
SOME DISEASES CHARACTERIZED
BY PARESTHESIA OR PRURITUS
SYMPTOMS
AUTOIMMUNE DISEASES (LUPUS)
CARDIOVASCULAR DISEASE
CIRRHOSIS
DIABETES
HEPATITIS
HIV INFECTION
HODGKIN‟S DISEASE
HYPERTHYROIDISM
HYPOTHYROIDISM
HEAVY-METAL POISONING
LYME DISEASE
MALIGNANCIES/NEOPLASMS
MULTIPLE SCLEROSIS
PARKINSON‟S DISEASE
RENAL FAILURE
STROKE
SYPHILIS
VITAMIN DEFICIENCIES
Top 10 U.S. Prescription Products by Sales, 2008
DRUG
POSSIBLE SIDE EFFECTS
1
Vicodin
2
Lipitor
Urticaria, pruritus, rash, erythema
3
Amoxicillin
Erythema, urticaria
4
Lisinopril
Paresthesia, pruritus, rash, urticaria, erythema
5
Lotensin
Erythema, rash, urticaria
6
Tenormin
7
Zithromax
8
Lasix
9
Xanax
10 Lopressor
Rash, paresthesia, pruritus
Erythema, rash
Dermatitis, pruritus, paresthesia, rash, urticaria
Paresthesia, dermatitis, pruritus, rash, urticaria
Paresthesia, pruritus, rash
Paresthesia, pruritus, urticaria
“COCAINE BUGS” AND “METH MITES”
“COCAINE BUGS”
AND
“METH MITES”
COCAINE
The patient
complained of a
worm infestation in
his neck. He used a
pair of scissors to
excise the imagined
worms.
The toxicology screening of this patient was
positive for cocaine, opiates, and tranquilizers.
PSYCHOLOGICAL CAUSES
STRESS
ANXIETY
DEPRESSION
DISPLACEMENT ACTIVITY
an unconscious defense mechanism whereby the
mind redirects from situations producing
internal conflict (uncertainty or anxiety) and felt
to be dangerous or unacceptable to a focus felt to
be safe or acceptable.
Scratching and autogrooming („picking‟) are the
most commonly reported displacement activities
among primates.
FIRST –
IDENTIFY THE PEST
What does your
agreement to treat
obligate you to?
SCABIES MITE
HUMAN LOUSE
THE ONLY ARTHROPODS THAT INFEST HUMAN
BODIES ARE SCABIES MITES AND HUMAN LICE.
BECAUSE THESE LIVE EXCLUSIVELY ON
HUMAN BODIES, THERE IS NO ROLE FOR A PMP
IN CONTROLLING THEM.
THEY ARE STRICTLY MEDICAL CONDITIONS.
No insect or mite can live in the environment and
switch to infesting the human body.
No insect or mite can feed on inorganic materials, so
cannot survive on furniture or carpeting.
No winged insects infest human bodies.
No invisible mites or insects infest human bodies.
No external animal parasites can infest humans.
Bird mites cannot infest humans.
Human body infestation is a medical condition and
must be treated by a physician.
Refer cases to UGA ([email protected]) 706-542-9033
EKBOM SYNDROME IS A MEDICAL CONDITION