People with Morgellons falsely believe harmful fibers are coming out of their skin and causing wounds.
[2] Diagnosis requires the delusion to be the only sign of psychosis, not caused by another medical condition, and present for at least a month.
[4] People with delusional parasitosis believe that "parasites, worms, mites, bacteria, fungus" or similar organisms have infected them.
[8] People with this condition recall events like a bug bite, travel, sharing clothes, or contact with someone they think was infected.
[1] Those affected may see any skin mark or small object on them or their clothing as proof of a parasitic infestation.
The name stems from the fact that the evidence is typically stored in a small container, like a matchbox.
[1] Related is a "digital specimen sign", in which individuals bring collections of photographs to document their condition.
[8] Approximately eight out of ten individuals with DP have co-occurring conditions, such as depression, substance use disorders, and anxiety.
Their personal and professional lives are frequently disrupted due to extreme distress regarding their symptoms.
[1][8] For example, substances that block dopamine reuptake, like cocaine and methylphenidate, can cause symptoms like formication.
Additionally, several conditions linked to faulty dopamine transporters can also lead to secondary delusional parasitosis.
Examples of such conditions include: "schizophrenia, depression, traumatic brain injury, alcoholism, Parkinson's and Huntington's diseases, human immunodeficiency virus infection, and iron deficiency".
Medical conditions associated with secondary delusional parasitosis include: deficiencies in vitamins such as B12 or folate, thyroid dysfunction, diabetes, Parkinson's disease, dementia, encephalitis, meningitis, and multiple sclerosis.
These include "phenelzine, pargyline, ketoconazole, corticosteroids, amantadine, ciprofloxacin, pegylated interferon alpha, and topiramate.
Secondary delusional parasitosis occurs when another psychiatric condition, medical illness or substance (prescription or recreational) use causes the symptoms.
[8] The secondary organic form may be related to vitamin B12 deficiency, hypothyroidism, anemia, hepatitis, diabetes, HIV/AIDS, syphilis, or use of stimulants like methamphetamine and cocaine.
[8][11] The first step in diagnosis is to conduct a comprehensive examination to rule out other causes of the person's symptoms.
Examples of such analyses include complete blood count, comprehensive metabolic panel, erythrocyte sedimentation rate, C-reactive protein, urinalysis for toxicology and thyroid-stimulating hormone.
[1][10] Tests may also be done for "human immunodeficiency virus, syphilis, viral hepatitis, B12 or folate deficiency", and allergies.
[8] Healthcare professionals first distinguish delusional parasitosis from actual infections like scabies or mites.
Treatment guidelines emphasize the importance of gaining the person's trust and collaborating with other providers.
[5] Other studies have found annual incidence rates to be anywhere from 2-17 cases per 1 million people per year.
[9] Karl-Axel Ekbom, a Swedish neurologist, first described delusional parasitosis as "pre-senile delusion of infestation" in 1937.
[17] The eponymous Ekbom's disease was changed to "delusions of parasitosis" in 1946 in the English literature, when researchers J Wilson and H Miller described a series of cases, and to "delusional infestation" in 2009.
[5] Ekbom's original was translated to English in 2003; the authors hypothesized that James Harrington (1611–1677) may have been the "first recorded person to suffer from such delusions when he 'began to imagine that his sweat turned to flies, and sometimes to bees and other insects'.
[21][22] Leitao and others involved in her foundation (who self-identified as having Morgellons) successfully lobbied members of the U.S. Congress and the U.S. Centers for Disease Control and Prevention (CDC) to investigate the condition in 2006.
Publications "largely from a single group of investigators" describe findings of spirochetes, keratin and collagen in skin samples of a small number of individuals; these findings are contradicted by the much larger studies conducted by the CDC.
[27] Her detailed description of her own experience with mites was later shown to be incorrect,[26] and has been described by others as a classic case of delusional parasitosis.
[28][16][29][30] Matan Shelomi says the paper has done "permanent and lasting damage" to people with delusional parasitosis, "who widely circulate and cite articles such as Traver's and other pseudoscientific or false reports" via the internet, making treatment and cure more difficult.
[29] Shelomi published another study in 2013 of what he called scientific misconduct when a 2004 article in the Journal of the New York Entomological Society included what he says is photo manipulation of a matchbox specimen to support the claim that individuals with DP are infested with collembola.