Seasonality of Delusions of Parasitosis

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  • This article was downloaded by: [UQ Library]On: 13 November 2014, At: 19:44Publisher: Taylor & FrancisInforma Ltd Registered in England and Wales Registered Number: 1072954Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH,UK

    Journal of AgromedicinePublication details, including instructions forauthors and subscription information:http://www.tandfonline.com/loi/wagr20

    Seasonality of Delusions ofParasitosisJerome Goddard PhD a ba Mississippi Department of Health , USAb University of Mississippi Medical School , USAPublished online: 30 Sep 2008.

    To cite this article: Jerome Goddard PhD (2003) Seasonality of Delusions ofParasitosis, Journal of Agromedicine, 9:1, 23-26, DOI: 10.1300/J096v09n01_04

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  • REVIEWS, CASE HISTORIES,AND RESEARCH

    Seasonality of Delusions of Parasitosis

    Jerome Goddard, PhD

    ABSTRACT. Delusions of parasitosis (DOP) is an emotional disorderin which patients are convinced that they are infested with tiny, almostinvisible, mites or insects. Despite sample examination by entomologistsand repeated doctor visits, no evidence of a real infestation can be found.Previous studies of DOP patients have described epidemiological fea-tures such as age, race, and gender. This is the first report of an apparentlink between season of the year and DOP. [Article copies available for afee from The Haworth Document Delivery Service: 1-800-HAWORTH. E-mailaddress: Website: 2003 by The Haworth Press, Inc. All rights reserved.]

    KEYWORDS. Parasitosis, dermatology, seasonality, entomology, Mis-sissippi, delusions of parasitosis

    Jerome Goddard is Medical Entomologist, Mississippi Department of Health andAssistant Professor of Medicine, University of Mississippi Medical School.

    Address correspondence to: Jerome Goddard, Mississippi Department of Health,P.O. Box 1700, Jackson, MS 39215.

    Journal of Agromedicine, Vol. 9(1) 2003http://www.haworthpress.com/store/product.asp?sku=J096 2003 by The Haworth Press, Inc. All rights reserved.

    10.1300/J096v09n01_04 23

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  • INTRODUCTION

    Delusions of parasitosis is defined as a psychiatric disorder in whichthe patient is convinced of being infested with tiny insects or mites. Thecondition was first described in 1894 by Thibierge who called it acaro-phobia.1 Subsequently, various other names were proposed to describethe disorder, but most authors ultimately adopted the term coined byWilson and Millerdelusions of parasitosis (DOP).2 More recently,controversy has arisen over use of the term DOP because of definitionsof the word delusion.3,4 In mental health terminology, by definition, adelusion is a fixed false belief, and in some DOP patients, the belief (il-lusion?) is not fixed, but, instead, subject to change. Regardless ofname, DOP is a serious problem in which affected people may move outof their homes, quit their jobs, burn furniture, self-medicate themselveswith powerful drugs, and repeatedly use dangerous pesticides to ridthemselves and their families of the supposed infestation. Several ex-cellent overviews of DOP have been published.5-8

    Based on the hypothesis that onset of DOP symptoms, or at least theinitiation of calls to specialists by DOP patients, may be related to sea-son of the year, a review of older literature and recent clinical papers onDOP was initiated. In descriptions of at least 97 DOP patients, no men-tion of date of onset was included.3,4,9,10 Therefore, apparently there hasbeen no report in the scientific literature of DOP seasonality. This paperpresents data from client calls to the health department or the Coopera-tive Extension Service suggesting that onset of reporting of DOP in-creases in the summer and fall.

    METHODS

    A careful analysis of the authors logbook of all entomological con-sultations for the 8-year period from August 1, 1993-July 31, 2001 wasmade, noting all first-time reports of apparent DOP cases. Repeat callsfrom the same patient were excluded, as well as reports made by otherson behalf of the patient. In addition, workplace infestations involvingmultiple individuals were also excluded. It is important to note that notall cases included here were confirmed as DOP; many were lost to fol-low-up. Incidentally, 11 of these cases were carefully investigated andresults later published.11 Dates of first report to the medical entomolo-gist were plotted as to season of the year. Cases were placed in seasonalcategories as follows: Spring, March 21-June 20; Summer, June 21-

    24 JOURNAL OF AGROMEDICINE

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  • September 22; Fall, September 23-December 20; Winter, December21-March 20. In addition, two state-level Cooperative Extension Ser-vice entomologists were interviewed as to their cumulative experiencewith DOP cases.

