The Unseen Infestation: A Comprehensive Report on Delusional Parasitosis

From Historical Roots to the Digital Age ✨

Introduction

This report provides a multi-faceted examination of Delusional Parasitosis (DP), a profound and distressing psychiatric condition in which individuals hold an unshakeable, false belief of being infested with parasites or other pathogens. Though classified as a delusional disorder, its primary manifestations are dermatological, creating a complex diagnostic and therapeutic challenge at the interface of psychiatry and dermatology. 1 Sufferers experience intense physical sensations and psychological anguish, often leading to self-inflicted skin damage, social isolation, and a desperate, cyclical search for medical validation that is perpetually frustrated. The condition is characterized by a fixed, false belief that is impervious to contrary evidence, leaving patients feeling profoundly misunderstood by a medical establishment that cannot see what they so vividly feel.

A complete understanding of Delusional Parasitosis requires an interdisciplinary approach that moves beyond the purely clinical. This report will argue that the condition can only be fully comprehended by examining its psychiatric underpinnings, its historical conceptualization within medicine, its deep-seated cultural and anthropological roots in the universal fear of bodily invasion, and its potent amplification in the digital age. We will trace the condition’s academic history from its earliest descriptions to its modern classification. We will explore the rich tapestry of folklore and cultural beliefs about infestation that provide the symbolic “raw material” for the delusion’s content. Finally, we will analyze how the internet and social media have transformed the experience of this illness, creating both supportive communities and dangerous echo chambers. The recent, highly public case of social media personality Brandi Glanville will serve as a compelling contemporary anchor, illustrating the convergence of the condition’s core features with the modern dynamics of celebrity, social media, and health misinformation. 5 By synthesizing these diverse fields, this report aims to present a definitive and nuanced portrait of an illness that is as complex as it is devastating.

1. The Clinical Landscape of Delusional Parasitosis

This section establishes the modern medical and psychiatric understanding of Delusional Parasitosis, defining its core features, diagnostic criteria, etiological underpinnings, and contemporary controversies. It provides the clinical foundation upon which the historical and cultural analyses will be built.

1.1. Defining the Delusion: Nosology and Classification

The core of Delusional Parasitosis is a fixed, false, and unshakeable belief of being infested by living organisms—such as insects, mites, worms, or bacteria—or, in some cases, inanimate objects like fibers or crystals. 1 This belief is classified as a delusion because it is held with absolute certainty and is incorrigible to logical counterargument, scientific reasoning, or the repeated presentation of negative medical evidence. 10 The patient’s conviction is not a matter of fear or worry but of perceived fact.

Over the years, the condition has been known by several names, including psychogenic parasitosis, delusional infestation (DI), and Ekbom Syndrome, named after the neurologist Karl-Axel Ekbom who provided its first detailed clinical description. 1 The term “Delusional Infestation” is increasingly preferred in clinical literature because it is broader, encompassing delusions about inanimate objects, whereas “Delusional Parasitosis” remains more specific to living organisms but is still widely used. 1

Formally, Delusional Parasitosis is classified in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) as a Delusional Disorder, Somatic Type. 1 This specific classification is critical, as it distinguishes the condition from other psychotic disorders like schizophrenia. In Delusional Disorder, the delusion is the primary and often sole symptom of psychosis. Functioning outside the specific belief system is not markedly impaired, and the individual’s behavior is not considered obviously bizarre or odd. 18 This allows individuals with DP to often maintain jobs, relationships, and social roles, despite the profound internal distress and the specific, targeted behaviors related to the delusion.

(Source: Adapted from DSM-5 criteria outlined in various sources. 12)

1.2. The Patient’s Reality: Symptomatology and Behavioral Manifestations

The subjective experience of a person with DP is one of genuine and severe suffering. The delusion is not an abstract intellectual belief but is accompanied by visceral physical sensations. Patients commonly report intense and persistent pruritus (itching) and tactile hallucinations, the most notable of which is formication—a distinct sensation resembling insects crawling on, under, or burrowing into the skin. 1 These sensations are often described with vivid and distressing detail, such as biting, stinging, or movement, and are the primary source of the patient’s conviction and anguish. 3

This profound distress drives a set of characteristic behaviors aimed at eradicating the perceived infestation. In a desperate attempt to remove the imagined pathogens, patients frequently engage in self-excoriation and self-mutilation. They may use their fingernails, tweezers, knives, or other instruments to dig at their skin, or apply caustic and dangerous substances like gasoline, kerosene, or harsh insecticides to their bodies. 10 This behavior invariably leads to real skin damage, including deep excoriations, ulcers, lichenification, permanent scarring, and secondary bacterial infections.

