Reframing delusional infestation: perspectives on unresolved puzzles

Abstract

Delusional infestation (DI), a debilitating psychocutaneous condition, featured as a false fixed belief of being infested accompanied by somatosensory abnormality, behavior alteration, and cognitive impairment. Although management of primary causes and pharmacotherapy with antipsychotics and/or antidepressants can help to alleviate symptoms in most patients, the underlying etiology of DI still remains unclear. Morgellons disease (MD), characterized by the presence of cutaneous filaments projected from or embedded in skin, is also a polemic issue because of its relationship with spirochetal infection. This review aims to discuss the following topics that currently confuse our understandings of DI: 1) the relationship of real/sham “infestation” with DI/MD; 2) behavior alterations, such as self-inflicted trauma; 3) neuroimaging abnormality and disturbance in neurotransmitter systems; and 4) impaired insight in patients with this disease. In discussion, we try to propose a multifactorial approach to the final diagnosis of DI/MD. Future studies exploring the neurobiological etiology of DI/MD are warranted.

British Association of Dermatologists guidelines for the management of adults with delusional infestation 2022

“…13 Confidence of general dermatologists in managing DI is very variable. 16 DI has two main forms, primary (a monosymptomatic hypochondriacal psychosis characterised by delusions, somatosensory abnormality, behavioural alteration, cognitive distortions) and secondary symptoms (caused by another defined organic or pre-existing psychiatric disorder, or by substance use) 12,14,15,[17][18][19] The primary form is without definite cause or underlying illness, and according to the International Classification of Diseases (ICD-10) and Diagnostic and Statistical Manual of Mental Disorders (DSM-5), meets the criteria for a persistent delusional disorder (ICD-10) or a delusional disorder of somatic type. 12,20 The delusion should be present for greater than one month without a diagnosis of schizophrenia, 21 the patient should be able to function despite the delusion, the duration of the delusion should be longer than the duration of any mood changes and the delusion should not be secondary to organic pathology or substance use (DSM-5).…”

“…DI is a debilitating condition and causes significant suffering to the patient and their loved ones. 14,15 The symptoms of DI often impact work, relationships and quality of life, thus constituting a high disease burden. 12,15 Patients prefer to seek consultation with general practitioners and specialist physicians (e.g.…”

“…fibres or threads). DI is a debilitating condition and causes significant suffering to the patient and their loved ones 14,15 . The symptoms of DI often impact work, relationships and quality of life, thus constituting a high disease burden 12,15 .…”

“…DI has two main forms: primary (a monosymptomatic hypochondriacal psychosis characterized by delusions, somatosensory abnormality, behavioural alteration and cognitive distortions) and secondary symptoms (caused by another defined organic or pre‐existing psychiatric disorder, or by substance use) 12,14,15,17–19 . The primary form is without definite cause or underlying illness, and, according to the International Classification of Diseases 10th Revision (ICD‐10) 20 and the Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DSM‐5), 21 meets the criteria for a persistent delusional disorder (ICD‐10) or a delusional disorder of somatic type 12,21 .…”

Клинические И Психологические Модели Патологических Кожных Ощущений

“…У пациентов имеются значительные повреждения кожных покровов как результат их борьбы с мнимыми паразитами [32,34]. В аспекте патогенеза обсуждаются нарушения интероцепции, неправильные обработка и интерпретация воспринимаемых ощущений как способствующие формированию галлюцинаций [35].…”