• Home
  • Store
    • Newsletter Subscriptions
    • Multimedia Subscriptions
    • Books
    • eBooks
    • ABPN SA Courses
  • CME Center
  • Multimedia
    • Podcast
    • Webinars
    • Blog
  • Newsletters
    • General Psychiatry
    • Child Psychiatry
    • Addiction Treatment
    • Hospital Psychiatry
    • Geriatric Psychiatry
  • Log In
  • Register
  • Welcome
  • Sign Out
  • Subscribe
Home » Blogs » The Carlat Psychiatry Podcast » Morgellons: A Tiny Bug or a Big Delusion?

The Carlat Psychiatry Podcast
The Carlat Psychiatry Podcast RSS FeedRSS

Clear, engaging, and practical updates on clinical psychiatry.
Earn CME for listening to the podcast with a Podcast CME Subscription.
Listen for free here or using Apple Podcasts, Android, or Stitcher.

Morgellons: A Tiny Bug or a Big Delusion?

September 16, 2020

If you haven’t seen a patient with Morgellons yet, it’s a good guess that you soon will. Patients with this syndrome experience crawling, biting, and stinging sensations in the skin.


Published On: 9/16/2020


Duration: 8 minutes, 4 seconds


Transcript:

If you haven’t seen a patient with Morgellons yet, it’s a good guess that you soon will. The disorder was named in 2002 by Mary Leitao, a former lab technician whose son complained of bugs under his skin. She had gone to numerous specialists who diagnosed delusional parasitosis or even f Munchausen's by prox. Frustrated, Mary dug into medical history and found reports from 1656 by Thomas Browne who described a condition he called Morgellons where children broke out with harsh black hairs on their back. Since Mary had found multi colored fibers in her son’s sores, she adopted the name and created a website which attracted thousands of followers. In the coming years the lobbied congress and the CDC to investigate with the help of singer Joni Mitchell who also identifies with the illness. 

Patients with this syndrome experience crawling, biting, and stinging sensations in the skin. They present to dermatologists with skin lesions like rashes or sores and complain of fibers emerging from their skin, often bringing Ziploc bags of skin samples with them. Most dermatologists believe these are just clothing fibers that got embedded in self-imposed sores, and studies at the Centers for Disease Control – CDC – and the Mayo Clinic originally concluded the same, finding that the fibers were cotton in orgin.

After the CDC report came out in 2012, Mary Leitao retreated from public life and the Morgellons website transitioned to other hands. But a small group of clinicians and researchers took up the mantel. The main players here are Randy Wymore, a pharmacologist at Oklahoma State University, Virginia Ginger Savely, a family nurse practitioner; Raphael Stricker, an internist in California, and Marianne Middelveen, a Veterinary Microbiologist in Canada. And their argument is that these fibers are not fragments of clothing but are part of an inflammatory reaction to a spirochete infection, that’s the spiral shaped family of bacteria like syphilis and the controversial Lyme disease.

Virginia Savely carved out a specialty in Lyme disease and published a paper with Dr. Stricker claiming that 97% of the Morgellons patients they saw tested positive for the Borrelia spirochete that causes Lyme’s disease. This caught the attention of Dr. Middelveen, the Veterinary Microbiologist, who concluded that the fibers were not made of cotton but rather of keratin and collagen and most likely likely produced by epithelial cells in the skin. But why would the skin start producing them? Dr. Middelveen hypothesized that it was a reaction to a spirochetal infection. And why were these hairs blue? Melanin pigmentation was Dr. Middelveen’s conclusion    n, admitting that some of the fibers were from clothing, plastic and dust that got imbedded in the skin.

One problem with this research is that they use their own criteria to diagnose Lyme disease, which greatly inflates the diagnosis. One of their studies found a 90% rate of Lyme disease in Morgellon’s patients, but the rate was only 10% when the CDC criteria were used. This discrepancy of definitions seeps into psychiatric practice, where patients often present with a diagnosis of Lyme disease made by an alternative medicine provider. Rather than taking sides on this issue I’ll suggest these patients look at both sides of the controversy and make up their own minds. QuackWatch gives a more skeptical view of overblown medical claims and has a good section on Lyme disease.

The other problem is that most of the papers supporting the infectious cause of Morgellons come from this small group of researchers, only one of whom is a physician. And some of these writers have had struggles with scientific ethics. Dr. Stricker, M.D. was accused of falsifying data by the National Institutes of Health in 1993. His paper claimed to have identified a antibody to the HIV virus that was found only in homosexual patients. It was published in the New England Journal of Medicine in 1985, was retracted. The debacle caused Dr. Stricker to lose his post at UC San Francisco, set loose from academia he tried out new pursuits, including directing a penis enlargement clinic before starting a Lyme Disease specialty clinic in San Francisco.

