I’ve decided to describe a largely unacknowledged process of disease pathogenesis that I will call folie a news. To explain though, I’ll have to first discuss a disease called delusional parasitosis.
Delusional parasitosis (DP – sometimes called Ekbom’s disease) is a lot like what it sounds like. Normal or abnormal sensations of itching are interpreted by the patient as being bug bites, or bugs traveling under the skin despite the absence of histological evidence of a parasitic infection. This is what is known as a “fixed delusion” and it becomes an obsession for the patient. The disease has a few known organic causes such as amphetamine or cocaine-use and many common co-morbities including diabetes, schizophrenia, fibromyalgia, chronic fatigue syndrome, lyme disease and depression.(1) Patients usually present to a dermatologists office complaining of sensations of itching and biting from insects, and frequently carry in samples of skin or lesions they’ve scratched off – this is referred to as “matchbook sign” in that the patients would often present with their skin scrapings in a small box like a matchbook. These days it’s probably more likely to be “zip lock sign”.
12% of DP patients present with what is known as folie a deux(literally madness of two) in which the patient is not the primary sufferer of the delusion, but has adopted the delusion of another patient – usually a spouse or other family member.(2) It’s also important to remember that these people may be perfectly rational in every other way, but have just this single fixated delusion. Also, the feelings they’re having are real – one must not tell them it’s just “in their head” – it’s just what they’re ascribing them to is off . Further treatment with atypical anti-psychotics – which is effective a majority of the time – should be broached carefully as people feel stigmatized by diagnoses of mental illness.
Now keep these things in mind while watching the following video that grrlscientist blogged this weekend about people who think bugs are crawling out of their skin.
(video and more below the fold)
All the symptoms of DP are there, but what I find unfortunate about this presentation is how credulous the reporters are and how sensationalized the report was. Why not consult a dermatologist or two? And the comparisons to ignroring the AIDS epidemic? The guy who says it is a doctor, he should know better that public health officials were desperate to get the word out on HIV and it was primarily politicians who didn’t want to be seen as caring about a disease of gays (his reference to “and The Band Played On” is a work about the attempts by researchers to get attention and funding to an emerging disease). Or how about even an entomologist? That creepy moving bug and those chunks of bug parts? Likely a springtail – or collembola – which is pretty much the most ubiquitous arthropod on the planet making the diagnosis more likely that she had unwashed hands or had recently been gardening rather than being bitten by a bug with no mandibles to bite!
This reminds me of a similar “outbreak” of a similar skin disorder which was dubbed by the sufferers “Morgellon’s disease” after a somewhat ancient description of, well, DP. The patients have even founded the Morgellon’s research foundation to fund investigation into what they believe is an emerging disease (also see Morgellonswatch – a group that debunks Morgellon’s claims). Outbreaks are linked, more than anything, to news coverage of people who believe they are being parasitized by insects. Prominent positive signs also tend to include an internet connection. Collembola was also identified (although the images are pretty sketchy) in the skin scrapings of several Morgellon’s patients. If real it’s a sure sign of dirty fingernails rather than a sudden shift in behavior of a ubiquitous bug from eating decaying leaves to eating human flesh. It’s been recently a topic of discussion in the Journal of the American Academy of Dermatology to use Morgellon’s disease as a “A rapport-enhancing term” for DP, but no real scientists believe that it is separate disorder from DP (although the advocates have acquired a crank MD).
Here’s where my title for this article comes in. It does people no good when media reports credulously report this kind of conspiratorial nonsense about science or disease without consulting real experts (not fake ones) that can give people insight into what is actually going on. Pretty much any dermatologist or psychiatrist could proffer a good explanation for what’s happening here, and rather than having people go on driving themselves nuts looking for bugs, treating themselves with pesticides, and generally making things worse, they could see the appropriate healthcare professionals that could make a real improvement in the quality of their lives. Instead, what do we have? News reports that sensationalize a disease in such a way that it’s now likely that more people will adopt the delusion, and worse yet, not seek or be resistant to appropriate treatment. All this kind of reporting creates is fear and misery, and should be opposed vehemently by people who are actually concerned that patients suffering from such symptoms get appropriate care. Instead what we have is junk reporting, fearmongering, and, surprise surprise, more people reporting these symptoms, not from some mystery being uncovered, but rather from folie a news. Hell, the report made me itchy for hours.
I think we should consider folie a news (or to be consistent folie a televise or folie a nouvelle but I like how “news” kind of rhymes with “deux”) a new source of disease pathology. News stories that are so bad, so hysterical, and so irresponsible, that they actually contribute to illness in a population by increasing delusional symptoms in the populace and misdirecting efforts of patients away from beneficial treatment. There are dozens of examples of news reports causing similar mass hysteria (from the New Delhi monkey man to penis panic(koro) to photosensitive epilepsy to this recent idiocy about electrosmog) , maybe it’s time we considered evaluating bad news reports as what they are – a public health menace.
(1) Delusional parasitosis or Ekbom syndrome: a case series. Nicolato R – Gen Hosp Psychiatry – 01-JAN-2006; 28(1): 85-7
(2) Koo J., Lee C.S.: Delusions of parasitosis: a dermatologist’s guide to diagnosis and treatment. Am J Clin Dermatol 2. 285-290.2001;
(3) Morgellons disease: a rapport-enhancing term for delusions of parasitosis. Murase JE – J Am Acad Dermatol – 01-NOV-2006; 55(5): 913-4