Understanding Morgellons Disease

A Delusional Disorder Manifesting as Skin Infestation

Woman scratching arm
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A mere 200 years ago, before the advent of modern medical research and evidence-based practice, physicians believed that 4 humors – yellow bile, black bile, phlegm, and blood – struck the balance of health. Without a doubt, we've come a long way from these early views of physiologic homeostasis; nevertheless, we still have much more to learn about disease and the human body. In light of our still limited comprehension of the ineffable complexity of health, we must be careful to refrain from outright dismissing possible pathology no matter how unlikely.

In recent years, a very small yet vociferous patient population has complained of skin infestation by either parasites or inanimate matter along with related somatic complaints. People with convictions of such infestation report poor or non-healing skin sores (skin lesions); itchiness (pruritis), and sensations of stinging, biting, and insects crawling on or under the skin (formication). These people also claim that thread-like fibers are excreted from these skin lesions.

Despite this condition having neither any established diagnostic criteria and treatment nor any formal institutional recognition, among members of the lay population, this dermopathy has been termed Morgellons disease. Many dermatologists and psychiatrists, however, believe that Morgellons is, in fact, delusional parasitosis, a psychiatric disease. More specifically, such experts point out that delusional parasitosis is a monosymptomatic psychosis, and formication is a common complaint among people with psychiatric disease. Furthermore, cases of Morgellons disease often clump among couples and other family members suggesting shared psychosis.

To date, we have no cohort studies examining risk factors that contribute to the development of Morgellons disease (a term that I will continue to use throughout this article for consistency). Instead, much of our knowledge is based on case reports, case series, anecdotal accounts and a limited number of retrospective analyses done by catchment health-care institutions including the Mayo Clinic and Kaiser Permanente. Undoubtedly, and as is the case with many other diseases, more research needs to be done on Morgellons disease.

Characteristics of People With Morgellons

Typical characteristics of people who complain of Morgellons disease include the following:

  • middle-aged
  • symptoms lasting more than 3 years
  • disability caused by this condition
  • co-morbid psychiatric disease
  • illicit drug use
  • doctor-hopping with hopes of finding treatment
  • a steadfast belief that disease is medical in nature

Of note, few people with complaints of Morgellons disease initially present to psychiatrists and instead are referred to psychiatry only after being seen by a dermatologist or emergency physician.

Morgellons disease came to wider attention among health professionals in the early aughts. Because complaints of Morgellons disease increased shortly after Internet use became ubiquitous, many people have called it a disease spread by the Internet ... a disease that patients ascribe to only after reading other personal accounts.

A common complaint among people with Morgellons disease is that fibers can be pulled from skin lesions. In a 2012 PLoS ONE article titled "Clinical, Epidemiological, Histopathologic and Molecular Features of an Unexplained Dermopathy," researchers at Kaiser Permanente examined 115 people with complaints consistent with Morgellons disease and found that on skin biopsy, lesions contained no parasites or mycobacteria. Instead, materials procured from skin usually consisted of cotton-like material mixed with pus, and skin changes were most likely caused by excoriation (scratching) or arthropod (insect) bites. These findings seem to suggest that these fibers come from clothing.

Final Thoughts

Without a doubt, people who complain of Morgellons disease suffer. More specifically, a majority of people with this condition complain of chronic fatigue and a host of co-morbid conditions including depression and substance abuse.

We still are unsure how to treat people with Morgellons disease. A very limited amount of research has shown that people with Morgellons disease may benefit from antipsychotic medication. However, because many people with Morgellons disease truly believe that the etiology is infectious, it's often difficult to convince these patients that psychiatric treatment is a good idea. Some experts have gone so far as suggesting that clinicians essentially trick patients with Morgellons disease into taking psychiatric medications under the auspices of therapeutic privilege or therapeutic exception. A better solution probably involves psychiatrists working with dermatologists as a therapeutic team to provide guidance and treatment.

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Article Sources
  • "Delusional infestation: Clinical presentation in 147 patients seen at Mayo Clinic" by AA Foster and co-authors published in the Journal of the American Academy of Dermatology in 2012.  
  • "Clinical, Epidemiologic, Histopathologic and Molecular Features of an Unexplained Dermopathy" by ML Person and co-authors published in PLoS ONE in 2012. 
  • "Information, Consent and Treatment of Patients with Morgellons Disease: An Ethical Perspective" by Y Söderfeldt and D. Groß published in the American Journal of Dermatology in 2014.