    RESULTS AND DISCUSSION

    A total of 62 apparent DOP cases meeting the criteria outlined abovewere identified from the logbook over the 8 year period: 12 in Spring;17 in Summer; 21 in Fall; and 12 in Winter (Figure 1). There was asteady increase in DOP cases as late summer and fall approached eachyear. The seasonal distribution of DOP reports may be due, amongother things, to changes in weather (lower humidities, etc.), changes inbehavior (staying inside more), or a combination of the two. One of theExtension Service entomologists reported, In general, I have noticedan increase in apparent DOP cases as Fall and Winter approach. Thismay be due to the fact that people are inside more, humidities are lower,or people are developing dry skin conditions. All of these factors maycontribute to itchy feelings or crawling sensations on the skin (Per-sonal Communication, Dr. James Jarratt, MCES, Mississippi State Uni-versity, October 2001). The other Extension entomologist said, Iusually start to see an increase in DOP complaints in August when the

    Reviews, Case Histories, and Research 25

    Number of DOP Cases

    40

    20

    0Spring Summ. WinterFall

    12 17 21 12DOP Cases

    FIGURE 1. Seasonal distribution of delusions of parasitosis cases reported tothe Mississippi Department of Health, 1993-2001.

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  • humidity starts to drop and people are still running their air conditionersat full tilt (Personal Communication, Dr. Karen Vail, TCES, Univer-sity of Tennessee, October 2001).

    Further research is needed to carefully document factors affectingonset of DOP cases. Theoretically, knowledge of these precipitatingfactors could lead to better management/treatment of the disorder by thehealthcare community. In addition, research concerning other time fac-tors in the natural clinical history of DOP could help define the dura-tion of symptoms, the cure rate, the relapse or recurrence rate, as well assingle or multiple treatment modalities. Unfortunately for medical ento-mologists, the number of cases of DOP for such study is small in any lo-cale.

    REFERENCES

    1. Thibierge, G. Les acarophobes. Rev Gen Clin Therap. 1894; 32:373-376.2. Wilson JW, Miller HE. Delusion of parasitosis. Arch Dermatol Syphilol. 1946;

    54:39-56.3. Zanol K, Slaughter J, Hall R. An approach to the treatment of psychogenic

    parasitosis. Int J Dermatol. 1998; 37:56-63.4. Slaughter JR, Zanol K, Rezvani H, Flax J. Psychogenic parasitosis: a case series

    and literature review. Psychosomatics 1998; 39:491-500.5. Lyell A. Delusions of parasitosis. Br J Dermatol. 1983; 108:485-499.6. Driscoll MS, Rothe MJ, Grant-Kels JM, Hale MS. Delusional parasitosis: a

    dermatologic, psychiatric, and pharmacologic approach. J Amer Acad Dermatol.1993; 29:1023-1033.

    7. Webb JP Jr. Case histories of individuals with DOP in southern California and aproposed protocol for initiating effective medical assistance. Bull Soc Vector Ecol.1993; 18:16-25.

    8. Hinkle NC. Delusory parasitosis. American Entomol. 2000; 46:17-25.9. Zomer SF, DeWit RFE, Van Bronswijk JEHM, Nabarro G, Vloten WAV. Delu-

    sions of parasitosis. A psychiatric disorder to be treated by dermatologists? An analysisof 33 patients. Br J Dermatol. 1998; 138:1030-1032.

    10. Bhatia MS, Jagawat T, Choudhary S. Delusional parasitosis: a clinical profile.Int J Psychiatry Med. 2000; 30:83-91.

    11. Goddard J. Analysis of 11 cases of delusions of parasitosis reported to the Mis-sissippi Department of Health. S Med J. 1995; 88:837-839.

    RECEIVED: 04/18/02REVISED: 05/06/02

    ACCEPTED: 05/06/02

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