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.
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.
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 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.
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:
Methylphenidate (Ritalin), a medication for ADHD
Antidepressant medications called MAO inhibitors, like phenelzine or pargyline
Medical conditions can cause formication. Some, particularly neurological illnesses, can cause formication because they affect how the brain works. Examples include:
Traumatic brain injury
Meningitis or encephalitis
Vitamin B12, folate, and niacin deficiencies
Chronic kidney disease
Chronic liver disease
Congestive heart failure
Endocrine disorders (such as diabetes mellitus or thyroid disease)
Cancer (such as leukemia, lymphoma)
Infection (such as HIV, syphilis, tuberculosis, gonorrhea)
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.
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
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.
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