The following extract is from an article that deals with several delusional disorders.  The article differentiates Morgellons from delusions of parasitosis.   Note that this article does not mean the symptoms of Morgellons are purely delusional, but rather that, as with DOP, there is often a delusional component to what may or may not be a physical condition.   I’ve added it here as it is a useful reference to the most current medical opinion on Morgellons.  I’d encourage people to read the full article, available via this link.

http://dermatology-s10.cdlib.org/146/review/delusions/robles.html

Delusional disorders in dermatology: a brief review
David T Robles MD PhD1, Sharon Romm MD2, Heidi Combs MD2, Jonathan Olson BS1, Phil Kirby MD1
Dermatology Online Journal (2008 June 15) 14 (6): 2

Morgellons disease

In the seventeenth century Sir Thomas Browne used the term Morgellons disease to describe an unusual symptom complex resembling those seen in patients today [21]. Patients with this condition maintain the unshakeable belief that fibers or some other material is imbedded or emerging from their skin. They pick and dig at their skin to extract the offending “material.” They may reject the notion that they have parasites but may still exhibit the “matchbox” sign, bringing in fragments of clothing fibers, lint, hair fibers and dried skin fragments for examination.

We consider Morgellons to be within the spectrum of delusions of parasitosis, except that the patients are focused not on parasites but on “unusual material” that they believe is in their skin. We have seen a number of such patients in our clinic and all manipulate their lesions enough to self-induce irregular ulcerations. They frequently dig at their lesions with their own nails as well as house-hold items such as nail clippers or tweezers, the so-called “tweezer sign” (Robles, in press). It is important to ask patients if they use instruments in addition to fingernails because in our experience, the use of mechanical devices portends a more malignant psychological profile.

Morgellons disease has received recent attention, primarily through the internet and through the website of Morgellons Research Foundation (http://www.morgellons.org). The Morgellons Research Foundation claims that this condition is an emerging infectious disease [21], however, no available evidence exists to confirm this hypothesis. Some authors affiliated with the Morgellons Research Foundation claim that Lyme Borreliosis [22] has an association but this has not been substantiated.

Epidemiology

There are no data available describing the prevalence of this syndrome. It may be seen in association with a number of psychiatric conditions including unipolar and bipolar depression, schizophrenia and abuse of drugs [21].

Treatment

There are no randomized control studies to establish the recommended treatment of this disorder. Some experts discuss the importance of establishing patient rapport by referring to the delusions as Morgellons disease [23]. After ruling out an organic cause, emphasis should be placed on how disconcerting the symptoms must be for the patient.

Medication trials have been intermittently effective. Pimozide has been used in doses of 0.5-2.0 mg daily. Koblenzer believes that Pimozide, with the added anti-pruritic effect, is a preferred treatment [24]. The use of atypical antipsychotics such as risperdal, olanzapine and aripiprazole may also be of benefit [21, 23]. In our experience, the use of extra-thin hydrocolloid dressings over the ulcerations is generally very effective because it provides a mechanical barrier to manipulation and facilitates wound healing. The wounds frequently become secondarily infected, making the use of topical or systemic antibiotics an important adjunctive measure.

21. Koblenzer CS: The challenge of Morgellons disease. J Am Acad Dermatol 2006; 55(5): 920-2.

22. Savely VR, Leitao MM, Stricker RB: The mystery of Morgellons disease: infection or delusion? Am J Clin Dermatol 2006; 7(1): 1-5.

23. Murase JE, Wu JJ, Koo J: Morgellons disease: a rapport-enhancing term for delusions of parasitosis. J Am Acad Dermatol 2006; 55(5): 913-4.

24. Koblenzer CS: Pimozide at least as safe and perhaps more effective than olanzapine for treatment of Morgellons disease. Arch Dermatol 2006; 142(10): 1364.

15 Responses to “Delusional disorders in dermatology: a brief review.”

  1. Actually on second thoughts, I’d just settle for a big hug right now.

    I felt something today that I haven’t felt in 20 or 30 yrs. I (my family) are under the most extreme stress (no victim role playing here – reality!).

    After a day of nothing but bad news, I have experienced the most overwhelming anxiety, fear & trembling. My stomach churned in a major way, literally made me shudder all over. The really bizarre thing though when my stomach churned was the first instant thought that came into my mind, which was my stomach used to do that just before I was about to be bashed in the play ground at school by a group of kids.