A destructive feedback loop is thus established: the initial itching or formication leads to scratching, which creates a physical lesion. The patient then misinterprets this self-inflicted wound and the resulting scab or debris as incontrovertible proof of the infestation, which further entrenches the delusion and justifies more aggressive attempts at removal. The symptom becomes the “proof,” creating a self-perpetuating cycle that makes the belief incredibly resistant to external invalidation.

One of the most pathognomonic behaviors associated with DP is the presentation of “evidence” to clinicians, entomologists, or pest control experts. Patients meticulously collect samples of what they believe to be the parasites or their byproducts—typically pieces of skin, dried scabs, lint, dust, or clothing fibers—and present them in small containers such as matchboxes, plastic Ziploc bags, or affixed to adhesive tape. 2 This clinical sign is so characteristic that it has been given specific names: the “matchbox sign,” the “specimen sign,” or the “Ziploc bag sign.” The patient offers this material with the earnest expectation that microscopic analysis will finally validate their suffering, and they often react with frustration, anger, and distrust when laboratory results inevitably fail to identify any pathogenic organisms.

The impact of the delusion extends far beyond the skin. The all-consuming nature of the belief often leads to severe social and functional impairment. Patients may develop social isolation, avoiding friends and family for fear of infecting them. 23 They may quit their jobs, abandon or repeatedly move from their homes, destroy furniture and clothing, and spend ruinous amounts of money on repeated medical consultations, pest exterminators, and ineffective treatments. 3 The constant stress, frustration, and lack of validation frequently lead to the development of comorbid psychiatric conditions, most commonly major depressive disorder and anxiety disorders. 25

In a significant minority of cases, estimated to be between 5% and 25%, the delusion is not confined to a single individual. It can be transmitted to a close associate, typically a spouse, partner, or family member who lives in close proximity and is often in a dependent or suggestible relationship with the primary individual. This phenomenon of a shared delusion is known as folie à deux (“madness for two”). When it involves more members of a family or a larger group, it can be termed folie à famille or, in the modern context of online communities, folie à Internet. 1

1.3. Etiological Pathways: Primary vs. Secondary Forms

Delusional Parasitosis is not a monolithic entity; its etiology can be categorized into primary and secondary forms, a distinction that is crucial for proper diagnosis and treatment. 1

Primary Delusional Parasitosis is considered a standalone, monosymptomatic psychiatric disorder. In this form, the delusion of infestation is the sole or predominant symptom, and it cannot be attributed to any other underlying medical, neurological, or psychiatric condition. 1 The patient is otherwise psychologically healthy, and their delusion is the entirety of their psychosis.

Secondary Delusional Parasitosis, in contrast, arises as a symptom or manifestation of another underlying condition. This form is more common and can be further subdivided based on its cause: 1

• Secondary to Organic/Medical Conditions: A wide range of physical illnesses can produce symptoms of pruritus or paresthesia (abnormal skin sensations) that may be delusionally misinterpreted as an infestation. These include metabolic and endocrine disorders (e.g., hyperthyroidism, diabetes mellitus, vitamin B12 or folate deficiency), infectious diseases (e.g., HIV, syphilis, tuberculosis, leprosy), neurological conditions (e.g., dementia, stroke, multiple sclerosis, brain tumors), and even post-infection syndromes like those reported following COVID-19. 1 Certain prescribed medications have also been implicated as triggers. 26
• Secondary to Psychiatric Conditions (Functional): The delusion can be a feature of a broader psychiatric illness. It may occur in the context of schizophrenia, major depressive disorder with psychotic features, bipolar disorder, obsessive-compulsive disorder, or post-traumatic stress disorder. 1 In these cases, the delusion is one of several psychotic or mood symptoms.
• Secondary to Substance Use: The use of certain recreational drugs is a well-established cause of tactile hallucinations and secondary DP. Stimulants are the most common culprits, particularly cocaine (leading to the phenomenon known as “cocaine bugs”) and methamphetamines (“meth mites”). 1 Acute alcohol withdrawal, sometimes associated with delirium tremens, can also induce these symptoms. 1

The leading neurobiological theory for the development of primary DP is the dopamine hypothesis. This model posits that the symptoms arise from dysregulation of the neurotransmitter dopamine within the brain, specifically an excess of dopamine activity in the striatum. 1 This is thought to be caused by a decreased number or reduced functionality of dopamine transporters (DAT), proteins responsible for clearing dopamine from the synapse. This hypothesis is strongly supported by two key lines of evidence: first, the proven efficacy of dopamine-blocking agents (antipsychotic medications) in treating the condition, and second, the fact that dopamine-enhancing drugs (like cocaine and amphetamines) are known to induce the very symptoms of formication and paranoia seen in DP. 1

1.4. The Morgellons Controversy: A 21st-Century Subtype

In the early 2000s, a new variant of delusional infestation emerged and gained significant public attention: Morgellons disease. Sufferers of Morgellons report the classic symptoms of DP—crawling and biting sensations, intense itching, and non-healing skin sores—but with one defining additional feature: the belief that multicolored fibers, threads, specks, or other inanimate materials are emerging from their skin. 2

