Mick West

From Psychiatric News March 16, 2007, Volume 42, Number 6, page 18:
http://pn.psychiatryonline.org/cgi/content/full/42/6/18

OCD Patients May Seek Help From Dermatologists
A substantial percentage of patients who show up in dermatologists’ offices have skin conditions that arise from obsessive-compulsive disorder, highlighting the need for dermatologists and psychiatrists to forge closer collaborations.
[…]
Some people who scratch and pick their skin excessively have delusions of infestation by parasites. Specimens brought to the dermatologist, Kestenbaum said, often prove to be lint from clothing or ordinary sloughed off skin cells.

Self-diagnosed Morgellons disease is a relatively new phenomenon in the dermatologist’s office, she said, fueled by media reports and the Internet. People who believe they have this disorder commonly report crawling, stinging, and biting sensations. Some claim that fibers emerge from intact skin (Psychiatric News, December 15, 2006).

While all symptoms demand a careful workup, Kestenbaum said, “patients with such complaints whom I have seen appeared to have a delusional parasitosis.”

Meanwhile, a multidisciplinary task force at the Centers for Disease Control and Prevention (CDC) is developing an instrument to investigate the symptoms these patients present. “There is no credible evidence at present to implicate any pathogen in Morgellons disease,” CDC spokes-person Dan Rutz told Psychiatric News. Several different mechanisms may account for patients’ distress, he said.

Writing in the November 2006 Journal of the American Academy of Dermatology, Philadelphia dermatologist/psychoanalyst Caroline Koblenzer, M.D., suggested that “Morgellons syndrome” may be a more apt name for this symptom complex than “Morgellons disease.”

So, it seems that the term “Morgellons” may in fact eventually enter the official medical lexicon, but meaning different things to doctors and patients. A “rapport enhancing term” for a complex of symptoms that includes a degree of mistaken belief in some parasite or pathogen.

It seems unlikely the CDC wil report before 2008. But in the meantime, the above article (read the whole article), is probably the most accurate reflection of the medical establishment’s position on “Morgellons”

People are ill, people have various real physical symptoms, and people are not all getting cured. Nobody denies this. Nobody is suggestion that people are “imagining” sores or “imagining” pain. The symptoms are real.

But, the fundamental question is: can the symptoms be explained by existing conditions, or is there evidence of a new disease, called “Morgellons”?

If you have a car, you will at some point in your life get a ding in your windshield. Suppose thousands of people got these dings, is this evidence of anything? It’s possible to believe so:

http://www.historylink.org/essays/output.cfm?file_id=5136

On April 15, 1954, Bellingham, Seattle and other Washington communities are in the grip of a strange phenomenon — tiny holes, pits, and dings have seemingly appeared in the windshields of cars at an unprecedented rate. Initially thought to be the work of vandals, the pitting rate grows so quickly that panicked residents soon suspect everything from cosmic rays to sand-flea eggs to fallout from H-bomb tests. By the next day, pleas are sent to government officials asking for help in solving what would become known as the Seattle Windshield Pitting Epidemic.

Obviously windshield dings are real and nothing new. But what causes people to suddenly notice them, and believe that something new is happening? The article concludes:

The Seattle Windshield Pitting Epidemic of 1954 did indeed become a textbook example of collective delusion, sometimes mistakenly referred to as “mass hysteria.” To this day, sociologists and psychologists refer to the incident in their courses and writings alongside other similar events, such as Orson Welles’ Martian invasion panic of 1938, and supposed sightings of the “Jersey Devil” on the East Coast in 1909.

The Seattle pitting incident contains many key factors that play a part in collective delusion. These include ambiguity, the spread of rumors and false but plausible beliefs, mass media influence, recent geo-political events, and the reinforcement of false beliefs by authority figures (in this case, the police, military, and political figures).