    I’m sure there are a lot of people reading this that think I am a complete pain in the arse. That’s ok. I do think that of myself most days (which I shouldn’t). I know that I’m not a pain in the arse in reality. I know that I am a good person. I have always told the truth, asked for help from the right people, loved & respected my family & fellow human beings.

    Thanks to the internet & Michael’s museum I mean blog I can vent my frustrations which seems ok to me, but then I learn that maybe a lot of this info. is just winding up in the wrong hands in a bitter twisted web.

    Well heck! I’ve come this far I can’t turn back now, what’s said is said, & what’s done is done. Believe me from the bottom of my heart I never never meant to hurt, torment or intimidate anyone at anytime on this blog. It sure appeared that way though a couple of years back, and if I were to blame my disease that wouldn’t even get me off the hook. Even though I’ve got these darn overlapping delusional disorders, with CFS & Fibromyalgia, chronic sinus mucosal disease, bruxism, irritable bowel syndrome, temperomandibular joint dysfunction, chronic rickettsiosis, eczema, hayfever, fuzzy blue feet disorder & I can’t learn to shut my big fat mouth syndrome.

    It would be nice to think that maybe someone out there could be benefiting from reading my ramblings. Just connecting with feeling the way I do at times “bloodly hopeless”! & feeling “different”compared to others. I just don’t know where any of this is taking me, other than to CognitiveBehavoiuralTherapyWatch!

    Chao.

  2. The video is extremely sad.

    “Two spots” together on the skin???

    “spots”, “lesions” & “scars” on lower legs & this is where it started???

    Ok then, since the same thing happened to me as did with the Marshs, am I allowed to say what we have could be the same??

    NO – cuz “delusional disorders in dermatology” is the agenda is it not?

    Any or all of this (Morgellons) a conincidence??

    Nooo, the research bunnies are the last to know.

  3. Saddly, after a couple weeks visit to the MDR forum, I’m inclined to agree with the theory that at least a large part of Morgellons “sufferers” have a degree of this in their diagnoses.

    Those people, who I figured should be trying to CONVINCE others that the disease is real, istead wound up convincing me that maybe it ISN’T…..a position I didn’t hold upon joining that forum.

    I saw several acts of attempted ridicule & just plain old thinly veiled aggression towards anyone who dared to question ANY of their claims, no matter how wild and/or unsupported. That was the problem I had. As a scientific type person, I want to see evidence of the claims that can be legitimatly studied….as any of the actual scientists & doctors who may decide to study this “disease” will want.

    WOW!!! Did that open up a can of worms. I should NEVER have brought THAT up!! You mean you don’t believe us when we tell you that a tiny white creature is living in my arm, which can outpull a tractor that’s been hooked to it’s nose?!?! What kind of person are you??

    With the aggresive way that they defend their words, & the way they make excuses to NOT produce believable evidence, leads me to strongly feel now that something more is happening than meets the eye.

    I’m even right on the verge of thinking Morgellons might not be a new, or distinct, disease at all…..but one that has been around forever….hypochondria.

    That feeling is even reinforced by the fact that the “Morgies” THEMSELVES introduced that possibility into my mind, simply by the actions & attitudes that I noticed in my short stay at their place.

  4. David – I agree with you. A lot of these people are merely feeding their own hysteria by exchanging these ludicrous ideas. They’ll post pics magnified 100x of ‘monsters’. If I yank any hair out of any part of my body it looks the same. They claim that slathering themselves in yoghurt and milk produces ‘white granules’, well yes, it would, it’s called dried milk. They post ‘morg’ pics that are obviously nothing more than sebum plugs from blackheads, or scabs, or fluff.

    These people spend so much time cataloguing normal bodily occurrences, slathering themselves in horse antibiotics, and of course posting at MRF/Lymebusters that it’s no wonder they feel so ill! I’d be positively exhausted if I catalogued every loose hair, scab, skin flake or itch.

  5. Gillian,

    No, it is real. Every symptom you have described I have documented in digital photos and videos, and digital microscopic photos and videos. So much of Morgellons has not been researched or documented that I guess that gives credence to this site and its unfathomable motivation.

    I will have many photos, videos, theories and conclusions published on http://www.morgellonsrevealed.com in the next few weeks. I am hopeful that what I have documented will be the start we need to get some professionals to take it to the next level and get some help.

    Hold fast.

