HomeHealth TopicMental Health

What Is Formication?

Robert Shafton, MDKatie E. Golden, MD
Written by Robert Shafton, MD | Reviewed by Katie E. Golden, MD
Published on January 6, 2022

Key takeaways:

  • Formication is the sensation that bugs are crawling on or under your skin when they don’t really exist.

  • Causes include mental health conditions such as depression, medical conditions like Parkinson’s disease, certain prescription medications, or drug use.

  • The best way to treat formication is to treat the underlying problem. But there are also medications that can help get rid of the symptoms. 

Black and white portrait of a young woman scratching her arm. There is a yellow graphic circle behind her.

Formication is the sensation that insects are crawling on or under your skin when they aren’t really there. It’s one kind of a condition called delusional infestation or delusional parasitosis, which is a false belief about any infestation or infection. 

People with this condition are convinced the bugs are real, even with reassurance from others that it is their imagination. This makes formication difficult to treat for the person and their medical provider. 

We’ll cover some of the different causes of this particular hallucination, related conditions, and how it’s treated. 

What causes formication?

Formication can occur on its own, or it can be the result of another condition. When formication is a mental condition on its own — without any other problems or symptoms — it is called primary delusional infestation. When it is a symptom of another mental health condition or physical illness, it is called secondary delusion infestation.

For 3 out of 4 people with formication, the underlying cause is a mental health condition. But other conditions, drugs, or prescription medications can also lead to formication. 

Experts believe it occurs whenever there is an imbalance of the chemical dopamine in the brain. So any process that disrupts dopamine levels can cause formication or other abnormal sensations. 

Formication in mental illness

Formication is a type of hallucination. This means people really feel like bugs are on or under their skin. They may even have sores or cuts on their skin from scratching or washing. 

Like other hallucinations, this is a symptom of psychosis that can occur in schizophrenia. But  depression and anxiety are the most common psychiatric conditions associated with formication. It also is seen in patients with OCD, PTSD, and bipolar disorder

Formication in drug and medication use

Recreational drug use can also cause formication. Cocaine and methamphetamines are the most common offenders (leading to the common terms “cocaine bugs” and “meth mites”). Up to half of people who use these drugs may experience formication at some point. People who are withdrawing from alcohol or opioids may also develop this condition.

But it’s not just recreational drugs. Prescription medications can cause formication, too:

Formication in other medical illnesses

Medical conditions can cause formication. Some, particularly neurological illnesses, can cause formication because they affect how the brain works. Examples include:

  • Parkinson’s disease

  • Multiple sclerosis

  • Traumatic brain injury

  • Delirium

  • Dementia

  • Stroke

  • Huntington’s disease

  • Meningitis or encephalitis

But experts still don’t know why many other conditions can lead to these hallucinations. Other examples of conditions that can cause formication include:

  • Vitamin B12, folate, and niacin deficiencies

  • Anemia

  • Chronic kidney disease

  • Chronic liver disease

  • Congestive heart failure

  • Endocrine disorders (such as diabetes mellitus or thyroid disease) 

  • Cancer (such as leukemia, lymphoma)

  • Lupus

  • Infection (such as HIV, syphilis, tuberculosis, gonorrhea) 

What is the difference between formication and Morgellons disease?

Morgellons disease is another type of delusional infestation that’s different from formication in one important way: People with Morgellons believe they are contaminated by non-living materials, not bugs. They have the sensation of fibers, threads, hairs, or splinters underneath their skin. They may also have other symptoms, such as joint pains, neuropathy, extreme fatigue, concentration problems, headaches, and dizziness. 

Experts have observed a growing number of people who believe that they have this condition. And they are not sure why. But some think this is because of misinformation found on the internet. 

Will formication go away? What is the treatment?

Formication is difficult to treat. If someone does not believe their symptoms are a hallucination, it can be hard for them to understand the recommended treatment. But if they are open to help, there are several different options. 

Often, the first step is to relieve the symptoms with medications. Antipsychotics are useful for treating both primary and secondary formication. The medication pimozide (Orap) was once  preferred. But newer antipsychotics, such as risperidone (Risperdal) or olanzapine (Zyprexa), are now favored because they work better. Antidepressant medications may also be helpful when depression is the root cause.

Treatment may also include tending to the skin symptoms from formication. This can include medications for pain associated with sores or skin itching. Some people may also need antiseptics or antibiotics for any infection in skin wounds.

In addition to psychiatric medications and wound care, treatment may also involve:

  • Stopping recreational drug use 

  • Stopping or lowering the dose of offending medications 

  • Prescribing medications to ease alcohol or opioid withdrawal 

  • Treating any underlying medical condition

  • Offering psychological counseling and support

The bottom line

Formication is the false perception that bugs are infesting your skin. It can be a very uncomfortable and distressing symptom. And it can be hard to help people understand that the bugs are not real. Often this delusion is the result of an underlying mental health condition, medical condition, or drug or alcohol use. 

If someone is open to receiving help, treatment often involves psychiatric medications and treating any contributing medical condition. 

View All References (9)

Driscoll, M. S., et al. (1993). Delusional parasitosis: A dermatologic, psychiatric, and pharmacologic approach. Journal of the American Academy of Dermatology

Freudenmann, R. W., et al. (2009). Delusional infestation. Clinical Microbiology Reviews.

Harth, W., et al. (2010). Morgellons in dermatology. Journal of the German Society of Dermatology.

Hylwa, S. A., et al. (2012). Delusional infestation is typically comorbid with other psychiatric diagnoses: Review of 54 patients receiving psychiatric evaluation at Mayo Clinic. Psychosomatics.

Middelveen, M. J., et al. (2018). History of Morgellons disease: From delusion to definition. Clinical, Cosmetic and Investigational Dermatology.

Mumcuoglu, K. Y., et al. (2018). Delusional parasitosis: Diagnosis and treatment. The Israel Medical Association Journal.

Reich, A., et al. (2019). Delusions of parasitosis: An update. Dermatology and Therapy.

Rusyniak, D. E. (2013). Neurologic manifestations of chronic methamphetamine abuse. The Psychiatric Clinics of North America.

Swick, B. L., et al. (2005). Drug-induced delusions of parasitosis during treatment of Parkinson's disease. Journal of the American Academy of Dermatology.

GoodRx Health has strict sourcing policies and relies on primary sources such as medical organizations, governmental agencies, academic institutions, and peer-reviewed scientific journals. Learn more about how we ensure our content is accurate, thorough, and unbiased by reading our editorial guidelines.

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