Dr. Stricker has published many of the articles on the Lyme-Morgellons connection along with nurse practioners he employes, starting with Ginger Savely. Ms Savely came to work with Dr. Stricker after being reprimanded by the State of Texas for practicing outside the standards of care in her Lyme Disease specialty clinic where she placed patients on long-term antibiotic therapy for a reported $500 a visit. In 2011 Kamala Harris, who was then attorney general of California and now a vice presidential candidate, publically reprimanded Ms. Savely for similar problems. 

So what do you do when a patient presents with unexplained skin lesions, fibrous strands, and complaints of bugs crawling under their skin? First, establish a working alliance – not an easy feat in these cases but one that Michael Posternak tackled in this Monday’s podcast. Next, check for dopaminergic agents which can often cause formication or the feeling of bugs crawling in the skin. Stimulants, cocaine, but also meds for restless leg syndrome like pramipexole and even aripiprazole, buproprion and the modafinils which have mild dopaminergic effects. Finally, consider an antipsychotic, and our online issue has guidance on that step.

References:

  • Hylwa SA, Ronkainen SD. Delusional infestation versus Morgellons disease. Clin Dermatol. 2018;36(6):714-718. 

  • Middelveen MJ, Fesler MC, Stricker RB. History of Morgellons disease: from delusion to definition. Clin Cosmet Investig Dermatol. 2018;11:71-90. 

  • NIH, Final findings of scientific misconduct, Volume 22, Number 23, June 25, 1993 2011-461

  • State of California Case 2011-461, OAH No. 201012317 Stipulated settlement and disciplinary order for public reproval.


Got feedback? Take the podcast survey.

Introducing Carlat Total Access Subscriptions

Complete access to every article you search on the website.

Shop for Total Access
Free Psychiatry Updates
The latest unbiased psychiatric information sent to your inbox.
Specify Your Interests
Featured Book
  • CMFB2e_Cover.png

    (PRE-ORDER) Child Medication Fact Book for Psychiatric Practice, Second Edition (2023)

    All the important facts covering child and adolescent psychopharmacology.
    READ MORE
Featured Video
  • therapist_canstockphoto9201097.jpg
    General Psychiatry

    Using SAMe In Clinical Practice with Garrett Rossi, MD

    Read More
Featured Podcast
  • canstockphoto11543850.jpg
    General Psychiatry

    Elvis, Adderall, and a Broken Heart - Part 1

    A new medical investigation changes our understanding of Elvis Presley’s untimely death and offer some pearls for modern psychiatric practice.

    Listen now
Recommended
  • Approaches to Autism Intervention

    January 31, 2022
    canstockphoto2240982_child-bubbles_thumb.jpg
  • Currently Available Cannabis Products

    September 1, 2022
  • Interpreting Assessment Discrepancies from Multiple Sources

    October 17, 2022
    ChildAssessment.png
  • Approaches to Autism Intervention

    January 31, 2022
    canstockphoto2240982_child-bubbles_thumb.jpg
  • Currently Available Cannabis Products

    September 1, 2022
  • Interpreting Assessment Discrepancies from Multiple Sources

    October 17, 2022
    ChildAssessment.png
  • Approaches to Autism Intervention

    January 31, 2022
    canstockphoto2240982_child-bubbles_thumb.jpg
  • Currently Available Cannabis Products

    September 1, 2022
  • Interpreting Assessment Discrepancies from Multiple Sources

    October 17, 2022
    ChildAssessment.png

About

  • About Us
  • CME Center
  • FAQ
  • Contact Us

Shop Online

  • Newsletters
  • Multimedia Subscriptions
  • Books
  • eBooks
  • ABPN Self-Assessment Courses

Newsletters

  • The Carlat Psychiatry Report
  • The Carlat Child Psychiatry Report
  • The Carlat Addiction Treatment Report
  • The Carlat Hospital Psychiatry Report
  • The Carlat Geriatric Psychiatry Report

Contact

info@thecarlatreport.com

866-348-9279

PO Box 626, Newburyport MA 01950

Follow Us

Please see our Terms and Conditions, Privacy Policy, Subscription Agreement, Use of Cookies, and Hardware/Software Requirements to view our website.

© 2023 Carlat Publishing, LLC and Affiliates, All Rights Reserved.