Delusory parasitosis (DP) is a complex condition in which a person has the delusion that their home and/or their body is infested with parasites. This delusional state is often referred to Ekbom’s syndrome or Morgellons disease. Far too often sufferers of delusory parasitosis reach out to pest control operators not only for relief but for validation of their affliction. In this column I will share with you a commonly encountered case that is often referred to as a textbook case of DP and recommended responses, procedures and the potential outcome.

OUR RESPONSIBILITY. There are numerous causes for delusory parasitosis like mental illness, depression, loneliness or anxiety in which one might have a sense of formication (a tingling and prickly sensation on the skin when one feels that something is crawling on them). Other causes of formication might be recreational drug use, a dermatological allergic reaction to a soap or other substance, or other medical conditions. We are not licensed nor qualified to determine medical causes or diagnosis. One must take an investigative approach seeking to answer only one important question: Are there any arthropods present that might bite, sting or irritate humans at this account?

THE CASE. The subject in this case is a retired elderly female living alone in a second-floor condo in a gated community. At first glance of her arms there was visible scarification, which is usually the result of one picking at their skin to remove the supposed parasites and is heavier on the arm opposite their dominant hand. She reported that she was suffering from formication. No other tenants reported having any issues and no one else was bitten when visiting the subject’s home. She shared that her boyfriend and family had abandoned her as a result of her infestation.

THE REVEAL. After our introductions she proceeded to give me a tour of her residence and showed me samples she had collected for me to examine under my microscope. I went on to conduct a thorough inspection and listened carefully to all she had to share. As we continued down the hallway, she led me to the hall bath where she said she had something to show me. I stood apprehensively behind her in the event I needed to exit after she softly said, “I’m going to show you something I haven’t showed the others.” Then my jaw dropped as she pulled back the shower curtain to reveal to me her personal pesticide arsenal hidden in the shower. She had everything from over-the-counter pesticides to restricted-use agricultural pesticide products she had purchased online. I was flabbergasted when she said she mixed multiple products together and sprays her apartment every 36 hours.

MY PLAN. My approach to DP cases is consis- tent. An interview is performed prior to inspec- tion. During the interview I explain the limitations of my service and the fact that I am not medically trained or licensed to make any diagnosis regarding bites, lesions or secretions; therefore, there is no need to disrobe or attempt to show me any of these. I have them lead me to all of the areas where they feel the issue. I place and map insect monitors throughout their residence to be retrieved in 48-72 hours. I confirm whether anyone else has been afflicted with the same issue in the home and conduct a thorough inspection of the property. If I do not discover an infestation at the time of inspection, I will make an appointment to come back and retrieve the monitors I placed throughout the property.

MY FOLLOW-UP. Having a consistent plan and protocol will aid when legal or regulatory challenges may arise. I examine all specimens collected and those presented by the subject. Additionally, I will photograph all samples, bag and date them, and store them for at least 12 months in my file cabinet/file room in the event of a legal or regulatory concern. If I am in doubt about the identification of a specimen collected, I will forward the image and if requested will ship the sample to other experts for further examination. I then share my findings with the subject. If I find a pest covered by structural pest management, I will present them a solution. When there is no visible evidence of any arthropods, I recommend for the client to contact a physician for potential allergies.

MY CONCLUSION. I completed my inspection, packed up and catalogued her samples for investigation under my microscope. I told her I would provide her a copy of my report within five to seven days. I examined the specimens as I had committed to. The only arthropods found were a phorid fly and a springtail by an overwatered potted plant. All other specimens were scabs, fibers, dander, etc. I had my findings confirmed by two other entomologists before following up with her.

I followed up with the woman and like many she was furious I did not find anything. People are hard to predict and as we know things do not always go as we would like. With cases of this nature it is important to maintain a courteous and professional demeanor, which will go a long way in getting the best outcome possible. In some cases, the clients follow our advice and seek the help they need. No pest management professional should “spray and pray.” We should instead “investigate and hesitate!” My advice to you is to develop your own action plan and stay consistent with it. Also, be as flexible as you can with people.

The author is a 41-year pest control veteran who began his career in 1979 at Swat, a pest control company south of Atlanta. He has served in various roles at the Georgia Pest Control Association and been a speaker at CPCO of Georgia meetings. Today he is a technical support manager at Terminix.