Basics Is Morgellons Disease Real or a Delusional Disorder? By Naveed Saleh, MD, MS Naveed Saleh, MD, MS LinkedIn Twitter Naveed Saleh, MD, MS, is a medical writer and editor covering new treatments and trending health news. Learn about our editorial process Updated on March 02, 2020 Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Rachel Goldman, PhD, FTOS Medically reviewed by Rachel Goldman, PhD, FTOS Facebook LinkedIn Twitter Rachel Goldman, PhD FTOS, is a licensed psychologist, clinical assistant professor, speaker, wellness expert specializing in eating behaviors, stress management, and health behavior change. Learn about our Medical Review Board Print Science Photo Library / Getty Images 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. While this condition has neither any established diagnostic criteria and treatment nor any formal institutional recognition, this dermopathy has been termed Morgellons disease among members of the lay population. Emerging Research and Controversy About Morgellons Disease This condition is controversial. Many dermatologists and psychiatrists 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. Newer research, however, is exploring whether Morgellons disease is caused by the body's reaction to an infectious agent, the Borrelia spirochete that causes Lyme disease. The filaments may be composed of keratin and collagen, a reaction by the skin cells, and colored due to the presence of melanin. 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. Some medical experts do consider it a physical illness and may diagnose it as "unexplained dermopathy." This can be helpful for some people, since having a diagnosis or label for their symptoms and experience can help them feel heard and understood. There are medical providers that do not believe this is a delusional disorder at all and explain that "rigorous experimental investigations show that this skin affliction results from a physiological response to the presence of an infectious agent." Characteristics of People With Morgellons Typical characteristics of people who complain of Morgellons disease include the following: Middle-aged Symptoms lasting more than three years Disability caused by this condition Co-morbid psychiatric disease Illicit drug use Doctor-hopping with hopes of finding treatment A steadfast belief that the disease is medical in nature One study found that the condition was most common in middle-aged white women and was associated with an increased prevalence of smoking and substance use. 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 2000s. 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. However, other research has found that fibers more meticulously collected from deeper in the skin are composed of collagen and keratin and may be colored by melatonin. They might be produced by the body due to a reaction to the Borrelia spirochetes. It is also notable that people with spirochete infection often develop brain involvement, which can produce psychiatric symptoms. Final Thoughts on Morgellons Disease 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 (and some researchers) 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. A mere 200 years ago, before the advent of modern medical research and evidence-based practice, physicians believed that four 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. 7 Sources Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Wong JW, Koo JY. Delusions of parasitosis. Indian J Dermatol. 2013;58(1):49-52. doi:10.4103/0019-5154.105309 Middelveen MJ, Bandoski C, Burke J, et al. Exploring the association between Morgellons disease and Lyme disease: identification of Borrelia burgdorferi in Morgellons disease patients. BMC Dermatol. 2015;15:1. doi:10.1186/s12895-015-0023-0 Foster AA, Hylwa SA, Bury JE, Davis MD, Pittelkow MR, Bostwick JM. Delusional infestation: clinical presentation in 147 patients seen at Mayo Clinic. J Am Acad Dermatol. 2012;67(4):673.e1-10. Middelveen MJ, Fesler MC, Stricker RB. History of Morgellons disease: from delusion to definition. Clin Cosmet Investig Dermatol. 2018;11:71-90. doi:10.2147/CCID.S152343 Savely VR, Stricker RB. Morgellons disease: Analysis of a population with clinically confirmed microscopic subcutaneous fibers of unknown etiology. Clin Cosmet Investig Dermatol. 2010;3:67–78. doi:10.2147/ccid.s9520 Pearson ML, Selby JV, Katz KA, et al. Clinical, epidemiologic, histopathologic and molecular features of an unexplained dermopathy. PLoS ONE. 2012;7(1):e29908. doi:10.1371/journal.pone.0029908 Söderfeldt Y, Groß D. Information, consent and treatment of patients with Morgellons disease: an ethical perspective. Am J Clin Dermatol. 2014;15(2):71-6. doi:10.1007/s40257-014-0071-y By Naveed Saleh, MD, MS Naveed Saleh, MD, MS, is a medical writer and editor covering new treatments and trending health news. See Our Editorial Process Meet Our Review Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit Speak to a Therapist Online Advertiser Disclosure × The offers that appear in this table are from partnerships from which Verywell Mind receives compensation.