Whether it’s happened to you once or many times, we have all faced a time where a customer has called with some sort of sensation of biting or itching and there is no pest to be found. What must be determined is the presence or absence of a pest. If a pest is present and causing a reaction to the client then our job is easy. If a pest cannot be located, this is where our job gets a little sticky.

Customers will call in with all different types of stories. Those of sleepless nights, bite reactions, itches and even the truly sad stories where the pursuit of an answer has really impacted their life. Broken relationships, lost jobs and a feeling of helplessness are extreme, but not unheard of when dealing with these situations. The following process has worked for me in dealing with cases of mystery bites and itches, sometimes known as delusory parasitosis (DP), delusory infestation (DI) or Ekbom’s syndrome.

IDENTIFY. Not every DP case is the same, but they typically have a similar theme. Clients will have had multiple pest management providers that have not been able to solve the pest issue. They will believe that their body is infested with some insect or parasite. At times, this is caused by the surrounding environment, but when they have family living in the same space, they are the only one being bitten. When discussing anything but the itching, they seem completely rational. When asked, clients suffering from this typically avoid psychiatrists and consult dermatologists, microbiologists or general practitioners but often lose faith in professional medicine as they cannot seem to solve the problem either.

They will self-diagnose, self-treat and catalog specimens of the pests that are infesting them. This will result in hundreds of samples identified with times and dates organized in a chronological manner. The delusion begins to overtake their life. There are some classic patterns of a client who may be suffering from this type of situation described in the literature. First is the most prominent, a middle-aged to elderly woman with few social contacts, no psychiatric history, and normal cognitive and social function. Second is an older patient with dementia and possible vision or hearing impairment also suffering from multiple other diseases. The final is the sensations develop because of illicit drug use; “crack bugs” are an example.

INSPECT. Critical to handling a case of DP is to complete a thorough inspection of the property. It is also critical to remember that we are not, typically, medical professionals and cannot diagnose bites, skin conditions or reactions. In general, it is best to not examine a person’s body. Explain that if there is a pest in the environment then it will be your responsibility. If it is truly a pest infesting the body, it will need to be dealt with by a medical professional.

Inspect the property extremely well. Look for any evidence of pest activity that might be causing skin irritations or bites. This may be spider webbing, evidence of bed bugs, carpet beetles, fleas or lice. Ask questions about their recent activities. Did they go hiking through a meadow with tall grass or did they recently go camping? If so, they may have been exposed to chiggers. Likely, they have not traveled. They have been home…and scratching. Utilize tools to help your inspection. Clear packing tape will pick up things you may not be able to see with the naked eye. A good flashlight is a must. Even a magnifying glass can help you to find smaller pests. At a minimum, monitor boards should be placed around the property and collected later for further inspection.

DO NOT TREAT. If you cannot find evidence of a pest, do not treat. This should go without saying, but unfortunately it needs to be said. Do not spray water, do not spray product, do not spray air. As soon as you make an application to their property, you own it. You are now an accomplice to the problem. Not only have you made an application for something you have not identified (how did you decide what product to use and where to apply it?), but now you may have contributed to the sensations by introducing another chemical to the environment.

Any application for a pest in a situation where DP is a concern should be thoughtfully considered before being made, even if you find a pest. If you find and treat for an occasional invader, you may be on the hook for all the sensations that invader has caused this customer. Before any application, consider what success will look like. Explain that what you are treating for is not what is causing their sensations and make sure the customer understands that these are separate situations.

COMMUNICATE. Be honest. Tell the customer what you can and cannot do. Provide them with information. Educate them about what pests bite people, what pests infest humans and why you cannot treat for something you cannot find. Cases of DP are often filled with emotion and it is easy to get caught up in this. As service professionals, we are trained to help people. We are trained to solve problems. It is very important to remember that not every customer’s problem can be solved by us at a service visit. Not every problem is a pest issue and not every problem is solved with a spray.

We have a duty to help people. Sometimes that duty is to not treat, but to inspect and educate. Remember, often these customers get called names. They get called crazy. This could not be further from the truth. We need to remove that from our vocabulary when these situations arise. While this may be a clinical condition, it is no less a real situation that our customer is experiencing. They should be handled with respect, dignity and provided the highest level of care and respect as any of your other clients.

The author is senior technical services manager at Rollins in Atlanta.