Despite persistent claims from patient advocacy groups that Morgellons is a novel infectious disease, the overwhelming scientific and medical consensus is that it is a subtype of Delusional Parasitosis. This conclusion is anchored by a large, comprehensive study published by the U.S. Centers for Disease Control and Prevention (CDC) in 2012. 25 The CDC investigation involved 115 individuals with self-diagnosed Morgellons and found no underlying infectious cause. Extensive analysis of the “fibers” collected from patients’ skin sores revealed that they were overwhelmingly composed of cellulose, consistent with cotton from clothing and other textiles. The researchers concluded that the fibers were likely contaminants embedded in the self-inflicted lesions from chronic scratching and picking, rather than material originating from within the body. 25 The study noted that the condition was most often seen in middle-aged white women and that the symptom profile was highly similar to that of delusional infestation. 25

The emergence of Morgellons is not merely a clinical curiosity; it is a powerful case study in how the internet can shape the landscape of an illness. The term was coined in 2002 by a mother, Mary Leitao, who rejected the psychiatric diagnosis for her son’s symptoms and created the Morgellons Research Foundation (MRF). 40 The MRF website and other online forums became powerful vectors for the dissemination of the Morgellons narrative. They provided a space for isolated sufferers to connect, share their experiences, and find validation outside a medical system they perceived as dismissive.

This phenomenon represents a modern, technologically-facilitated mass delusion, or folie à Internet, where a contested illness narrative is created and sustained through online echo chambers that actively organize against the established medical consensus. 40 This process transformed what might have been a series of individual, private delusions into a shared, community-reinforced identity with its own specific language, alternative etiologies (often linking Morgellons to Lyme disease and spirochetal infections like Borrelia burgdorferi), and organized political goals, such as lobbying the CDC for research. 9 Recognizing the deep stigma associated with a psychiatric diagnosis, some clinicians have suggested that strategically using the term “Morgellons disease” with patients can be a useful tool for building a therapeutic alliance. Acknowledging the patient’s self-identified label, even while gently guiding them toward effective psychiatric treatment, may foster the trust necessary for successful intervention. 25

2. A History of an Unshakeable Belief

The history of Delusional Parasitosis is a story of medical discovery and evolving classification. It traces a century-long journey from the dermatological fringes to a recognized psychiatric disorder, revealing a fascinating tension between the specialties of dermatology and psychiatry for conceptual ownership of a condition that manifests on the skin but originates in the mind. The evolution of its name reflects this journey, charting a course from a description of fear to a diagnosis of delusion.

2.1. Early Conceptualizations and Precursors

Before Delusional Parasitosis was recognized as a distinct psychiatric entity, its manifestations were documented in medical literature under various descriptive, and often inaccurate, names. The earliest notable term was “acarophobia” (fear of mites), coined by the French dermatologist George Thibierge in 1894. 42 He used it to describe patients who held a fixed, unshakeable belief of being infested with mites, despite all evidence to the contrary. This early framing situated the condition as a specific phobia, albeit one with delusional intensity. Other terms from this era included “parasitophobia” and “dermatological hypochondriasis,” which similarly categorized the experience as an extreme form of health anxiety centered on the skin. 11

These initial accounts appeared predominantly in the dermatological literature, where physicians encountered these perplexing patients but lacked a clear psychiatric framework to understand them. The condition was often viewed as a medical curiosity, a severe and intractable form of hypochondria that produced real, albeit self-inflicted, skin lesions. 3

2.2. The Foundational Work of Karl-Axel Ekbom

The pivotal moment in the history of Delusional Parasitosis came in 1937 and 1938, when the Swedish neurologist Karl-Axel Ekbom published a series of meticulously detailed case studies. 48 Ekbom provided the first systematic clinical description of the syndrome, giving it the German name Praeseniler Dermatozoenwahn, which translates to “presenile dermatologic delusion”. 48 His work was foundational, moving the understanding of the condition from a vague “phobia” to a specific delusional state.

Ekbom’s papers were remarkable for their clinical precision. He clearly delineated the core features that are still recognized as central to the diagnosis today:

1. The Core Delusion: An unshakeable conviction of being infested with small creatures.
2. Tactile Hallucinations: The prominent sensation of formication, which he described as a feeling of insects crawling on or under the skin.
3. Characteristic Behaviors: The compulsive gathering and presentation of “specimens”—skin debris, lint, and other particles—as proof of the infestation. This is the behavior that would later be famously termed the “matchbox sign”. 51

In recognition of his seminal contribution, Delusional Parasitosis is still widely referred to as Ekbom Syndrome. It is crucial, however, to distinguish this condition from another that bears his name: Willis-Ekbom disease, more commonly known as Restless Legs Syndrome (RLS). 24 Ekbom also conducted extensive, groundbreaking research on RLS, and the shared eponym can lead to confusion. Ekbom Syndrome refers to the delusional disorder, while Willis-Ekbom disease refers to the neurological sensorimotor disorder characterized by an irresistible urge to move the legs.

