morgellons: disease or delusions?
TRANSCRIPT
Perspectives in Psychiatric Care Vol. 43, No. 2, April, 2007 67
Blackwell Publishing IncMalden, USAPPCPerspectives in Psychiatric Care0031-5990© 2007 Blackwell Publishing Ltd.?? 2007432
EDITORIAL
EditorialEditorial
Editorial
Morgellons: Disease or Delusions?
Is Morgellons a disease or a state of mind? Patients sayit is an infection and they need medical treatmentfor the disturbing symptoms. Some dermatologistscontend it is a case of delusional parasitosis, and theantipsychotic Orap relieves symptoms (Healy, 2006).Other physicians believe that the patients’ wounds areself-inflicted. Either way, Morgellons disease has recentlybecome a media headliner for TV, newspapers, and theInternet. The cause of Morgellons disease is currentlya medical mystery. After several requests to theCenters for Disease Control and Prevention (CDC) bypatients and politicians, the CDC initiated an investi-gation for potential causes in January 2006. Public healthofficials hope to rule out some unseen environmentaltoxin or new strain of infection. The epidemiologicinvestigation includes examining patients and collect-ing and analyzing tissue samples and strange fibersthat seem to emerge from the flesh.
Symptoms
The symptoms of Morgellons read like horrifyingscience fiction that is not real or possible. Ask 46-year-old Donna Grace about her symptoms and she will tellyou that they began in 2002 after receiving a flu shotand the injection site developed an infection.
Itching and crawling sensations under her skin beganand would not abate no matter what she did. In July 2006,Grace says she felt a mass rumbling beneath her scalpand a few weeks later she felt a hatching of hundredsof thousands of tiny bugs that crawled around her headand down her back. “I felt like I was going crazy, and Iknew I wasn’t” (Healy, 2006, p. F8). Individuals with thisdisease report disturbing sensations of bugs or wormscrawling, stinging, and biting as well as nonhealing skinlesions, rashes, and wounds. “I am not crazy,” patientsproclaim when describing symptoms of fiber-like fila-ments that emerge from the flesh and the presence ofblack speck-like material and crystal-like granules underthe skin. Nearly all people with this illness also reportextreme difficulty with mental concentration and short-term memory. Patients often suffer chronic fatigue and
what appear to be symptoms of depression, obsessive–compulsive disorder (OCD), and attention deficit dis-order (ADD) (Morgellons Research Foundation, 2006).
Is It Delusional Parasitosis?
As in the
DSM-IV-TR
(APA, 2000) Delusional Dis-order criteria, Morgellons patients are functioningin society, have no obvious signs of mental illness, andappear to have a nonbizarre somatic delusion. Manydermatologists say patients have been complaining ofthese symptoms for years and it is a dreadful, painfullyreal delusion. What are new are the name Morgellons andthe online community that has developed and reinforcesthe reality of this psychotic condition (Healy, 2006). Theprevailing conviction among most dermatologists thatthis is a delusion rather than a real disease results inpatients not being taken seriously and further investiga-tion being neglected. The physician fears reinforcing andmaking the patient’s delusion worse. Adding to the con-fusion is that over half of all individuals with Morgellonsdisease also suffer from mood disorders such asdepression and bipolar disorder. It is estimated that65% of children with Morgellons have some form ofpsychiatric illness such as attention deficit/hyperactivitydisorder, oppositional defiant disorder, mood disorders,or autism (Morgellons Research Foundation, 2006).
Dermatologist Mark Horowitz has treated patientswith these symptoms for over 30 years and believesthey have a “psychological disorder that’s very limitedin its spectrum” (Healy, 2006, p. F8A). Horowitz saysthat the recent upsurge in the disease and all the mediaattention can be directly traced to the Internet andinformation circulating widely online. Web sites havebecome a meeting place for patients who cannot findadequate medical help and turn to others with thesame symptoms in hopes of finding relief from thenightmarish disease. Sociologist Robert Bartholomew,with the Australian government, says that the WorldWide Web has become the incubator for mass delusionand it seems to be a socially transmitted disease overthe Internet (Healy).
