Parasites that crawl around under your skin are real. That's horrifying enough. But imagine being under the firm belief that you can feel these parasites or insects burrowing inside and crawling all over your body, even though they aren't really there.
That's the reality for up to 90,000 Americans who are suffering from a horrifying syndrome known as "delusional infestation", according to a new study published in JAMA Dermatology. It's far worse than you're picturing.
"Patients usually complained of crawling, burrowing and biting worms and insects," a team of psychiatrists wrote in the Annals of the Academy of Medicine, Singapore. "Patients may resort to self-mutilation in an attempt to remove the 'parasites', such as obsessive nail-biting, or using a razor blade."
Other sufferers are described as engaging in "purification rituals" and have been known to apply kerosene to their own hair and douse themselves in insecticide in order to kill the imagined bugs living under and on their skin.
A real case of parasites crawling beneath the skin.
One sufferer, a 58-year-old woman in South Carolina, went to extreme lengths to stop the spread of her imagined parasites after she began to believe brown and gray beetles were burrowing under her skin. Her psychiatrists report in Primary Psychiatry that she believed that larvae were coming out of her anus. Wanting to stop them from infecting other parts of her body including her genitals, she decided to duct-tape her anus shut in order to keep the bugs in. She also reported to doctors that she had taken a bath in kerosene, and used a tampon dipped in bug spray to stop the bugs from departing her anus.
The delusion in some patients is so complete, they'll gather "evidence" for their doctors that their parasites are real, which usually turns out to be pieces of skin or scabs that they've picked off themselves.
Alarmingly, researchers from the Mayo Clinic have now looked at a database of cases over the last 30 years and discovered that the delusion is a lot more common than previously thought. They found that between 1976 and 2010, there were 35 cases of the disorder in Olmsted County, Minnesota alone.
From this, they calculated that around 27 out of 100,000 people suffer from the distressing disorder, which means around 90,000 people in the USA could have the delusion right now.
The condition can be triggered by schizophrenia or seen in patients with dementia and other neurological disorders, as well as in users of drugs such as amphetamines and cocaine.
Dermatologist Mark Davis, an author on the paper, told Science News that patients often reject diagnoses of the disorder, and seek treatment elsewhere, still believing their delusion to be real.
A version of this article was first published in July 2018