2.3. Post-Ekbom Nosology and Standardization

Ekbom’s work laid the psychiatric groundwork, but the terminology continued to evolve. A significant step occurred in 1946 when Wilson and Miller proposed the term “delusion of parasitosis”. 3 This was a critical shift. By explicitly using the word “delusion,” they moved the condition’s identity firmly into the psychiatric domain, emphasizing the disturbance of thought content rather than the object of fear (as in “acarophobia”). This term gained widespread acceptance and remains in common use.

Over the following decades, other names were proposed but failed to achieve the same traction. Bers and Conrad suggested “chronic tactile hallucinosis” in 1954, focusing on the sensory experience, while Munro proposed “monosymptomatic hypochondriacal psychosis” in 1988, highlighting its nature as a single, focused delusion without other psychotic features. 48

The ultimate standardization of the condition came with its inclusion and refinement within the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM). This process culminated in the current DSM-5 classification, which places the condition definitively as a Delusional Disorder, Somatic Type. 1 This formal classification solidified its identity as a primary psychiatric disorder, providing clear diagnostic criteria and distinguishing it from schizophrenia and other related conditions.

This historical trajectory reveals a century-long conceptual struggle. Patients, experiencing physical symptoms, present almost exclusively to dermatologists, primary care physicians, and even entomologists. 2 The early medical understanding, therefore, was filtered through a dermatological lens, leading to names that reflected the content of the complaint (“acarophobia”). Ekbom, a neurologist, provided the bridge with his detailed psychiatric analysis. The final adoption of psychiatric terminology and DSM classification marked the victory of the psychiatric model in defining the illness. Yet, this history explains the central therapeutic paradox that persists today: patients seek help from skin specialists for what is now understood to be a brain disorder, creating a critical disconnect that clinicians must navigate with empathy and skill.

3. The Anthropology of Infestation: Cultural and Folkloric Resonances

The specific content of Delusional Parasitosis—the unshakeable belief in being infested by small creatures—is not born from a vacuum. It taps into a deep well of universal human fears and culturally specific narratives about purity, contamination, and bodily invasion. While the delusion itself is a product of neuropsychiatric dysfunction, its particular expression is profoundly shaped by the cultural “scripts” available to the individual. This section explores the anthropological and folkloric landscape that provides the rich, symbolic raw material for the delusion.

3.1. The Universal Fear and the Parasite-Stress Theory

The fear of parasites is a potent and primordial human emotion. The power of these organisms to invade, infest, consume, and transform the self from within is a recurring theme that “writhes and wriggles” through cultures and religions across the globe. 54 This reflects a fundamental revulsion to the loss of bodily autonomy and the horror of being consumed or controlled by hidden, external forces. 58 This is not merely a modern anxiety; the field of archaeoparasitology, which studies parasite remains in archaeological contexts, confirms that humans have co-existed and co-evolved with a wide array of parasites for millennia. Our diet, sanitation practices, development of clothing, and patterns of migration have all been shaped by, and in turn have shaped, our relationship with parasites. 59

From an evolutionary psychology perspective, this deep-seated fear is highly adaptive. The parasite-stress theory of sociality proposes that the historical prevalence of infectious diseases in a given ecology is a major force in shaping human cultural values and social structures. 69 In regions with high pathogen loads, cultures tend to develop traits that serve as a “behavioral immune system.” These include greater conformity to social norms (which often include hygienic practices), stronger in-group loyalties, and higher levels of xenophobia and ethnocentrism, as outsiders may carry novel pathogens against which the local population has no immunity. 69 This theory provides a powerful evolutionary framework for understanding why the fear of parasites and contamination is so deeply ingrained in the human psyche. It is a legacy of an evolutionary past where avoiding infection was a primary driver of survival and social behavior.

3.2. Cultural Manifestations of Infestation Beliefs

While the fear of infestation is universal, its specific expression is filtered through the lens of culture and folklore. Different societies have developed unique narratives and belief systems to explain the unseen world of parasites, and these narratives can provide a ready-made script for an individual experiencing the ambiguous and distressing sensations that often precede the onset of DP.