68 Perspectives in Psychiatric Care Vol. 43, No. 2, April, 2007
Editorial
Is It a Disease?
The more than 5,000 sufferers of this malady believethat there is a new type of infection caused by a parasite,a worm, or a virus, and its source is still unknown. Morgel-lons disease is also referred to as the fiber disease andis, as yet, unrecognized by the medical community. Fibersare reported in and on skin lesions and are usuallywhite, but clinicians also report seeing blue, green, red,and black fibers that fluoresce when viewed underultraviolet light. As many as 94% who have Morgellonsalso test positive for Lyme disease (Morgellons ResearchFoundation, 2006). Preliminary evidence suggests thatMorgellons disease is not delusions of parasites, accordingto Randy Wymore (2006), assistant professor of pharma-cology and physiology, who has taken on the researchchallenge of Morgellons in his academic research.Wymore empathizes with the patients and believes thathe and his team will find the etiology that will hopefullylead to successful treatment options. Dr. William Harveyof Houston (Fowler, 2004) says one parasite filament isconfirmed as the infectious yeast
Candida tropicalus
. Othersseem to be algae or mold, all common in moist areas.
Treatment
Very few medical practitioners recognize this diseaseor understand what the patients are going through.Today Ginger Savely, a nurse practitioner in San Franciscowho specializes in this disorder and Lyme disease, istreating Donna Grace, who lives in southern California.After treating about 100 patients with Morgellons disease,Savely has developed several cocktails of antibiotics,antifungal, antiparasitic medications, and herbal sup-plements. She has even tried light therapy (Savely &Leitao, 2005). Savely says, “Whatever is causing this isextremely resistant or very adaptable” (Healy, 2006, p. F8).Her protocols mostly provide symptomatic relief forall patients afflicted with the condition rather than apermanent cure. Aggressive, long-term antibiotic therapyhas provided significant symptom relief in chronic Lymepatients, and is also being used with Morgellons patients.
This seems to help some patients; however, if they arestopped the symptoms come back (Wymore, 2006).
Role of Psychiatric APRNs
It is important to note that a family nurse practitionerplays a significant role in treating Morgellons diseaseand providing real empathy toward a group of patientswho have few places to turn to except the Internet forunderstanding. As psychiatric nurses we need to be awareof this disease so we are not too quick to side with theskeptics just because the symptoms are bizarre, like somany delusional symptoms we see in the mentally ill.Even though there is no evidence yet of what causes thesestrange and unrelenting symptoms, the CDC and otherreputable scientists have taken on the challenge to uncoverthe mystery and provide answers for both patientsand providers of care. Attention needs to be drawn toMorgellons so physicians and nurses are informed andable to make accurate diagnosis the first time the patientshows up for help. When we simply dismiss patients’painful symptoms as delusional when there is no physicalevidence of fibers, granules, rashes, and unhealed wounds,we need to question our ability to shift our paradigmswhen reality challenges our educated beliefs. We needto be willing to believe in the unbelievable when itpresents itself to us in the form of a suffering human beingwho has come to us for help with strange symptoms.
Mary Paquette, PhD, APRN-BC
References
American Psychiatric Association. (2000).
Diagnostic and statistical manualof mental disorders
(4th ed., text revision). Washington, DC: Author.Fowler, J. (2004). Segment 2: Mysterious parasite striking bay area
residents. KTVU—FOX. San Francisco, CA April 30, 2004. RetrievedJanuary 2, 2007, from http://www.ilads.org/mysterious_parasite.htm
Healy, M. (2006, November 13). Disease: Real or state of mind?
LosAngeles Times
,
Health Section
, pp. FA, 8A.Morgellons Research Foundation. (2006).
Case definition
. RetrievedDecember 21, 2006, from http://www.morgellons.org/
Savely, G. R., & Leitao. M. (2005). Skin lesions and crawling sensations:Disease or delusion?
ADVANCE for Nurse Practitioners
,
May
, 16–17.Wymore, R. (2006).
Morgellons research
. Retrieved December 21, 2006, fromhttp://www.healthsciences.okstate.edu/morgellons/research.cfm