    NashBill

  6. Hi. I recently read an article on Morgellons in Self magazine. I have a morbid interest in bizarre diseases, but this was the first I’d heard of Morgellons. The Self article leaned towards the view that it is indeed a new disease, and I wanted to know more.

    I’ve spent the past few days looking at “official” Morgellons websites, photos of fibers, videos taken by sufferers, and most disturbingly, online support forums.

    It is very clear that even if Morgellons is a true skin condition, many people who believe they suffer from it are mentally ill. I hate to say this, but I don’t think I’ve yet seen anyone who claims to suffer from the disease who sounds rational. People post that these fibers crawl out of their ears and dance on their pillows, keeping them up all night; that the fibers are nano-robots created by the government; that they are being innoculated by alients; etc.

    Given the mental state of many sufferers, I find it shocking and revealing that none of these forums give any support to those who might be delusional. This seems incredibly irresponsible to me, *especially* if you really believe in Morgellons. Wouldn’t you want to differentiate between people who actually suffer from the disease and those falsely believe they do? Presumably the people who are mentally ill should be urged to get appropriate treatment.

    I’m also stunned at how much uncritical attention this disease has gotten from the media. It’s heartbreaking to read about people who believe it’s spread to their pets and children. Presumably at least some of these people are abrading the skin of these innocent victims.

    So, first I’d like to suggest to people who believe they have Morgellons: perhaps you do have a currently unrecognized disease. However, given that so many people who think they have it suffer from mental illness, perhaps you can be open to the idea that you might suffer similarly? There are uncaring, arrogant doctors out there, no question. But if a doctor has said you have a delusion, why not at least try the idea on for size? A doctor who believes you have a delusion should still have a treatment program. Perhaps this treatment will bring you the relief you need. If not, you’re not likely to be any worse off than you are now.

    Second: I don’t think this has been mentioned on this site before, so I’m going to bring this up: when tissues HEAL, they often ITCH. So if you have open lesions, they will probably itch regardless of what else is going on. If you are picking at lesions / extracting fibers / bleaching them, etc, why don’t you try leaving some section of your skin alone, or covering them with any kind of sterilized bandage. See if these heal normally.

    Finally, I really hope that everyone who suffers or believes that they suffer from this disease is helped. It sounds incredibly distressing. My heart goes out to you.

  7. Given the mental state of many sufferers, I find it shocking and revealing that none of these forums give any support to those who might be delusional.

    WARNING!!!!!

    DON’T try to make that suggestion on a Morgellons forum. You’ll immediately be blasted with curse-words, called names, your mother called names, & be accused of being a “paid spreader of disinformation” (whoever they are).

    Trust me. That’s EXACTLY what happened to me when I made a post that didn’t agree 100% with their outlandish theories.

    I have noticed the same thing. Many Morgellons sufferers ALSO suffer from quite obvious mental conditions, probably brought upon them by their extreme obsession with proving they, and every single person & animal around them, have a nonexistent disease.

    It’s a very sad situation, especially considering the fact that the people who claim they have the disease, have completely shut themselves off from any type of outside diagnoses, help, or treatment.

    Bill……I hope that you DO have some hard, scientifically studyable evidence like you claim you might. I hope that what you have doesn’t resemble the hundreds of pieces of “evidence” that the Morgellons community has already distributed.

    But I visited that site & there is currently NOTHING there except advertisements. So until I see something new & convincing there, I’ll have to file it under the normal excuse given by the Morgellons community when asked to present good evidence……”Trust me, it’s real. I saw critters crawling out of my friends skin. But she wouldn’t let me take any pictures. So just trust me.”

  8. Hello Merc,

    What a great post, & thank you for your good wishes.

    The itching was so intense for me even with no lesions present, a general anaesthetic may have eased the discomfort.

    Morgellons, I believe, is a new disease. Morgellons incorporates many different diseases, both physical & mental. The mind & body are one.

    These links are for the Morgellons Support Forums I go to, should anyone be interested. No hurt here.

    http://morgellonsfree.proboards81.com/index.cgi?board=general&action=display&thread=66&page=3

    http://morgellonsgroup.proboards23.com/index.cgi

    Take care.
    Gill

  9. Thanks, Gillian.

    I take it that you believe you have Morgellons? Would you be willing to share more information with me?

    - What symptoms do you exhibit?
    - Are close family members and friends able to see the symptoms you describe?
    - How many doctors have you seen, and in what specialties?
    - Have you received any diagnoses?
    - Do you have a microscope, or have you documented any of your illness?

