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Ekbom syndrome (delirium of parasitosis): causes and symptoms

Ekbom syndrome (delirium of parasitosis): causes and symptoms

January 17, 2022

Schizophrenia spectrum disorders, the abrupt cessation of alcohol consumption in addicted persons or traumatic brain injuries, among other alterations, may cause the appearance of a very peculiar type of delirium: the Ekbom syndrome or delirium of parasitosis .

People with this disorder believe they have insects or other parasites on their skin, and often continue to maintain this idea even if medical tests refute it. Let's see what causes are due and exactly what this delusion consists of.

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What is Ekbom syndrome?

Ekbom syndrome is a psychological disorder that is characterized by delusional belief that the person has insects under the skin, or small parasites of another type . This alteration is associated with the presence of tactile and pruritus hallucinations (constant itching in a part of the body that causes an intense impulse to scratch).


Those who have Ekbom syndrome can hold with great conviction the idea that they have parasites on their skin for a long time and despite the evidence against them that is obtained through medical examinations or in other ways. If these conditions are met, the alteration would be classified as a delusional disorder itself.

From other perspectives, the Ekbom syndrome is conceived as a psychosis with the delusional belief as the only symptom . This is why sometimes antipsychotic drugs such as pimozide and olanzapine are used to treat this disorder, although there are also psychological procedures for the management of delusions and hallucinations.


Other names that are used to refer to Ekbom syndrome are "Delirium of parasitosis", "delirious parasitosis", "dermatozoic delirium", "parasitic delirium" , "Delirium of infestation" and "imaginary parasitosis". The ICD-10 diagnostic manual, which specifically includes this disorder, calls it "delirium of parasitosis".

This alteration is more common in women, especially from the fifth decade of life. Some experts attribute this fact partially to the arrival of menopause, which is associated with the appearance of abnormal sensory phenomena to which the person could give a delirious interpretation, thus giving rise to the Ekbom syndrome.

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Symptoms and clinical picture

Most people who have Ekbom syndrome report sensations that they attribute to movements of insects that pass through the skin or that move through the inside of the skin. This abnormal perception is called "formication" and is part of the phenomena known as paresthesias, which also include punctures or numbness.


Although ants are one of the most frequently referred to "parasites" and give names to different terms that are used to refer to Ekbom syndrome, it is also common for people with this disorder to say that they have worms, spiders, lizards and other small animals. Sometimes they claim that these are invisible.

Under certain conditions, any person can perceive sensations of formation, especially if circumstances give rise to them, such as menopause or medical alterations that affect the sensory nerves . However, the generation of delusional belief is much less common and requires some kind of trigger.

There are two major categories of delusions of parasitosis depending on the nature of the alterations. We speak of primary Ekbom syndrome when the symptoms arise in the absence of identifiable problems, and therefore can be attributed to errors in the patient's reasoning. This subtype has a nature similar to that of acute psychosis.

In contrast, when an underlying disorder that triggers the delusional belief is detected, the disorder is classified as secondary. In turn, this type is divided into two: functional, which is diagnosed in cases in which the syndrome is due to a psychiatric disorder such as schizophrenia, and organic, when the cause is a disease or a drug .

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Disorders and related disorders

Often the appearance of the Ekbom syndrome is associated with a hyperactivation of the organism due to the consumption of certain substances. In particular, delusional parasitosis in many cases is due to Withdrawal syndrome in people with alcohol dependence or to excessive consumption of cocaine or other stimulants.

In addition to psychotic disorders, other alterations in the structure and functioning of the brain may explain the emergence of this disorder. Neurodegenerative diseases (including alcoholic dementia) and traumatic brain injuries, for example, are two common causes of Ekbom syndrome.

It is interesting to mention also delirious kleptoparasitosis, which is considered a subtype of the Ekbom syndrome. In this variant the person does not maintain the belief that there are bugs on their skin, but that they infest their residence and therefore run the risk of being parasitized. However, it is possible and usual for both disorders to occur at the same time.

Morgellons syndrome is another variant of delirium of parasitosis in which the parasites are replaced by fibers of different types that have had contact with the skin, such as cloth or remnants of bandages, or are not identified by the patient. It is a rare disorder that has begun to be studied just over ten years ago.


How to treat patients with delusional parasitosis (January 2022).


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