Delusional Parasitosis: Getting Rid of Invisible Bugs


If your loved ones are troubled by extremely small bugs infesting or attacking his/her body, it’s probably due to a condition called delusional parasitosis or Ekbom syndrome. It should be treated ASAP, or it can affect his/her quality of life.

The key in handling someone with delusional parasitosis is to get the affected person to consult a dermatologist. This can be difficult because most people refuse to accept the fact that they have psychological problems. Empathy and understanding are important for successful treatment.

What is Delusional Parasitosis?

Delusional parasitosis is a disorder where the patients strongly believe that they are infected by parasites even though they are not. 

The patients can’t be reasoned with facts that they are not infected, and are constantly under the pressure of the delusional infection. Check out this article if you want to learn more about delusional parasitosis.

How to Deal with Delusional Parasitosis?

Here’s one of my encounters with delusional parasitosis and how I dealt with it.

One of my customers had a booklice infestation in her apartment, which was treated and resolved. After 2-3 weeks, she started calling back and I was “tricked” by my colleague who can’t handle her to attend to her complaint.

The anxious customer told me that our treatment for booklice worked but the “bugs” came back after the treatment. They have crawled onto her body. She can feel “millions” of bugs jumping and crawling on her skin. She can even see them all around her skin!

She had to bathe every few hours using some shampoo bought from the pharmacy. She claimed some of the bugs survived the washing by burrowing underneath her skins, and the bugs love to go to her nostrils because it’s dark and warm inside.

She also showed me lesions and scratches on her hands and face, allegedly due to the bites from those bugs. They look like injuries from excessive scratches and rubbing though. 

Based on the observations, I suspect she suffers delusional parasitosis. But I might be slapped if I ask her to go to a doctor, and it would not help her. If you encounter such a situation and want to help the affected person, you have to show empathy and understanding so that she trusts you. No point proving them wrong because it will not eliminate the delusion, and that’s why it’s called delusional parasitosis.

So I played along, trying to show empathy. “It must be very uncomfortable having those bugs hiding in your skin, do they affect your sleep?” “I’d go mad if I had to bathe 8 times a day!” “Do they bite you?” etc.

The lady also asks me to inspect her face. I told her I saw no bugs and she immediately started crying helplessly. I had to suggest to her that the bugs might be too small for unaided eyes to stop her from crying. 

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.

So I promised her that I will inspect the samples, and contact her. Obviously, the scotch tapes only have her hairs and debris when viewed under the microscope.

I contacted her the next day, telling her I can’t find anything in her specimen. “The bugs might have burrowed into your skin when you try to tape them. Only a dermatologist can help you. They have all the equipment to detect those bugs in your skin and can kill those bugs.” I told her.

Some people may disagree with my approach because I am lying and may make her worry by saying the bugs had burrow into her skin. But I don’t have a better way to convince her to seek medical attention, given I am a complete stranger to her. Moreover, she was the one suggesting the bugs can bury under her skin in the first place.

Anyway, she was convinced and went to a dermatologist. She was given some medicine. She also accepted psychological therapy, and eventually recovered. 

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

What Caused Delusional Parasitosis

No one knows what caused delusional parasitosis. It could be an indirect result of other health issues which affect the brain. Although this condition is rare, anyone could have it.

What are the Symptoms of Delusional Parasitosis?

Symptoms of delusional parasitosis are the direct result of the delusion:

  • Sensation on/underneath skins as if some bugs are crawling/burrowing.
  • Able to describe how the bugs look like, and the description of the bugs may change over time.
  • Lesions and scratches on skin due to excessive rubbing and scratching.
  • Willing to apply any sort of chemicals on the skin to get rid of the imaginary bugs.
  • Attempt to collect proof of those bugs because no one believes the patients. They might even insist that a particular object (eg. dirt, a small bead, a nut etc.) is the bug.

Could it be A Real Parasite Infestation?

Potentially there could be a real parasite infestation. Examples of those parasites include fleas, scabies-causing mites, bed bugs, lice etc. Except for scabies-causing mites, the rest are visible with naked eyes. The main symptoms for scabies is itching that happens especially at night, but the patient will not be able to see and feel the mites on or in their skin. 

What is the Treatment for Delusional Parasitosis?

A dermatologist and psychologist can handle delusional parasitosis

Doctors may run some tests to check for the presence of any parasites. Usually, doctors will agree to any sort of tests requested by the patients just to convince them to go for the right treatment – psychological therapy. Without such tests, patients usually will not proceed to psychological therapy, because they genuinely believe the parasites are on their body.

Even with those test results, many patients may still insist not to accept psychological therapy.

The psychiatrists may prescribe antipsychotic medication to the patients. As the family members of the patient, it is important for you to convince the patient to take the medicine not to kill the “bugs” but to cure the condition that the patient is suffering from.  


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