Ekbom syndrome is an uncommon - though not rare - psychiatric condition, also known as 'Delusional
Parasitosis.' It occurs mainly in middle-aged or older women. It is classified in ICD-10 as
Persistent Delusional Disorder, and DSM-5 as Delusional Disorder, Somatic Type. Somatic
means a psychological condition with physical symptoms as part of it. I'm Dr Beth Colby from
Talk Mental Health, and I'm a psychiatrist in London. People with Ekbom Syndrome believe that
they are infested with organisms, and they refer to these as parasites, worms, larvae, insects
or bugs. Even when they've been thoroughly investigated for evidence of infestation
and the tests have come back negative, they still firmly believe that they are infested, and may
shop around for different doctors, believing that the previous ones have got the diagnosis wrong.
The belief is to a delusional intensity. Patients also experience tactile hallucinations,
such as insects crawling under or on their skin, or burrowing in their skin, biting them, stinging,
or other bodily sensations. Patients also experience visual hallucinations,
and believe that they can see the organisms. They are able to describe these in detail, and also
draw them. The commonest type of drawings are of arthropod-like animals with a head and legs,
or white cylindrical worms of various lengths. As patients don't believe that they have a
psychological or psychiatric disorder, they rarely see psychiatrists. This is unfortunate,
as Ekbom syndrome is treatable with antipsychotic medication and psychological therapies. Instead,
patients present to dermatologists or parasitologists, or even may call the pest-control
agents out. If they believe that their pet is infested, they may seek advice from their vet.
People who suffer from Ekbom Syndrome spend a lot of time trying to get evidence of infestation.
They may scratch or use sharp objects to try and get the parasites out of their skin. They may use
dangerous substances such as pesticides, or elements such as fire or electricity to try and
rid themselves of the organisms. They collect particles of skin,
hair, clots, scabs, dust and fibre as evidence, and often put these in a matchbox.
Patients present to doctors with evidence of self-mutilation of their skin, with scars, scabs,
burns and other markings. It is not uncommon for other people in the patient's household
to go on to believe that they themselves are infested, and they then become delusional with
the same delusions as the patient. This is known as 'folie a deux', or 'madness of two'. It's
understandable from the point of view that scratching is contagious, much like yawning.
If somebody mentions nits, the first thing I do is start scratching my head,
thinking that I might have them! If there are three patients in the household, the
name is 'folie a trois' ie 'madness of three', or 'folie a plusiers' is 'madness of many'.
Just because more than one person in the household believes that they are infested, it does not mean
that this is the case, though each patient should be investigated in their own right.
Initially, the patient is able to compartmentalize their symptoms and lead a normal life. However,
more and more, the delusions take over their mind and their lifestyle. They may leave their job,
believing that they may infest other people if they carry on working. People spend more and
more time obsessively cleaning their house to rid the house of parasites or other organisms.
They may throw away objects or clothes that they believe are infested and eventually they may leave
their 'infested' house. Finally, patients become very isolated, as they do not wish to infest other
people, and other aspects of their psychological life, like sleep and mood, are affected.
I hope you have enjoyed hearing about this interesting, though distressing, condition.
Thank you for listening. 'Bye for now.