Investigating Morgellons Syndrome
Delusional Parasitosis
The overwhelming reaction of dermatologists and other health professionals to patients presenting symptoms of Morgellons is that the disease represents nothing more than a case of Delusional Parasitosis (DP), with the fibres replacing insects in the classic ‘matchbox’ (or ‘ziplock’) sign, historically an indicator of DP.
Patients with DP feel as though insects are crawling beneath the skin causing terrible itching and extreme discomfort. The sufferer scratches and scratches, eventually breaking the skin and causing sores, or deliberately opens up a small wound in an attempt to get at the ‘insects’. The wound, uncovered, naturally attracts dust, dirt and pieces of lint and hairs and other everyday particles which the delusional patient perceives to be parts of the insects which are under the skin.
It is common for the patient to then put the ‘evidence’ in a matchbox and present it to physicians, often dermatologist, who are well versed in this minor drama. Perhaps too well versed, because contrary to the guidelines for establishing a diagnosis of DP, which stipulate that infestation must be categorically ruled out as a first step, many Morgellons patients complain that doctors neglect to examine their skin, or if they do, do so superficially and dismissively, already ‘knowing’ that there is no infestation.
The history of science suggests that expectations are rarely confounded and that if a scientist is expecting a certain result, or a practitioner is expecting to give a certain diagnosis, then these preconceived notions are an extremely powerful influence on the outcome.
Could it be possible for example, that there is a disease which mimics the symptoms of DP, i.e. that causes skin irritation and that has a neurological component, thus making the patient appear delusional, or at least psychologically unstable? If so then how would dermatologists be able to distinguish between the two without thorough examination? As specialists in skin and with scant expertise in psychiatry could they be relied upon to make the distinction?
At this point it is perhaps worth noting that Syphilis is a disease, a parasitic infection, whose later stages cause madness if left untreated. Many sufferers were condemned to the madhouse as insane before the true nature iof the infection became known. With this in mind, it is perhaps unwise to make definitive claims about Morgellons at this early stage.
A New Approach
Caroline Koblenzer, M.D., a clinical professor of dermatology at the University of Pennsylvania is better qualified than most to offer opinions on Morgellons, for as well as being a dermatologist she is a psychoanalyst too. Her view is that it is likely that Morgellons and DP are very similar, but that neither are entirely the result of delusion. She believes that;
"… there is indeed an altered sensation in the skin, probably triggered by neuropeptide release, usually associated with stress of some kind or depression, which the patient interprets in terms of parasitic infestation; that is, the basic change is in the skin, and this must be addressed appropriately, in addition to treating the thought disorder."
Whilst it has been shown that treatment with anti-psychotic drugs has been effective in the treatment of Morgellons patients, Koblenzer points out that the experimenters neglected to mention that the medication, Pimozide, is also known to have a marked anti-pruritic effect and would therefore be expected to ease the suffering caused by itchy skin.
The considerable medical opposition to the idea of Morgellons is, at least in part, a result of the way the practice of medicine is structured in the U.S. Doctors are prone to 10 minute consultations and prefer to make a diagnosis in that time. According to Elizabeth DeVita-Raeburn (2007), writing in Psychology Today, this is the reason for the prevalence of the DP diagnosis – it appears to act as a convenient ‘wastebasket’ diagnosis when nothing else seems to fit.
Robert Bransfield, a psychiatrist and also an MRF board member, argues that as Morgellons advances neurological problems become more pronounced and sufferers become increasingly paranoid and delusional, these feelings are surely exacerbated by the refusal of doctors to take patients claims seriously. Bransfield further contends that doctors are poorly trained to deal with illnesses which may combine physical and psychological symptoms, he observes;
“The way we have compartmentalized specialties contributes to our difficulties in dealing with problems like this.”
Morgellons, not DP
The striking aspect of the Morgellons reports according to Bransfield is the uniformity of sufferers’ descriptions of symptoms compared to highly variable nature usually found in those suffering from DP. The Mayo Clinic, which actually recognises Morgellons , in a study on DP found that of 175 patients diagnosed with the condition, 50% of them, upon closer investigation, turned out not to be suffering from DP at all.
It is quite a striking statistic, admittedly on a very small sample, however it does suggest that the DP diagnosis is overused and may have become a an easy option for practitioners who are pushed for time and need to make a diagnosis. It is also consistent with Branfield’s observation on the variability of patients’ descriptions of experiences of DP – they are so varied because actually all patients are not describing the same affliction!
That DP may be an overused diagnosis does not in itself provide evidence that Morgellons exists. There are numerous skin diseases, some of which are little understood, for example prurigo nodularis, which causes extremely itchy nodules on the surface of the skin, another, better known, is scabies, in which tiny mites do in fact burrow under the skin. Both conditions produce some of the symptoms described by Morgellons sufferers.
Another recognised condition, cutaneous dysaethesia was originally believed to be a tactile hallucination, but as more becomes known, it is not clear that it is in fact a hallucination at all. The statistics for skin and itching are striking; there are 182 distinct types of bacteria that live on, or in, human skin , some of these have only recently been identified, whilst a search for ‘skin itch’ in the online Merck Manual will list over 500 conditions.
There appears to be enough evidence to at least consider the validity of the DP diagnosis. DP is after all an extremely rare condition and the Mayo clinic study suggests the diagnosis is already overused. Even if most of the Morgellons cases are actually DP, which seems unlikely,it begs the question; why are so many cases appearing at this particular time?