Delusional Parasitosis: Getting Rid of Invisible Bugs

One of my more memorable encounters in the pest control business involved a situation that I never could have predicted. A customer had initially contacted me about a booklice infestation in her apartment. After the treatment, everything seemed to be resolved—but that’s when things took an unexpected turn.

Several weeks later, she reached out to complain that "the bugs" had returned. This time, however, the situation was different. She claimed that the bugs were crawling on her skin, causing severe discomfort. She felt "millions" of bugs jumping and crawling over her body. No matter how much she bathed, she claimed they continued to burrow under her skin, especially in her nostrils. She even showed me lesions and scratches on her face, insisting they were caused by the bites from these bugs.

From my observations and experience, I suspected she might be suffering from delusional parasitosis—a condition where individuals believe they are infested with parasites, despite there being no physical evidence of such infestations.

Then she went into her room and came out with a few scotch tapes. Apparently she tried to stick those bugs on scotch tapes so that I could inspect them under a microscope. This is called the matchbox sign, an indication of delusional parasitosis where the patients present proof containing hairs, skins, debris, etc., but no parasites are found inside.

Eventually, I persuaded her to consult a dermatologist since the "bugs are inside her skin", as what she claimed, and dermatologists are skin experts. Luckily, she was convinced and seek for medical help in the hospital. She was given some medicine and referred for psychological therapy, and finally recovered.

The key is to persuade the patient to seek medical attention, not by force!

What Causes Delusional Parasitosis?

Delusional parasitosis is typically caused by a combination of psychological and physiological factors. It is considered a psychiatric condition where individuals are convinced that they are being infested by parasites, even when there is no evidence to support that belief. Some studies suggested that this condition become common with age, and it might be more prevalent in women.

The causes can range from stress, trauma, or a previous bad experience with pests, to more complex mental health issues such as schizophrenia, depression, or other disorders. In some cases, certain medications or drug use can also contribute to the onset of delusional parasitosis.

Could It Be a Real Parasite?

In this particular case, despite the customer's belief that she was dealing with a parasitic infestation, the situation was not caused by a real parasite. The bugs she was describing were not present on her skin or in her living environment.

While it’s always important to rule out actual infestations before jumping to conclusions, delusional parasitosis typically manifests in the absence of any physical parasites. Real infestations, such as fleas, bedbugs, or scabies, can cause itching and discomfort, but they are accompanied by visible signs like bites or skin rashes, which were not present here.

What Are the Symptoms of Delusional Parasitosis?

The main symptom of delusional parasitosis is the persistent belief that one is infested with parasites. These individuals may feel itching, crawling sensations, or see bugs in their environment or on their skin. Other common symptoms include:

• Intense anxiety about the supposed infestation

• Physical scratches and lesions from excessive itching or rubbing

• The Matchbox Sign: Patients may present small samples, such as debris or hairs on scotch tape, claiming they are proof of parasites (but no actual parasites are found).

• Behavioral signs: Frequently checking their skin or environment for bugs, washing or bathing excessively, and trying various home remedies.

What Is the Treatment for Delusional Parasitosis?

The treatment for delusional parasitosis primarily involves addressing the psychological aspect of the condition. Here’s how you can guide your loved one toward getting the help he/she needed:

• Encourage medical attention: Gently suggest getting professional's help. A dermatologist can help rule out any possible medical conditions, while a psychologist or psychiatrist can address the underlying mental health aspect.

• Empathy and reassurance: During my interaction, I showed understanding and sympathy, acknowledging how uncomfortable and distressing her experience must have been. I validated her feelings without directly confronting her beliefs.

• Therapy: Cognitive Behavioral Therapy (CBT) is often used to help individuals with delusional parasitosis reframe their thoughts and reduce the anxiety associated with their delusions.

Final Thoughts

Dealing with delusional parasitosis requires patience, empathy, and a delicate approach. While you might not have the medical expertise to directly treat the condition, you can guide the individual toward professional help in a supportive way. In my experience, it's essential to never dismiss the person's feelings, as this could exacerbate the situation. Instead, showing understanding while gently encouraging them to seek medical attention is the most effective path forward.

If you encounter a similar situation in your friends or family members, remember: it's not about proving someone wrong; it's about helping them find the help they truly need. If you ever have concerns about a customer's well-being, always refer them to a medical professional for a thorough evaluation.