• Daoist Folklore (China): Traditional Chinese and Daoist beliefs include the concept of the sanshi (三尸), or the “Three Corpses” or “Three Worms.” These are thought to be demonic, supernatural creatures that inhabit the body’s three main energy centers (dantian) from birth. Their goal is to accelerate the death of their human host so they can be freed to become malevolent ghosts. The Three Worms are believed to cause illness, report the host’s moral transgressions to the celestial bureaucracy, and feed on decaying matter in the intestines. 71 This belief system provides a detailed framework for mapping internal sensations, illness, and even moral failings onto the actions of indwelling parasitic entities. One type of “corpse-infestation,” the fēishī or “flying corpse,” is described as roaming about a person’s skin and boring into their organs, causing stabbing pains—a description remarkably similar to the sensations reported in modern cases of DP. 71
• Hindu Beliefs (India): Hindu culture places a profound emphasis on the concepts of ritual purity (shaucha) and pollution (aśauca), which extend beyond physical cleanliness to social, ceremonial, and spiritual contamination. 72 The body is conceptualized as a “dwelling with nine doors” (Navadwaras), referring to the nine bodily orifices (eyes, ears, nostrils, mouth, urethra, and anus). These orifices are seen as crucial portals of communication between the individual and the physical and spiritual world, and maintaining their purity is essential for a healthy life. 78 Within this framework, an infestation of the body, particularly of its orifices, can be interpreted as a powerful symbolic expression of spiritual decay, moral impurity, or a loss of control over the self due to psychotic disorganization. This provides a culturally specific script that can shape the delusion’s content, explaining why some studies have found a predominant focus on orifice infestation in patients from Hindu backgrounds. 54
• Traditional African American Hoodoo: In Hoodoo, a spiritually-based healing and harming practice with roots in West African traditions, illness is often understood not as a random biological event but as the result of a spiritual attack or “conjure.” Affliction narratives from the 19th and early 20th centuries are replete with vivid descriptions of unwelcome internal inhabitants, such as worms, snakes, lizards, scorpions, and frogs, which are seen as the material manifestations of the curse. 79 These creatures are believed to have been introduced into the body through magical means, linking physical suffering directly to social conflict, jealousy, or malevolence within the community. These narratives provide a powerful framework for interpreting unexplained physical suffering as a targeted, external assault made manifest by an internal infestation. 79
• Medieval European Lore: In medieval and early modern Europe, the worm was a potent dual symbol. It represented the physical decay of the body after death and, by extension, the moral corruption of the soul through sin. The human body was often metaphorically described as a “sack of worms,” and it was a common belief that vermin could be spontaneously generated from the putrefied, corrupt humors within the intestines. 55 Medical texts from the period, such as that of the physician Antonio Benivieni, describe cases of patients evacuating horrifying worms of various shapes and sizes from their stomachs, intestines, and even nostrils, blurring the line between real parasitic infections and the folkloric horror of internal generation. 80

These diverse cultural examples demonstrate a common human tendency to concretize abstract suffering—be it physical pain, moral guilt, or social anxiety—into the tangible, horrifying image of a parasite. This process reveals that Delusional Parasitosis is not simply the spontaneous generation of a false belief ex nihilo. Rather, it is often the delusional interpretation of a real, albeit mundane, physical sensation. An individual may experience an ambiguous bodily feeling—pruritus from dry skin, paresthesia from neuropathy, or the lingering memory of a genuine but long-resolved insect bite. This sensation demands an explanation. The individual’s cultural background provides a library of potential scripts to make sense of this experience. For someone steeped in Hoodoo traditions, the explanation might be a “conjure” involving worms. For someone in a Hindu cultural context, it could be a sign of impurity manifesting as parasites entering the body’s orifices. For an individual in a secular, modern Western society saturated with science fiction and news of emerging diseases, the explanation might be a novel, undiscovered organism like Morgellons.

The underlying neuropsychiatric vulnerability, likely related to dopamine dysregulation, is what causes this culturally-shaped interpretation to crystallize into a fixed, unshakeable, and pathological delusion rather than remaining a passing thought. The form the delusion takes is not random; it is pathoplastically molded by the cultural and symbolic resources available to the suffering individual.

4. The Digital Contagion: Delusional Parasitosis in the Internet Age

The advent of the internet and social media has fundamentally transformed the landscape of Delusional Parasitosis. What was once a rare, isolating, and intensely private affliction can now become a shared, public, and community-reinforced identity. The digital world acts as both a powerful vector for the spread of delusional beliefs and a stage for their public performance. This section analyzes the mechanisms of this “digital contagion” and culminates in a detailed case study of reality TV personality Brandi Glanville, whose public ordeal exemplifies the convergence of psychopathology, celebrity culture, and the dynamics of online health discourse.