    The itching you describe sounds terrible. As this site has documented, there are literally over 1,000 known reasons why people can itch, and presumably some unknown reasons as well. Have you consulted a dermatologist to deal with this symptom? I don’t know much about skin disorders, but I’m sure there are a number of treatements to deal with “idiopathic itching.”

    Finally, are you able to keep yourself from scratching to the point you break the skin, or is the itching too intense?

  10. Also, I’m not sure if anyone has posted the link to the Mayo clinic page on Morgellons. I thought it was very helpful:

    http://www.mayoclinic.com/health/morgellons-disease/SN00043

    If you believe you suffer from Morgellons, then that implies two possibilities:

    - You suffer from a curently unrecgonized illness who contagiousness, morbidity, and mortality are poorly understood.

    - You suffer from some type of mental condition that causes you to falsely believe you have Morgellons. You may also have some other type of illness which causes skin problems.

    In EITHER of these cases, you are going to need to work with compassionate doctors on an ongoing basis to get to the bottom of the matter. You need as much support as you can get going through something this difficult. If possible, find a therapist to deal with any issues you have. I mean, either option is pretty scary – either you’re infested with something unknown, or your senses are deceiving you. A therapist can help you sort this out.

    I’d also like to say that having a delusion about your skin does not mean you are crazy. Some very brilliant people have severe OCD, to the point that they are disabled. That doesn’t mean they are raving lunatics – it means they need treatment for that particular disorder. OCD was not well understood in the 70s, and people with severe cases were accused of malingering, hypochondria, hysteria etc. Now it appears that other types of illnesses, such as anorexia nervosa, may also be expressions of OCD. The good news is that there are good drugs on the market now to control OCD.

    Stay healthy, everyone!

  11. I don’t know if Morgellons is real or not. I will tell you, however, that I have watched my wife suffer unbearably for the last two years. I have seen tiny lesions on her skin burst open with small crystalline type fragments about one-fourth the size of a bb, for those of you who remember how big a bb is. It went from that to lesions inside her ear canals which have just about driven her out of her mind. She has lost over 30 pounds whichc is more than 25% of her body weight. She has lost the ability to concentrate on anything. She as had fibers erupt from her skin. Most of them, in her case, are red fibers about half the diameter of sewing thread and are either red or transparent. I don’t know what her disease is. We have been to the Cleveland Clinic, the Mayo Clinic and many hospitals. We have seen over 35 doctors, including ENT’s, rheumatologists, neurologists, dermatologists, general practitioners, and, yes, even a psychiatrist. Not a single one of them as prescribed any treatment whatsoever. Some have told her there is nothing wrong, but most just say I don’t know, and please pay me on the way out without even referring her to another physician. I know that if we don’t get some kind of help, she is going to die, from starvation if nothing else. She is so consumed that she can’t even eat. It is a very sad situation.

    Personally, I believe it is either Morgellans or some other kind of disorder that is very real. My wife is a strong person mentally. She has a variety of other ailments which force her to take a lot of pain medication. But nothing helps relieve the pain and distress of her condition.

  12. Hello, Richard. I’m sorry you and your wife have such a situation. Is a lot of pain medication all that your wife has been prescribed for whatever the variety of other ailments are that you alluded to? Did she have whatever those ailments are before seeing the over 35 doctors and specialists? Do you feel it’s a very good idea that she continues taking pain medicine when it doesn’t even help her any?

  13. Richard, surely, if you meant what you said about thinking your wife is going to die, of starvation, if nothing else, you can convince her to see an expert to keep that from happening. Have you tried?

  14. Richard, do you mean to say that your wife was formerly 120 lbs, and is now 90 lbs? Or that she was formerly 150 lbs, and is now 120 lbs?

    I ask because I would think that that kind of involuntary weight loss would set off all kinds of alarm bells for a doctor. It could be a sign of diabetes, or heaven forbid, cancer. Have you made any physicians aware of this change in her weight?

    You mention that she has other ailments and is taking pain medication. Is it possible that these other problems have caused her weight loss? Or do you believe the loss is caused by stress?

    I guess I am a little confused by your post, because you say that doctors have told her that nothing is wrong – but if she is on a significant amount of pain medication, presumably at least the prescribing doctor believes that she is in some type of distress. Are you saying that these other doctors have told her that they don’t understand the specific symptoms you describe here, or that they are an expression of other illnesses she suffers from? Or are you saying something else?

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