Both arms and legs were freshly bandaged, but the red was still visible on the surface seeping through the soft, white gauze. The misery that rose up out of her was pervasive, filling up the exam room.
“What on earth happened to you?”
“Doc.” She paused for a deep breath. “I have worms.” I could see the fear. Even if they were not real, they were real to her and that was all that mattered. “They are crawling under my skin and I don’t know how to make them stop. I try to catch them with tweezers but no matter how fast I am or how deep I dig, I just can’t reach them.”
She was on blood thinners for her heart, which made this worse.
“I saw this thing on the news about Morgellons Disease. I think that is what I have.” Sure enough, it had been all over the news. Doctors everywhere were upset as people flocked to the office worried that any itch or burn or skin lesion was this mysterious disease.
“Wait. Did this start before of after the news story?”
“Why do you think you have it?”
“I see these fibers inside the sores…”
“Wait. Did you have these sores or did you make them with the tweezers?”
She looked embarrassed. “I made them.”
“Do you have some of these fibers so I can look at them?”
“Welllllll…. No. But I see them all the time. I bet there are some right now.”
We unwrapped her arms and legs and did a thorough search for the fibers. Nothing.
“I just don’t understand why we can’t find any…” She was very distressed.
I told her not to worry, she could save some for me and bring them to her follow up visit in a few days. We talked about wound care. I gave her an antibiotic for the infection that was starting and a steroid for the itching, hoping that would take care of it but knowing that it probably wouldn’t.
Long story short, she never could bring any fibers and she never got better. She could not stop picking, even when her family took away the tweezers. We had months of this. She and her family got more and more frantic. She became anemic. She lost weight.
Several dermatology consults turned up nothing. Nothing except delusions of parasitosis…
In these kinds of situations you cannot just tell someone it is all in their head.
“I have a medication that can help with that itching.”
“No way am I going to take that, doc. It’s for crazy people!”
How does a nice, reasonable woman with no prior psychiatric history have this happen? How does that switch get flipped?
Eventually she did agree to take the medication. The switch flipped off. Just when everything was almost healed, she decided to stop it. It came roaring, raging back and she was bandaged up all over again.
This became a battle that persisted for several years until she eventually died (from other causes). It would go away when she was on the antipsychotic drug and return when she was off of it.
It is so easy to discount people as “crazy”, to put them into a box and close the lid, but delusions and psychosis are still real and are responsible for very real suffering. Remember your compassion.