This combination of factors, added to the simple fact that for the first time people actually looked “at” their windshields instead of “through” them, caused the hubbub. No vandals. No atomic fallout. No sand-fleas. No cosmic rays. No electronic oscillations. Just a bunch of window dings that were there from the start.

With Morgellons, people are sick for all the usual reasons. Then they look at their skin, and see the normal things you find on anyone’s skin, but because this is the first time they have closely examined their skin, they see specks and fibers. Then they self-diagnose with Morgellons. Sure, maybe Morgellons is a new distinct condition, but there is no more evidence to suggest this than there was evidence to suggest that H-bomb fallout was pitting windshields in Washington, back in 1954.

Professor Citovsky asked me to post the following note:

I would like to clarify the involvement of my research group in the Morgellons studies. We are biochemists and cell and molecular biologists who study fundamental and diverse biological processes, such as genetic transformation, intercellular transport, and chromatin remodeling, using plants as experimental systems. Because one of our model organisms, Agrobacterium, is capable of genetically transforming not only plants, but also other eukaryotic species, including human cells, we were contacted by Dr. Stricker and MRF to investigate potential presence of Agrobacterium in biopsies from Morgellons patients. A limited number of anonymous samples provided by Dr. Stricker were tested by PCR for the presence of different families of Agrobacterium genes. Control reactions included samples from healthy donors provided by us. Only Morgellons, but not healthy subjects tested positive in these studies. This observation does not imply that Agrobacterium causes Morgellons or that Morgellons is indeed an infectious disease. However, it does encourage future studies to determine (i) statistical significance of our data, (ii) whether or not Agrobacterium is not only present extracellularly, but also causes genetic transformation of the infected tissues, and (iii) whether or not infection of laboratory animals with Agrobacterium can recreate at least some symptoms of Morgellons. These are the immediate goals which may or may not be pursued, depending on the available research funding which is currently non-existent for Morgellons.

Vitaly Citovsky, Ph.D.
Professor of Biochemistry and Cell Biology

This NPR piece just tells the  story of Morgellons:

http://www.npr.org/templates/story/story.php?storyId=6685822

It’s reasonably well done.  Of interest is that the CDC expects their investigation to “take six months and cost hundreds of thousands of dollars”.  Which means you probably won’t be hearing anything from the CDC until sometime late 2007.

Still, it looks like the medical profession is forging ahead – again in the story is a mention of simply taking the name “Morgellons” and making it synonymous with Delusions of Parasitosis.   Overall, I feel the discussions surrounding Morgellons will eventually lead to the development of better ways of treating people with DOP, as well as some investigation into various physical triggers for DOP/Morgellons.

A couple of interesting articles:

Strange List of Symptoms Perplexes Patients, Doctors
http://pn.psychiatryonline.org/cgi/content/full/41/24/19

Psychiatric Arsenal Has Weapons Against Morgellons Disease
http://pn.psychiatryonline.org/cgi/content/full/41/24/19-a

The latter puts to rest the belief that doctors always dismiss patients automatically as delusional without examining them:

Caroline Koblenzer, M.D. […] a clinical professor of dermatology at the University of Pennsylvania and a psychoanalyst, has treated dozens of delusional parasitosis patients over the years and several dozen morgellons patients during the past six months.
“We do biopsies, we do blood tests, all those things that would rule out the extrusion of any foreign material, whether it be living or nonliving.

“If a patient came to me, I would make sure that he or she had an evaluation by a dermatologist to make sure that there wasn’t any.. .infestation by an organism,” Gerard Gallucci, M.D., said. ”

“I would recommend [doing] some testing to make sure that the patient does not have a skin infection,” said William Meehan, M.D., Ph.D., a University of Massachusetts psychiatry resident who co-wrote a paper about delusional parasitosis in the March Archives of Dermatology. “I would also want to rule out any other problem that might lead to a sensation of bugs crawling on the skin—for example.. .using cocaine or.. .certain endocrine problems, such as thyroid and liver disease.”