4.1. The Internet as an Echo Chamber and Vector for Folie à Internet

The architecture of modern social media is uniquely suited to fostering and reinforcing delusional beliefs. Research into the psychology of online health misinformation shows that individuals experiencing health-related anxiety are more susceptible to believing and accepting inaccurate information. 82 Social media algorithms, designed to maximize engagement, create powerful “echo chambers” and “filter bubbles.” These systems preferentially show users content that aligns with their existing beliefs and past interactions, effectively insulating them from dissenting views and reinforcing confirmation bias. 83

For individuals suffering from the terrifying and isolating symptoms of DP, the internet offers an immediate and accessible source of information and community. A person experiencing crawling sensations and finding no relief from doctors can search their symptoms online and discover communities of people reporting identical experiences. This discovery can be profoundly validating. It provides a name for their suffering (e.g., “Morgellons”), a community of fellow sufferers who believe them, and a shared narrative that explains their persecution by a skeptical medical establishment. 45

These online forums and social media groups function as digital vectors for what can be termed folie à Internet—a shared delusion facilitated and sustained by web-based dissemination. 9 Within these echo chambers, anecdotal evidence is treated as scientific proof, alternative theories (such as links to Lyme disease or environmental toxins) are circulated and amplified, and distrust of conventional medicine becomes a core tenet of group identity. 40 Linguistic analysis of these online spaces reveals the development of a specialized jargon and rhetorical practices designed to construct the belief system as an objective, external reality while actively contesting the medicalizing discourse that frames their experience as a mental disorder. 40 This transforms a private delusion into a collective, politicized identity, making psychiatric intervention even more difficult.

4.2. Case Study: The Public Ordeal of Brandi Glanville

The case of Brandi Glanville, a prominent American reality television personality and social media influencer, provides a vivid and cautionary illustration of Delusional Parasitosis playing out in the public sphere of the 21st century. Her experience demonstrates how celebrity status can act as a powerful magnifier for the condition’s core features, transforming a personal psychiatric crisis into a widely followed public spectacle.

4.2.1. Narrative and Symptomology

Since 2023, Glanville has publicly documented a severe and distressing health crisis that she attributes to a “facial parasite”. 6 She has stated her belief that she contracted the organism while filming a reality show in Morocco, a classic inciting event narrative often seen in cases of DP where a travel history or specific exposure is identified as the origin point. 12 In a move that personalizes and externalizes the delusion, she has named the parasite “Caroline,” a likely reference to Caroline Manzo, a rival reality TV personality with whom she had a contentious on-set interaction. 5

Glanville’s descriptions of her symptoms align closely with the clinical picture of DP. She reports that the parasite “jumps around my face,” causing significant swelling, facial disfigurement, painful lumps in her jaw and neck, a constant “oily, foul-tasting drainage” into her mouth, and even tooth loss. 6 She describes tactile sensations of “tiny bubbles bursting” on her skin and feels that the organism is “s---ing or having babies in my face”. 96 These vivid, visceral descriptions are characteristic of the somatic delusions and associated tactile hallucinations found in DP.

4.2.2. Self-Treatment and Public Reaction

The most dramatic and concerning manifestation of Glanville’s belief was her widely publicized attempt at self-treatment. In August 2025, she posted a video to TikTok showing her face with severe redness and irritation, explaining that she had applied Nair, a chemical hair removal product, to her face. 5 She described this as a “beauty hack,” claiming that having an “exfoliated face… pisses the Caroline off”. 5 She admitted to leaving the product on for too long and being in “some pain,” having sustained significant chemical burns. 8

This act is a clear and public example of the self-mutilating behavior common in DP, where patients use caustic substances in a desperate attempt to eliminate the perceived infestation. 23 Chemical depilatories like Nair contain potent alkaline chemicals, such as calcium hydroxide and potassium hydroxide, which dissolve hair but can also cause severe chemical burns to the skin if misused. 103 Glanville’s public broadcast of this dangerous act of self-harm, framed as a “hack,” sparked widespread alarm and concern among her followers and the media, with many urging her to seek immediate medical help. 7

4.2.3. Medical and Media Commentary

Glanville’s narrative has been publicly challenged by medical experts, most notably Dr. Terry Dubrow, a board-certified plastic surgeon and co-host of the television show Botched. After consulting with Glanville and taking biopsies, Dr. Dubrow has repeatedly stated his professional opinion that her condition is not a parasite. 96 Instead, he has suggested her symptoms are more consistent with “an infectious process or a foreign body reaction to something she’s had injected,” possibly a difficult-to-treat mycobacterial or fungal infection related to cosmetic fillers. He described her situation as a “ticking time bomb” that requires a proper diagnosis and treatment to prevent permanent scarring and damage. 97

This public disagreement creates a collision of diagnoses. On one side is the patient’s narrative, rooted in a classic DP trigger story of foreign travel and contaminated food. 97 On the other is the expert’s narrative, grounded in her known history of cosmetic procedures and suggesting a plausible iatrogenic complication. 105 The public is left to adjudicate between these competing stories. Those predisposed to believe in exotic illnesses or distrust cosmetic procedures may find Glanville’s account compelling, while those who trust medical expertise may favor Dr. Dubrow’s assessment. This dynamic illustrates how, in the public sphere, medical diagnosis can become a battle of narratives rather than a purely scientific process, especially when definitive medical records are not public.

