For Morgellons Disease Awareness Month 2022, we have prepared this letter which can be mailed to your local Dermatologists and Psychiatrists regarding patients concerned about “Morgellons”.
Dear Dr. _______,
My name is _________________, and I am a “Real Morgellons” patient/advocate. At this point you may be wondering why I feel there is any difference between “Morgellons” and “Real Morgellons”? Fortunately for both of us there is peer-reviewed research we can turn to for answers instead of relying on my subjective interpretation. Please excuse me if you are already aware of this research.
“There is significant overlap in the array of symptoms that may accompany LD (Lyme disease), MD (Morgellons disease), and mental illness, thus complicating the diagnosis. In theory, patients who do not have MD but who are delusional could think they have MD if they have had exposure to the topic through the Internet or other means.7,87 To complicate the diagnosis further, MD patients may exhibit neuropsychiatric symptoms, and many have psychiatric diagnoses, such as bipolar disorder, attention-deficit disorder, obsessive compulsive disorder, and schizophrenia.1,7,81 Therefore, many MD patients may have psychiatric comorbidities, and in some cases, patients have been misdiagnosed with a psychiatric illness that they do not have.7 Some MD patients may have false beliefs that are not delusional in origin. Lack of scientific knowledge can cause patients to misinterpret symptoms, such as the presence of filaments and sensations of formication as worms, arthropods, or other infestations. In addition, MD lesions are sticky and arthropods or artifacts can adhere to exudate, and patients may incorrectly believe these external factors are associated with the dermopathy.7,87”
History of Morgellons disease: from delusion to definition – PMC (nih.gov)
“The first step needs to determine whether delusion exists or not. A delusion is defined as a firmly, but false belief held with strong conviction and contrary to the superior evidence. It is distinct from beliefs based on an unusual perception, such as formication. The beliefs that patients hold could be delusion, true observations, or overvalued ideas. This must be determined on a case-by-case basis. The presentation of a specimen is not a delusional behavior. Patients with DI/MD with animate or inanimate objects can exist, but the belief of cutaneous fibers may or may not be delusional. 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. 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)
Clearly, the two previous passages infer that some patients can in fact become confused and mistakenly believe they have Morgellons disease. I’m sure you’ve probably seen many people who, because of exposure to the topic through the internet or other means, have become convinced that they have MD. Since you are not an Infectious Disease doctor or a Lyme disease specialist who would prescribe antibiotic therapies, that any individuals with “Morgellons” that you may have “cured” with psychotropic medication may have only mistakenly believed they had Morgellons. Of course, Lyme disease doesn’t simply resolve on its own and requires appropriate antibiotic therapies.
You may be thinking to yourself that Lyme disease is rare in my region. Consider this paper from 2000 regarding the prevalence of Lyme disease in South Carolina. “Based on serologic evidence that 38% of the P. gossypinusmice from South Carolina that were tested had antibodies to B. burgdorferi (21), the cultivation of 146 isolates ofB. burgdorferi sensu lato from birds, rodents, and ticks from seven geographic sites within five counties in South Carolina (including Charleston County) (12, 25); J. H. Oliver, Jr., unpublished data), the widespread distribution of I. scapularis in South Carolina (10, 11, 18, 26) and its proclivity to feed on various vertebrates (18, 20) (including humans ), the reports of physician-diagnosed LD in the state (34, 35), and the characterization of 28 isolates as B. burgdorferi sensu stricto in this study, we conclude that B. burgdorferi is cycling enzootically in the state and speculate that humans are probably being infected with the spirochete.” Isolation, Cultivation, and Characterization of Borrelia burgdorferi from Rodents and Ticks in the Charleston Area of South Carolina | Journal of Clinical Microbiology (asm.org)
Consider also that there is potentially another infectious disease which can result in the Morgellons condition. “Although we have not detected T. pallidum in any MD subjects to date, given that there is a historical association with T. pallidum infection in comparable cases, it is reasonable to hypothesize that T. pallidum could be an etiologic factor in a subset of MD patients.” Classification and Staging of Morgellons Disease: Lessons from Syphilis – PMC (nih.gov)
I’m certain you’re aware of the mental compromise patients could experience if exposed to this notoriously destructive disease. “His mental status examination revealed increased psychomotor activity, irritable affect, delusion of infidelity and persecution, impaired judgment, and poor insight.” Syphilis presenting as late-onset psychosis : Indian Journal of Psychiatry (lww.com)
I would hope you are aware of the current resurgence of this old foe as well. Why Syphilis Rates Are Rising – The Atlantic
Thank you for making time to review my email, and please consider this information about “Real Morgellons” and the potential that patients you see concerned about “Morgellons” may either
- A) Really Have Morgellons
- B) Mistakenly Believe They Have Morgellons
In either case, I challenge you to consider that in the face of this scientific evidence that every patient deserves to have Morgellons disease thoroughly ruled out before attempting any treatment which may either prolong the infectious process or result in a negative consequence and erosion of patient trust.
“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)
I hope you will consider this evidence when a patient visits your practice concerned about “Morgellons”, and I look forward to hearing back from you regarding this matter.
- Highest Regards,