What happens when an insect scientist develops invisible bug syndrome?

Illustration for article titled What happens when an insect scientist develops invisible bug syndrome?

Approximately 100,000 Americans are afflicted with Ekbom Syndrome, a psychological disorder in which sufferers believe that they're infested with insects. Ekbom sufferers are reluctant to get psychological treatment, as they believe bugs are the cause of their discomfort. And when an entomologist suffers from Ekbom Syndrome, the result is one of the most skin-crawling scientific papers imaginable.

Vaughan Bell of Mind Hacks has brought to our attention the case of University of Massachusetts entomologist Jay Traver. In 1950, Traver thought her body was infected with dermatophagoides, or the common house dust mites. Dermatophagoides live in bedding, eat sloughed-off human skin cells, and can trigger allergies, but they don't parasitize humans. You can see why people would be somewhat perturbed by Traver's discovery.

In 1951, Traver published her dealings with the phantom insect attacks in Proceedings of the Entomological Society of Washington. Her paper — "Unusual Scalp Dermatitis in Humans Caused by the Mite, Dermatophagoides (Acarina, epidermoptidae)" — is an uncomfortably visceral account of Ekbom Syndrome:

Invasion of the eyes was not confined to the period immediately following the use of the mercuric iodide soap, but continued for many days thereafter, this invasion occurring mostly between midnight and 3 a.m. The victim of their attack would have fallen into a light sleep, when a sharp pin-prick-like sensation in one eye, followed by an immediate response on the part of the already badly swollen eye would drive sleep away quite effectively. The movements of a mite that had entered under the eyelid could be felt as it crawled slowly about, then began to 'dig in' at which moment the eye suddenly became even more swollen than before. An almost continuous flow of lachrymal secretion seemed to attract the mites and made vision difficult. At no time, however, was there evidence of the formation of pus in the affected eyes.

Invasion of the nostrils produced quite distressing symptoms, as of something crawling and scratching in the mucus membrane; ofthen this accompanied by a distinct irritation of the throat, trachea and bronchi. Early invasions of the ears seemed confined to the region of the pinna, in the folds of which the mites burrowed, producing the usual itching red papules. Their prresence [sic] in the ears was the cause of some concern on my part, as it is well known that certain species of mites may cause great damage in the ears of small animals. Apparently we may consider ourselves most fortunate that his particular mite did not choose to invade the external auditory meatus, from which location it might easily have pierced the eardrum. The difficulty of controlling such an infestation in the ear, had it occurred, is at once apparent, since as yet we have found no drug that is completely effective against the mites.

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Later in the paper, Traver visits a dermatologist, who in turn recommends that she receive psychiatric treatment (Traver declines):

A dermatologist, recommended by a local physician, was apparently convinced without more than a very casual examination, that the patient's symptoms were largely imaginary, those that did exist having been caused by an ill-advised attempt on the part of the patient to rid herself of something that was not there. Not until three days after my visit to his office, however, did he tell me this. [...] After the third day in the hospital, he turned me over to a neurologist for treatment of my 'psychoneurotic' condition. The patient, however, succeeded in convincing the neurologist that she had no need of his services.

You can read more about Ekbom Syndrome in this recent paper by University of Georgia entomologist Nancy Hickle (NCBI).

[Photo via Jonathan Fox's Flickr]

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DISCUSSION

I'm not convinced by the evidence that Jay Traver actually suffered from this, or that anybody actually does. Not being able to locate an insect doesn't mean that one isn't present, sufferers make repeated visual observations of the insects parasitizing them - Jay had multiple specimens she collected from herself and her family - and the phenomenon where the sufferer's close associates develop the same symptoms suggest a genuine epidemiology - crazy isn't catchy. One of the "symptoms" of ES is "patient frequently denies that they are delusional" but isn't that a bit of a catch-22? Someone who had genuinely been misdiagnosed with a delusion would certainly protest that they were not delusional! To consider that evidence of the delusion is circular reasoning. "Patient refuses to consider any explanation" is another catch-22 when the only other explanation being offered is mental illness. How many of you would be especially receptive to the notion that all of your obvious symptoms were all in your head?

Jay actually succeeded in convincing the treating neurologist - as well as the review panel for the Proc. ESW. - that she was genuinely being parasitized. What's the evidence that she was just a crazy person? It appears to be one cursory examination by her GP. Sure, there's "no such thing as a facultive parasite" - that we know of. Until recently we could have said the same thing about halophiles, psychrophiles, thermophiles, and other organisms that thrive under conditions we thought impossible.

Certainly some sufferers could genuinely have an illusion. But 100,000 people, including insect experts and medical professionals? It seems like we're just taking it for granted that psychologists have some magic way to accurately recognize delusion. But sometimes people genuinely are misdiagnosed with delusions, when really they just have personal experience with things others consider unlikely.