Patient with Disfiguring Holes in Cheeks Sent Home on Antipsychotics Highlights Growing Need for Morgellons Educational Resources
The general misunderstanding of contemporary research about the topic of Morgellons disease is highlighted in this recent case-study. An adult woman presented with not only the facial disfiguration and erosion of both her cheeks, but also skin lesions and “cicatricial changes” on her arms, trunk, and face. After multiple biopsies, Morgellons fibers were reportedly “visualized”, and the patient was tested for Lyme disease. After the patients Lyme test produced a negative reaction, she was then prescribed antipsychotic medications and sent home to recover.
- If fibers are visible and physically present, seeing them is a true observation but not a delusional belief.
- If sensitive Lyme and Tick-Borne Diseases testing is not performed, the underlying infection may not be detected.
- If there is an underlying infection causing illness, then according to the DSM-5-TR Morgellons symptoms should not be classified as Delusional Disorder Somatic Type.
- If visualizing fibers is categorized as a delusional belief, are the staff and attending physician delusional as well for visualizing them?
Perform a Fiber Analysis
In this regard it seems that it was the presence of microscopic filaments which resulted in the diagnosis of Morgellons, that in turn resulted in the patient’s treatment with antipsychotics. However, the course of action described in this case-report omits several critical steps towards diagnosis.
“A physician is required to perform fiber analysis to identify the nature of fibers. If fibers are present and biofilaments of human origin, then they are a true observation. It is also possible that patients might observe fibers and mistake them for worms in which case the idea of infestation could be an overvalued idea. Real infestation with arthropods such as mites can also occur. Additionally, some patients could have lesions with adhering textile fibers that are accidental contaminants and could mistakenly believe that they have MD, in which case they do not have a delusional belief, but a mistaken belief.”Reframing delusional infestation: perspectives on unresolved puzzles – PMC (nih.gov)
In this case, it was the physician who observed the filaments in the patient’s biopsy. What the physician seemingly failed to do next was determine if the fibers originated from the patient or from the environment.
“These investigations have determined that the cutaneous filaments are not implanted textile fibers, but are composed of the cellular proteins keratin and collagen and result from overproduction of these filaments in response to spirochetal infection.”History of Morgellons disease: from delusion to definition – PMC (nih.gov)
Test for Lyme, then test for TBRF, T.Denticola, and Syphilis
“If there are cutaneous fibers present and the belief is not delusional, the underlying cause of the symptoms, such as potential infection, should be examined. A diagnosis of MD is more convincing when spirochetal infection is identified. If a patient has delusional beliefs and has cutaneous fibers, then testing of an underlying infection that can result in neuropathy is needed.”Reframing delusional infestation: perspectives on unresolved puzzles – PMC (nih.gov)
While the patient was afforded testing for Lyme disease, we have evidence Morgellons can also be associated with Tick Borne Relapsing Fever at the same frequency as Lyme disease, Detection of tick-borne infection in Morgellons disease patients by serological and molecular techniques – PMC (nih.gov), and we can also theorize that Morgellons can be associated with syphilis, the tissue damage which results in the characteristic filaments are indistinguishable between syphilis and Lyme disease, Classification and Staging of Morgellons Disease: Lessons from Syphilis – PMC (nih.gov). In this case, it should have been appropriate to also test for T.Denticola, syphilis, TBRF, and to deploy molecular tests for each including Lyme disease, obtaining samples directly from the patients’ wounds, PCR detection for syphilis diagnosis: Status and prospects – PMC (nih.gov).
Screening for TBRF requires a different test than for Lyme disease. Lyme disease testing itself can be particularly insensitive, often it can produce a false positive result in light of syphilis.
Morgellons Fibers are not a Delusional Belief
“In summary, if a physician cannot differentiate between true observations, delusions, and overvalued ideas, they should not immediately make a diagnosis of delusional mental illness.”Reframing delusional infestation: perspectives on unresolved puzzles – PMC (nih.gov)
Spirochetal infections are also well known to result in mental and behavioral concerns, however if any of them are elicited then it’s the underlying infection which should be treated.
It has been well documented in numerous published medical studies of Borrelia’s ability to cause many recognized personality disorders and forms of depression; such as anxiety, depression, confusion, aggressive behaviour, mild to moderate cognitive deficits, fatigue, memory loss, and irritability. As such, the American Psychiatric Associations recommends that specialist doctors and councillors alike should seek to rule out Borreliosis as a possible differential diagnosis before commencing with any form of psychological intervention.Highlights of the 2000 Institute on Psychiatric Services | Psychiatric Services (psychiatryonline.org)
Psychiatric comorbidities do not confer a delusional status, and a physician should be keen to place care in the consideration of their patient’s physical status. Morgellons is a skin condition.
Delusions resulting from infectious processes do not meet the DSM-V criteria for delusional disorder. Furthermore, the presence of psychiatric comorbidities is not proof that a patient is delusional. Some patients have a component of posttraumatic stress disorder and are hypervigilant and overreactive to physical symptoms, rather than being delusional. If a health care provider cannot tell the difference between a hypervigilant patient and a delusional patient, the provider is not qualified to diagnose delusional disorder.History of Morgellons disease: from delusion to definition – PMC (nih.gov)
We hope this seems like a responsible framework to develop a diagnostic protocol for Morgellons patients, that should make it easier for doctors to tell patients who don’t have microscopic filaments that they do not have Morgellons, as well as provide patients who do have Morgellons responsible screening for associated diseases. Should any of these pathogenic bacteria be elicited, then it would make the treatment of Morgellons more straight-forward while promoting a potentially more favorable prognosis.
Free Introductory Course
We host a free online introduction course to help you learn the basics about Morgellons disease, including the fact that Morgellons fibers originate inside the skin. Sign up today to help afford patients like the one described in this case study the benefit of modern diagnostic technology, and hopefully with responsible treatment – a new lease on life. The New Morgellons Movement (teachable.com)
2 thoughts on “Patient with Disfiguring Holes in Cheeks Sent Home on Antipsychotics Highlights Growing Need for Morgellons Educational Resources”
Wonderful analysis and shows the complexity of this horrible condition that has variable presentations and underlying conditions. How any physician could casually dismiss this as delusional psychosis is heartbreaking.
Hey Robin, you’re absolutely right – it’s more than just oversight which led to this unfortunate case.