Polite Dissent

One of the more unusual diagnoses I have seen as a physician is delusional parasitosis. In this condition a person is convinced that they are infested with parasites such as insects, spiders, lice or worms. As the name of the condition suggests, no such infestation exists; it is all a delusion of the patient.

This is an extremely difficult condition to treat. The patient is absolutely convinced that they are infected and there is nothing a physician can do to convince them otherwise. These patients go from doctor to doctor trying to find someone who believes them and can cure their infestation. They have repeatedly sprayed and bug-bombed their house in an attempt to get rid of the insects. They have had several exterminators inspect and treat their house. Often, they will scrub themselves raw with harsh chemical such as bleach or cleanser in order to get rid of the bugs.

A common aspect of their delusion is the “matchbox sign.” The patients will bring the doctor “proof” of their infestation. They will show the physician their evidence convinced that it shows insects, worms or eggs. In reality, their proof is nothing more than flakes of dried skin and other normal detritus. This is known as the matchbox sign because the evidence is usually carried in a matchbox or other small container. The last patient I saw with this condition brought in a zip-loc bag with a couple pieces of sweater lint convinced that they were “cocoons.”

Another interesting feature of delusional parasitosis is folie deux, or shared delusion. Not only is the patient convinced that they are infested, but they’ve managed to convince their significant other of the infection as well. Therefore both people share the same delusion that the patient has parasites. So not only do you have to convince the patient of the truth, but their spouse as well.

Rarely, delusional parasitosis is due to an underlying physical condition such as low thyroid or vitamin deficiency. In these cases, correction of the underlying condition is the best treatment. In most cases, however, delusional parasitosis is a purely psychological condition. Because of this, and because the patients refuse to believe that it is psychological and not physical, treatment is very difficult. Psychiatric counseling is key, as are antipsychotic medications.

What does this have to do with comics?

I was re-reading some of Alan Moore’s Swamp Thing, and came across this lovely picture by Stephen Bissette and John Totleben from Saga of the Swamp Thing #29.

These panels are the perfect example of delusional parasitosis. Abby is convinced that she is infested with bugs, and has scrubbed herself raw and bleeding with wire brushes and nasty chemicals. She’s even tried to burn her clothing.

Admittedly, her situation goes a little deeper than just delusional parasitosis because she is having olfactory hallucinations (the smell of burnt insects) and a sensation of being unclean, but her main condition is still delusional parasitosis. (In this case we know what the inciting cause was: sleeping with your husband who was really your back-from-the-dead evil uncle).

More information on delusional parasitosis can be found here.