Table of ContentsView AllTable of ContentsSymptomsCausesDiagnosisTreatment
Table of ContentsView All
View All
Table of Contents
Symptoms
Causes
Diagnosis
Treatment
Skin crawling is a type of sensoryhallucinationcalledformicationin which you have physical sensations of bugs crawling on your skin in the absence of a physical explanation.
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What Does Formication Feel Like?
Formication is described as the sensation of having bugs or insects crawling on or inside your skin. The feeling can be relatively mild or intense and be limited to certain parts of the body or cover the entire body. A person may also describe itching, stinging, or pins-and-needles sensations.
Formication feels like a real dermatological condition; up to 90% of people who experience it seek treatment from a dermatologist.
A person with formication will often experience these sensations for months or years and seek extensive diagnosis from multiple specialists, none of whom can find a physical cause. They typically experience high levels of anxiety and feelings that they are being ignored, dismissed, or lied to.
In a desperate effort to find an explanation, some people will embrace controversial diagnoses like Morgellons disease and use alternative treatments that may or may not be of any help.
One notable feature of formication is that 5% to 15% of people share the symptoms with a close friend or relative, a phenomenon known asfolie à deux.
What Causes Skin Crawling Sensations?
Formication is a sensoryhallucinationthat falls under the umbrella of adelusional disorderin the “Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition”(DSM-5). It is a rare condition affecting roughly two out of every 100,000 people in the United States.
For reasons that are not entirely clear, females are affected twice as often as males. The highest incidence of formication occurs between the ages of 50 and 80.
Though this may suggest that skin-crawling is a purely mental condition, formication is not solely associated with psychiatric illness. Rather, clinicians will categorize the formication as being either primary (occurring on its own), secondary (occurring with a psychiatric condition), or organic (occurring with a medical condition).
Primary Formication
Primary formication is a psychiatric disorder where the delusions of a parasitic infestation are the only symptom. This is diagnosed after all possible causes, both psychiatric and somatic (physical), have been excluded.
It may be that the individual has not met the diagnostic criteria of a psychiatric condition outlined in the DSM-5, or it could be that the symptom isidiopathic(of unknown origin).
The diagnosis of primary formication is sometimes used as a “placeholder” to avoid declaring it as either being either psychiatric or somatic. In such cases, a person may be referred to a neurologist, endocrinologist, toxicologist, or other specialist for further investigation.
Secondary Formication
Secondary formication is when skin-crawling affects someone with a diagnosed psychiatric condition. Skin-crawling is a common experience in people with:
Delusions, hallucinations, delirium, andpsychosesare common when these conditions are severe and/or left untreated.
Organic Formication
Organic formication is when skin-crawling is secondary to an underlying medical condition or cause. Formication is sometimes seen with:
It is important to note that formication is only diagnosed if other causes of the sensations are excluded. A prime example isperipheral neuropathywhich causes numbness, burning, tingling, or pins-and-needles sensation due to nerve injury or toxicity.
Formication is only diagnosed if the pattern or characteristics of “skin-crawling” are not consistent with how neuropathy normally presents. Extensive neurological testing may be needed.
Other delusional symptoms include angry moods, mistrust in friends and family, outsized responses to what is being told you, and a belief that you are being taken advantage of.
Does Skin-Crawling Have a Medical Cause?
More research is needed.
How Is Formication Diagnosed?
This doesn’t mean that the person describing skin-crawling is inherently delusional; there may be an underlying cause yet to be undiagnosed.
To this end, the investigation may include a battery of tests to rule out diseases, infections, and actual infestations (like scabies) that might account for the symptoms.
This may include:
Referral to multiple specialists, including dermatologists and neurologists, may be needed to definitively rule out all possible causes.
A psychiatric evaluation is also useful to the diagnosis, although many people will resist seeing apsychiatrist or psychologist, believing that doing so suggests they are mentally ill or are making up their symptoms.
How Is Skin Crawling Treated
The treatment of formication generally starts with building a strong, trusting relationship with your primary care provider. Skilled practitioners will devote the necessary time to listen to and acknowledge your symptoms without perpetuating the delusion.
While people with formication may rejectpsychotherapy, at least initially, they usually desire treatment and may be responsive to antipsychotic drugs commonly used to treat delusional disorders.
Currently, second-generation antipsychotics are recommended for the treatment of formication as they have a lower risk of side effects.
These include medications like:
Studies suggest that up to 88% of people treated with antipsychotics will experience complete or partial remission of skin-crawling symptoms. The response rates may improve with regular provider interaction or counseling.
Some studies have also shown that antidepressants calledselective serotonin reuptake inhibitors (SSRIs)are effective, particularly in people with primary formication, leading to complete remission in up to 79% of cases.
Summary
Formication is a type of delusional disorder that manifests with sensations of skin crawling. The causes are classified as primary formication (occurring for no reason), secondary formication (related to a psychiatric disorder), or organic formication (related to a disease or medical condition).
To diagnose formication, all other possible causes must be excluded. This can involve extensive testing and, even then, a person may not accept the diagnosis.
Treatment of formication typically involves antipsychotics or selective serotonin reuptake inhibitors (SSRIs) in tandem with regular provider interaction or counseling.
7 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Centers for Disease Control and Prevention.Perspectives: delusional parasitosis.Mindru FM, Radu AF, Bumbu AG, et al.Insights into the medical evaluation of Ekbom syndrome: an overview.IJMS. 2024;25(4):2151. doi:10.3390/ijms25042151Reich A, Kwiatkowska D, Pacan P.Delusions of parasitosis: an update.Ther (Heidelb).2019;9(4):631-638. doi:10.1007/s13555-019-00324-3Wong JW, Koo JYM.Delusions of parasitosis.Indian J Dermatol.2013;58(1):49. doi:10.4103/0019-5154.105309Waykar V, Wourms K, Tang M, Joseph V.Delusional infestation: an interface with psychiatry.BJPsych Advances. 2021;27(5):343-348. doi:10.1192/bja.2020.69Knapp B, Tito E, Espiridion ED.Delusional parasitosis in a patient with alcohol-induced psychotic disorder.Cureus. 2019 Mar 29;11(3):e4344. doi:10.7759/cureus.4344Lu JD, Gotesman RD, Barghese S, Fleming P, Lynde CW.Treatments for primary delusional infestation: systematic review.JMIR Dermatol. 2022 Mar 30;5(1):e34323. doi:10.2196/34323
7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Centers for Disease Control and Prevention.Perspectives: delusional parasitosis.Mindru FM, Radu AF, Bumbu AG, et al.Insights into the medical evaluation of Ekbom syndrome: an overview.IJMS. 2024;25(4):2151. doi:10.3390/ijms25042151Reich A, Kwiatkowska D, Pacan P.Delusions of parasitosis: an update.Ther (Heidelb).2019;9(4):631-638. doi:10.1007/s13555-019-00324-3Wong JW, Koo JYM.Delusions of parasitosis.Indian J Dermatol.2013;58(1):49. doi:10.4103/0019-5154.105309Waykar V, Wourms K, Tang M, Joseph V.Delusional infestation: an interface with psychiatry.BJPsych Advances. 2021;27(5):343-348. doi:10.1192/bja.2020.69Knapp B, Tito E, Espiridion ED.Delusional parasitosis in a patient with alcohol-induced psychotic disorder.Cureus. 2019 Mar 29;11(3):e4344. doi:10.7759/cureus.4344Lu JD, Gotesman RD, Barghese S, Fleming P, Lynde CW.Treatments for primary delusional infestation: systematic review.JMIR Dermatol. 2022 Mar 30;5(1):e34323. doi:10.2196/34323
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Centers for Disease Control and Prevention.Perspectives: delusional parasitosis.Mindru FM, Radu AF, Bumbu AG, et al.Insights into the medical evaluation of Ekbom syndrome: an overview.IJMS. 2024;25(4):2151. doi:10.3390/ijms25042151Reich A, Kwiatkowska D, Pacan P.Delusions of parasitosis: an update.Ther (Heidelb).2019;9(4):631-638. doi:10.1007/s13555-019-00324-3Wong JW, Koo JYM.Delusions of parasitosis.Indian J Dermatol.2013;58(1):49. doi:10.4103/0019-5154.105309Waykar V, Wourms K, Tang M, Joseph V.Delusional infestation: an interface with psychiatry.BJPsych Advances. 2021;27(5):343-348. doi:10.1192/bja.2020.69Knapp B, Tito E, Espiridion ED.Delusional parasitosis in a patient with alcohol-induced psychotic disorder.Cureus. 2019 Mar 29;11(3):e4344. doi:10.7759/cureus.4344Lu JD, Gotesman RD, Barghese S, Fleming P, Lynde CW.Treatments for primary delusional infestation: systematic review.JMIR Dermatol. 2022 Mar 30;5(1):e34323. doi:10.2196/34323
Centers for Disease Control and Prevention.Perspectives: delusional parasitosis.
Mindru FM, Radu AF, Bumbu AG, et al.Insights into the medical evaluation of Ekbom syndrome: an overview.IJMS. 2024;25(4):2151. doi:10.3390/ijms25042151
Reich A, Kwiatkowska D, