Psychological Implications in Morgellons Disease, Part II: Factitious Disorders

Sarah Bione-Dunn

In Sickened, a memoir of Münchhausen syndrome by proxy by Julie Gregory, Dr. Marc Feldman writes: “Münchhausen by proxy may be the single most complex– and lethal– form of maltreatment known today. It is formally defined as the falsification or induction of physical and/or emotional illness by a caretaker of a dependent person. In most cases, the perpetrator is a mother and the victim is her own child.”

Factitious disorders such as Münchhausen syndrome (MS) and Münchhausen syndrome by proxy (MSBP) may be factors for some cases of Morgellons disease. Symptoms of factitious disorders include intentional production or feigning of physical signs or symptoms, and physical symptoms motivated by a desire to assume the sick role (DSM-IV-TR). Depression, need for a sense of community, and unsupportive parental relationships are suggested causes of MS/MSBP, though the precise cause of factitious disorders are not understood (Ozden & Canat, 1999).

Many Morgellons sufferers and MS/MSBP sufferers have behaviors in common. MS/MSBP sufferers research their supposed ailments and are knowledgeable about medicine (Miner & Feldman, 1998). People with MS/MSBP eagerly undergo or offer to partake in painful testing or treatment (Stern & Cremens, 1998), as do Morgellons sufferers. Both conditions continually reject known explanations for their health; Morgellons sufferers notably reject diagnoses such as eczema, environmental factors, poor nutrition, side effects from medication, side effects from illegal substances, etc. as the agents of their illness. The two conditions also share negative attitudes toward the medical community, strong aversion to mental health, and doctor-shopping behaviors for someone to find something– anything– wrong with them.

Communication on an internet message board is indirect and impersonal. Lymebuster’s policy of banning anyone who questions another’s health, symptoms, or motivations, makes it a dangerous breeding ground for the few who suffer from MS/MSBP. Having MS/MSBP may not have been why they began to seek Morgellons as a new disease to fabricate, but because of the isolated, “no one allowed who doesn’t agree” attitude, it is a safe haven for people to continue in their deviance. MS/MSBP sufferers and perpetrators can then join the media pressure and participate in a “mysterious, emerging disease” to satisfy their psychological issues, as they already feel on the fringe from their continual rejection by physicians.

References:

Psychological Implications in Morgellons Disease, Part I: Somatoform Disorders

Sarah Bione-Dunn

Many sufferers of Morgellons complain that doctors won’t “open their eyes and see” that “something” is wrong with them. When physical illnesses have no apparent medical cause, physicians may suspect a somatoform disorder. A somatoform disorder is a pattern of physical complaints with largely psychosocial causes (Tayler & Mann, 1999). People with somatoform disorders do not purposefully induce their symptoms (as with Munchausen syndrome, a condition where people intentionally induce or feign illness) but believe that their problems are truly medical.

Preoccupation somatoform disorders involve people who are healthy, but become preoccupied with a mistaken belief that something is physically wrong with them. The DSM-IV-TR describes symptoms include a history of many physical complaints, usually beginning before the age of 30, that occur over a period of several years and result in treatment being sought or in significant impairment, physical complaints not fully explained by a known medical condition or drug, or extending beyond the usual impact of such a condition.

Some people with Morgellons disease have these symptoms. A history of treatment being sought for lesions, sores, crawling sensations and bugs emerging from the skin or body orifices, fatigue, fibers, and more, is typical of a Morgellons sufferer. Impairment includes people quitting their jobs, moving, staying in a hotel, withdrawal from family and friends. These complaints are not fully explained by a known medical condition or drug, and that is most significant, as it is that way with somatoform disorders. Morgellons sufferers are quoted as going from doctor to doctor for ten years without one finding cause for the complaint (Savely, 2006).

Morgellons sufferers will often admit to becoming hypersensitive or hyper vigilant regarding their skin, as is common with preoccupation somatoform disorders. This hyper vigilance creates an illusion of fantastic situations in what would normally be recognized as the usual and then dismissed. These mis-attributions snowball into a person engaging in dangerous self-medication and rebuffs from doctors, similar to Morgellons disease. In Morgellons disease, sufferers often self-medicate by bathing in bleach (or other caustic materials), ingesting mordacious concoctions, and cutting their own skin.

Even though self-proclaimed experts on Morgellons cite mental health problems as common correlates of Morgellons, the sufferers have a strong adverse reaction to the suggestion of mental health being involved in their condition, which is symptomatic of somatoform disorders. Because of this strong reaction to mental health, it is unlikely that a person who does not feel mentally ill would seek mental health assistance.

References

  • Savely, V., Leitao, M., & Stricker, R. 2006. The mystery of Morgellons disease: infection or delusion? Am. J. Clin. Dermatol. 7(1), 1-5.
  • Taylor, R., & Mann, A.H. 1999. Somatization in primary care. J. Psychosom. Res. 47(1), 61-66.

How can thousands of people across the country all have the same symptoms? This is a question I am often asked regarding Morgellons, and my response has generally been that they don’t, the symptoms are varied, and where the symptoms are similar, there are many known causes for those symptoms.

In my previous article, “Occam’s Hot Tub“, I posited a possible series of events that might lead to someone thinking they had Morgellons, when in reality they had hot tub folliculitus, neurotic excoriations and fiberglass splinters.

But let’s consider a much more common possible cause, one that could account for a very large percentage of cases. Consider if the symptoms of menopause match the symptoms of Morgellons.

First, remember who these thousands of people are. They are the people who filled in an internet form, first at the MRF, and now at OSU. The form is really lacking in epidemiologically useful questions, but does ask which of the following 12 Morgellons symptoms you have:

Lesions or sores
Fibers or filaments on skin
Granules or specks on the skin
Itching or stinging
Hair loss
Joint pain
Fatigue
Biting or crawling feeling on the skin
Mood disorder
Memory or concentration problems
(ex: ‘brainfog’, short term memory loss)
Vision problems
Edema or swelling

Skipping the first three for now (don’t worry, I’ll address them later), let us look at the rest, grouping them as appropiate:

Itching or stinging, Biting or crawling feeling on the skin
http://www.dvmen.org/dv-135.htm
“Formication, the feeling that ants or other insects are crawling on their skin, affects about 20% of women during perimenopause and menopause. Formication can cause a woman to scratch herself raw.”
“many women experience severe itching during perimenopause that is unrelated to formication”
http://www.healthsquare.com/fgwh/wh1ch29.htm
Some women experience a prickling, itching sensation on the skin, known as formication. It has been called “crawling skin” because it feels as though tiny insects are marching along your body.”
Menopause: A guide for Women and Those who Love them, Berg and Garcia, 1992, p.76
“Skin tingling or a feeling that unseen insect are crawling across your skin is called formication. It is a symptom of menopausal distress. [...] 20 percent of menopausal women report the problem”

Joint Pain
http://www.breastcancer.org/cmty_trans_2002_3_21.html
“Symptoms of menopause you may be experiencing include: [...] Muscle and joint pain
Joint pain is a common complaint in many women and men as we reach middle age.”

Fatigue, Mood disorder, Memory or concentration problems
http://www.merck.com/mrkshared/mmanual/section18/chapter236/236a.jsp
“Psychologic and emotional symptoms–including fatigue, irritability, insomnia, inability to concentrate, depression, memory loss, headache, anxiety, and nervousness–may be related to estrogen deprivation and the stress of aging and changing roles. Sleep disruption by recurrent hot flushes contributes to fatigue and irritability.”
http://en.wikipedia.org/wiki/Menopause#Symptoms
mood disturbance, irritability, fatigue, decreased libido, memory loss

Vision Problems
http://www.healthsquare.com/fgwh/wh1ch29.htm
Visual capacity, such as the ability to read road signs at night, has been reported to decline by a sample of menopausal women.”
http://www.ejfi.org/family/family-60.htm#menopause
Changes in visual acuity requiring changes in eyeglass prescriptions or other vision problems.”

Hair Loss
http://www.womentowomen.com/SYMhairlossdryskin.asp
“Approximately one-third of menopausal women report noticeable hair loss (called “alopecia”)”
http://www.power-surge.com/educate/hairloss.htm
“The most common cause of hair loss is low thyroid function, which is common among menopausal women.

Edema or swelling
http://www.epigee.org/menopause/weight_gain.html
Water retention and menopause often go hand in hand since water weight and bloating are caused by decreased progesterone levels.”
http://www.ezinearticles.com/?Menopause-and-Water-Retention&id=223203
Water retention is excessive accumulation of fluid in the body. It occurs in women during menopause or perimenopause when they take estrogen replacement hormones.”

So, 9 out of 12 symptoms are common symptoms of menopause. We can easily make it 10 by including lesions, since “Formication can cause a woman to scratch herself raw.”, but also since a “lesion” can be almost any abnormal change involving any tissue or organ. The most common skin lesion is acne:
http://www.acne.org/women_and_acne.html
“women undergoing menopause and post-menopause may also experience hormonal acne
http://www.menopauseinsight.com/menopause/menopause-acne.aspx
“Menopausal and post-menopausal women experience a dramatic decrease in estrogen levels, and an increase in testosterone. This causes the skin glands to produce more oil than they usually do, and as a result, more acne breakouts occur.”

So all we are left with is fibers and specks on the skin. If you look, you will find them. I have fibers and specks on my skin right now.

A slightly better survey of Morgellons believers can be found at:
http://www.usp-db.com/

In August 2006, this only had 305 respondents, but of those, 76% are women, and 80% are in the age range 35-60 (the age range of menopause onset), with the highest number in the 50-54 range – the average age of menopause onset)

So, all the symptoms of Morgellons on one internet survey are practically identical to the symptoms of menopause, and the other survey indicates that the vast majority of people with Morgellons are women of menopausal age.

Does this mean that all cases of Morgellons are actually menopause? Obviously not, we’ve got a few men there, and several people with highly odd symptoms, and some children. But the correlation is so staggeringly high, that it seems very likely that as many as half of those 5000+ people who say they have symptoms of morgellons actually have symptoms of menopause.

Most people who strongly believe they have Morgellons will complain that their doctors dismiss them as “DOP”, a common abbreviation for “Delusions Of Parasites”.

The Morgellons activists seek to portray their plight as a struggle of genuinely sick people against an uncaring medical profession that dismisses their symptoms as “all in your head”. Any suggestion of anything like DOP is reviled, and the believers wander from doctor to doctor, seeking those who will look beyond this.

To understand the Morgellons community, you need to understand DOP. One of the worlds leading experts on DOP is Nancy Hinkle, PhD. Hinkle is not a physician, she is an entomologist, so if anyone can find the bugs, it’s going to be her. Back in 2001, before the MRF got off the ground, she had an interview on this subject with the Discovery Channel in Canada.

http://exn.ca/video/?Video=2001030551.asx

If you are interested in Morgellons, I highly recommend you watch this video (it’s only about six minutes long), as it provides a simple overview of DOP, as well as the varied causes, which are mostly physical in nature. She also makes the distinction between those who are simply mistaken, and those who are delusional.

Out of the hundreds of samples that people have sent Dr. Hinkle over the years, NONE had insects in them. Her most telling quote: “If they are desperate enough they will usually find something”.

Dr. Hinkle also wrote a highly lucid paper on the subject in 2000:

http://www.ent.uga.edu/pubs/delusory.pdf

Scratching may produce papular eruptions. Any
repeated skin irritation produces a friction blister.
Repeated rubbing of an area often produces a bleb
(small blister) which, when ruptured, yields an open
sore that may become infected. Once the sore
begins oozing plasma and a scab forms, hairs and
cloth fibers become entrapped in the sticky fluid.
These flecks are dislodged and called mites or
insects because they look like they have “antennae”
and “legs” (Fig. 2). Hair follicles often are pulled
out; the follicle accompanied by the associated
sebaceous gland looks like a worm.

In his article “A cure for Morgellons disease?”, Dr Chris Rangel says something that Morgellons believers will like:

“these patients are neither crazy nor are they faking their symptoms “

I agree, at least with the point he is making. Here’s the full article:

http://www.rangelmd.com/2006/08/cure-found-for-morgellons.htm

Here is the article in the NY Times:

http://www.nytimes.com/2006/08/22/health/22symp.html

And here’s the actual study under discussion:

http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0030269

And the “cure” (Cognitive-Behavioral Therapy for Somatization Disorder)
http://archinte.ama-assn.org/cgi/content/abstract/166/14/1512 

Is this a “cure for Morgellons”? No, it’s an effective treatment for Somatization Disorder.  That might cover a lot of the cases of Morgellons, but it’s not going to treat those who have genuine dermatological and neurological disorder, and simply mistakenly believe they have Morgellons, since they find some fibers on their skin.  It might help them seek more effective treatments, however.

© 2012 Morgellons Watch Suffusion theme by Sayontan Sinha