What Is Formication? Why Some People Experience a Skin Crawling Feeling
Key takeaways:
Formication is the sensation that bugs are crawling on or under your skin when they don’t really exist.
Causes of formication 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.
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Table of contents
You might recall a time you thought you felt spiders crawling up your arm right after you saw one. Or when you had an unsettling sensation while watching a movie with spiders in it. This is a normal response. But some people have the sensation of bugs crawling on or under their skin constantly. This is a tactile hallucination known as formication.
People with this condition are convinced the bugs are real, even with reassurance from others they are a hallucination. This makes formication difficult to treat for the person and their medical provider.
We’ll cover some of the symptoms, different causes, related conditions, and how this particular tactile hallucination is treated.
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What are the symptoms of formication?
Formication can present in various forms. Some individuals may feel it mostly in their hands or feet, while others may experience it across their entire body.
Alongside the sensation of bugs crawling, other symptoms of formication include:
Tingling sensations
Skin itching
Discomfort or pain in the affected areas
Formication can often lead to excessive scratching or attempts to remove the bugs. This can result in serious skin irritation or damage. People may also report feelings of anxiety or distress because of the condition.
What causes formication?
Formication can be its own psychological disorder, unrelated to another condition. It can also be related to mental and physical health conditions, such as:
Psychosis
Illicit drug use
Medication side effects
Neurologic conditions
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Let's break down the possible causes of formication.
Psychological factors
These include mental health conditions like:
In these cases, people might genuinely believe they have bugs on their skin. And sometimes they might hurt themselves by scratching too much.
Drug use
Certain drugs, especially cocaine and methamphetamines, can make it feel like bugs are crawling on you. This sensation is so common with these drugs that there are nicknames for it like “cocaine bugs” and “meth mites.” Also, when you're withdrawing from alcohol or opioids, you might feel this way too.
Medication side effects
Some medications can cause formication as a side effect. These include drugs like:
Ritalin (used for ADHD)
MAO inhibitors (a type of antidepressant)
Medications for Parkinson's disease
Certain antibiotics
If you're taking any of these and feel like bugs are on your skin, it could be a side effect.
Medical conditions
Various medical conditions affecting the brain and nerves can also lead to formication. These include:
Parkinson’s disease
Traumatic brain injury
Delirium
Dementia
Stroke
Meningitis
Encephalitis
These conditions can mess with how your brain works and make it feel like bugs are crawling on you.
Will formication go away? What is the treatment?
Dealing with formication can be tough. Some people find it hard to accept that their symptoms aren't real, making it tricky to follow treatment advice. However, there are several options available if you're open to help.
First off, healthcare professionals might prescribe medications to ease the symptoms. Antipsychotics like risperidone or olanzapine are often used, along with antidepressants if depression is involved. Treating any skin issues caused by formication is also important. This might involve medications for pain or itching, and sometimes even antibiotics if there’s an infection.
Beyond medications and skin care, treatment could include:
Cutting back on personal drug use
Adjusting or stopping medications that might be causing the issue
Providing medications to help with alcohol or opioid withdrawal
Treating any other medical conditions that could be contributing
Offering counseling and support to address the psychological aspects of the condition
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 use. If someone is open to receiving help, treatment often involves psychiatric medications and treating any contributing medical condition.
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References
Juan Juan, C., et al. (2018). Prickling or formication after the use of cocaine. Revista Espanola de Sanidad Penitenciaria.
Kemperman, P. M. J. H., et al. (2022). Drug-induced delusional infestation. Acta Dermato-Venereologica.
Rusyniak, D. E. (2013). Neurologic manifestations of chronic methamphetamine abuse. The Psychiatric Clinics of North America.
Wong, J. W., et al. (2013). Delusions of parasitosis. Indian Journal of Dermatology.
For additional resources or to connect with mental health services in your area, call SAMHSA’s National Helpline at 1-800-662-4357. For immediate assistance, call the National Suicide Prevention Lifeline at 988, or text HOME to 741-741 to reach the Crisis Text Line.
