the morgellons mystery: march 23, 2007

[ladycolorado]

The Morgellons Mystery
An Old Disease Making New Waves
© Laurie Pawlik-Kienlen

Mar 23, 2007

Delusional parasitosis is a rare, time-honored psychiatric disorder in which you feel bugs crawling under your skin. Is Morgellons disease a variation of this disorder?
Morgellons disease, delusional parasitosis, people suffering from the disorder, and the federal Centers for Disease Control and Prevention are all embroiled in a heated debate.

According to Psychology Today (March/April 2007), this problem – Morgellons disease – was brought to light by a layperson who has a sick two-year old son. This is frustrating clinicians and doctors. They don't know how to proceed because usually an official source provides credible information that a problem exists. A layperson armed with a 17th century French medical article describing an obscure condition isn't the usual source of a new (or revived) medical disorder.

Morgellons disease
The morgellons are black hairs that emerge from the skin. The most visible aspect of this disease is skin symptoms, leading patients to consult dermatologists first. They often bring samples of what's found in their skin in matchboxes or plastic baggies; dermatologists determine those samples to be clothing fibers, and diagnose patients with delusional parasitosis. They prescribe antipsychotic medication.

A dermatologist in California called Noah Craft was approached by the Center for Disease Control to provide information about Morgellons disease for this investigation. Three years ago, his first "real" Morgellons patient brought information from the internet, not samples in a baggie. A dozen other doctors missed it, but she really had the disease. Now Craft biopsies the skin of all potential Morgellons patients to "do due diligence to rule out other causes" – and has seen a handful of people with Morgellons.

Delusional parasitosis?
Most physicians lean towards delusional parasitosis, but a few people think there's more to it than a psychiatric disorder. One reason is that the fibers from the two-year old boy with the layperson mother are unidentifiable. They're unknown even to forensic and fiber experts. Another reason is that Morgellons patients are all sick in similar ways: confusion, cognitive problems, loss of control of one foot, sagging mouth, neurological symptoms, joint pain, fatigue, skin sores and scars. A third is that close investigation with a dermatoscope reveals black, red, blue, and white fibers protruding from the skin (and they couldn't have been planted by the patient which is part of delusional parasitosis).

A co-infection could be occurring; 90% of Morgellons patients test positive for Lyme disease. The reason is unknown, but perhaps people with weakened immune systems could be at higher risk for both diseases.

Psychological symptoms of Morgellons
In the beginning stages of Morgellons, patients can't tell their story very well. They're usually forgetful and display speech hesitancies. As the disease progresses they can display extreme paranoia and even delusional behavior. Their personalities can change and other diagnoses can result: bipolar, ADHD, or autism. Morgellons isn't a well-known, easily-diagnosed disease and the patients are aware of this: the stigma of being told they have a psychological disorder instead of a "real" disease can trigger self-doubt, confusion, and fear – which could spiral downwards into a psychological disorder.

The doctors and psychologists
Doctors may enjoy social respect, but they don't usually enjoy luxurious days at work. It's not easy for doctors to diagnose rare diseases and deal with the psychological and emotional aspects of their patients. That's a great deal to juggle in a ten minute visit! Further, the health system is quite compartmentalized, making it difficult for doctors to communicate and pull all the pieces of one disease together.

What happens next?
The federal Centers for Disease Control and Prevention will continue their investigation. Whether Morgellons becomes a more common diagnosis or whether it's a type of delusional parasitosis remains to be seen.