Media coverage of Glanville’s ordeal has been extensive, oscillating between sympathetic reporting on her evident suffering and sensationalizing her bizarre claims and dangerous actions. 6 This media attention creates a powerful feedback loop. Glanville’s claims generate headlines and clicks, and the resulting media coverage, in turn, validates the perceived severity and importance of her condition, potentially reinforcing the delusion. 113

4.2.4. The Role of Social Media

Glanville has used her substantial social media platforms as the primary vehicle for constructing and disseminating her illness narrative. She posts selfies of her disfigured face, provides real-time updates on her symptoms, and expresses her profound frustration with the medical system, at one point stating she was “getting more help from social media and podcast listeners than i am [doctors]”. 6 This direct, unfiltered communication with her audience bypasses traditional medical and media gatekeepers.

Her celebrity status acts as a powerful amplifier for the classic features of DP. Where a typical patient might doctor-shop in private, Glanville’s quest is a public crusade against a medical system she portrays as incompetent. 6 Where a typical patient might present a physical sample in a matchbox, Glanville’s “specimen sign” is a continuous, digital stream of selfies, videos, and text posts delivered to millions. And where a typical patient might induce a folie à deux in a spouse, a celebrity can create a para-social folie à plusieurs, where thousands of followers can engage with, and in some cases validate, the delusional belief system.

The Brandi Glanville case is thus a quintessential example of Delusional Parasitosis in the 21st century—a private psychological struggle magnified into a public health drama by the intersecting forces of celebrity, social media, and the timeless, terrifying belief in an unseen infestation.

5. Diagnostic and Therapeutic Strategies

The management of Delusional Parasitosis presents a unique and formidable challenge to clinicians. It requires a delicate balance of rigorous medical investigation, astute psychiatric assessment, and exceptional interpersonal skill. The core difficulty lies in treating a psychiatric disorder in a patient who is utterly convinced their problem is purely physical and who vehemently rejects any psychological explanation for their suffering.

5.1. The Diagnostic Challenge: Ruling Out the Real

The first and most critical step in the diagnostic process is to conduct a thorough and respectful evaluation to definitively exclude a true parasitic infestation or any other organic cause for the patient’s symptoms. 1 This step is non-negotiable; it is essential for patient safety and is the only way to build the trust necessary for any subsequent therapeutic intervention.

The evaluation must be comprehensive, involving:

• A Detailed History: Including medical, psychiatric, psychosocial, travel, and substance use history. 115
• A Full Physical Examination: A complete dermatological assessment should be performed, looking for signs of true infestation (e.g., burrows in scabies, nits in pediculosis) as well as the self-inflicted lesions characteristic of DP. 115
• Laboratory and Diagnostic Tests: As clinically indicated, this may include a complete blood count (CBC) with differential to check for eosinophilia (which can suggest a true parasitic infection), tests for vitamin B12 and folate levels, thyroid function tests, and screening for infectious diseases like HIV and syphilis. Skin scrapings or biopsies of lesions may also be necessary. 1
• Meticulous Examination of “Specimens”: Any “proof” the patient provides must be examined carefully. While these samples almost always consist of skin debris, lint, or other inanimate material, there are rare but important case reports of a true parasite (such as cat fleas) being discovered. 116 A premature psychiatric diagnosis in such a case would be a significant medical error and would irrevocably damage the physician-patient relationship. Labeling a patient as delusional should only occur after all other possibilities have been exhausted.

The differential diagnosis for DP is broad, reflecting the many conditions that can cause itching and other abnormal skin sensations.

(Source: Compiled from various sources. 1)

5.2. Building the Therapeutic Alliance: The Art of Engagement

Once organic causes have been ruled out, the primary therapeutic challenge begins: engaging a patient who does not believe they have a mental illness. Direct confrontation or outright dismissal of the patient’s belief is invariably counterproductive. It is perceived as a rejection of their suffering, confirms their belief that doctors are incompetent or uncaring, and almost always results in the patient terminating the relationship and seeking another opinion, a behavior known as “doctor-shopping”. 2

The recommended approach is to build a strong, empathetic, and supportive therapeutic alliance. The clinician must acknowledge the reality of the patient’s suffering without validating the content of the delusion. 1

Key communication strategies include:

• Expressing Empathy: Statements like, “I can see how distressing these sensations must be,” or “It sounds like this has been a terrible ordeal for you,” validate the patient’s emotional experience.
• Paraphrasing Symptoms: Instead of using the patient’s language (“the parasites”), the clinician can refer to “the itching,” “the crawling sensations,” or “the skin problem.” This avoids reinforcing the delusion while still acknowledging the symptoms. 23
• Taking a Neutral Stance on Findings: A helpful approach is to state neutrally that no organisms are visible at this time, but that they may have been present before. This avoids direct contradiction while maintaining factual accuracy. 1
• Shifting the Goal to Symptom Relief: The focus of treatment should be framed around alleviating the distressing symptoms (e.g., the itching, the sores, the impact on sleep and quality of life) rather than on eradicating a non-existent parasite.

5.3. Evidence-Based Treatment Protocols

The cornerstone of effective treatment for primary Delusional Parasitosis is pharmacotherapy with antipsychotic medications.

• Pharmacotherapy: These medications are believed to work by modulating dopamine activity in the brain, directly addressing the likely neurobiological root of the delusion. While older, first-generation antipsychotics like pimozide were once the standard, current guidelines favor second-generation antipsychotics (SGAs) due to their generally more favorable side-effect profile, particularly regarding extrapyramidal symptoms. 32 Low doses are often effective, which further helps to minimize side effects. 115 Presenting the medication can be a delicate task; it is often best framed as a treatment for the severe itching or distressing skin sensations, or as a medication that can help the nervous system “calm down.” Some clinicians suggest telling the patient that psychiatrists may be able to help them “live better with their parasite problem” as a way to facilitate a referral. 33

(Source: Adapted from British Association of Dermatologists (BAD) Guidelines for the management of adults with delusional infestation. 115)

• Psychotherapy: While pharmacotherapy is the primary treatment for the core delusion, psychotherapy can be a valuable adjunct. Cognitive Behavioral Therapy (CBT) and other supportive therapies can help patients manage the secondary anxiety, depression, and social isolation that accompany the condition. 2 Therapy can also help patients develop coping strategies for the distressing sensations and reduce self-harming behaviors. However, its effectiveness is often limited by the patient’s lack of insight into the psychological nature of their illness.

5.4. A Multidisciplinary Imperative

Given the complex interplay of dermatological symptoms and psychiatric etiology, optimal patient care for Delusional Parasitosis is not the responsibility of a single specialty. The most effective management model is a collaborative, multidisciplinary team approach. 2 This team should ideally include:

• A Dermatologist: To conduct the initial workup, rule out true skin disease, manage the secondary skin lesions caused by excoriation, and, crucially, to build the initial therapeutic alliance.
• A Psychiatrist: To confirm the psychiatric diagnosis, manage the antipsychotic medication, and provide or refer for psychotherapy.
• A Primary Care Physician: To manage any underlying or comorbid medical conditions and to coordinate care.
• Other Specialists: As needed, an entomologist or infectious disease specialist can be consulted to definitively identify or rule out organisms from patient-provided samples, lending further authority to the diagnostic process.

This integrated approach ensures that the patient feels their physical complaints are taken seriously while allowing for a smooth and trusted transition to the necessary psychiatric care once organic causes have been confidently excluded.

6. Conclusion

6.1. Synthesis: The Crossroads of Mind, Skin, and Culture

Delusional Parasitosis is a severe and profoundly isolating psychiatric illness that exists at a unique and challenging crossroads of the mind and the skin, the individual and their culture. Its clinical history reflects a gradual but definitive shift from a dermatological curiosity to a recognized psychiatric disorder, yet its presentation remains firmly rooted in the worlds of dermatology and general medicine, creating a persistent diagnostic and therapeutic dilemma. The content of the delusion, far from being arbitrary, is pathoplastically shaped by a deep and universal reservoir of cross-cultural fears and folkloric narratives centered on the primal horror of bodily infestation and contamination. The digital age has fundamentally altered the landscape of this disorder, transforming it from a solitary affliction into a potential collective identity. The case of Brandi Glanville serves as a powerful, cautionary exemplar of these modern dynamics. Her celebrity status has magnified the condition’s classic features into a public spectacle, where her social media feed becomes the “specimen sign” and her followers a potential audience for a para-social folie à plusieurs. Her story highlights a critical tension in contemporary health discourse, where a patient’s subjectively experienced narrative, amplified by the internet, can compete on equal footing with expert medical opinion in the court of public opinion.

6.2. The Imperative for Empathy and Multidisciplinary Care

Ultimately, behind the bizarre claims, the self-destructive behaviors, and the frustrating resistance to psychiatric explanation lies profound and genuine human suffering. The sensations of itching and crawling are real to the patient, and the resulting distress is debilitating. Effective management, therefore, cannot be achieved through confrontation or dismissal. It requires a sophisticated, multidisciplinary approach grounded in scientific rigor and profound empathy. It is a process that seeks to build a therapeutic bridge to patients who are convinced they are fighting a physical war, when the true and tragic battle is, in fact, within the mind. Through a collaborative effort of dermatologists, psychiatrists, and primary care physicians, compassionate, evidence-based care is not only possible but is essential to help these individuals find relief from their unseen tormentors.

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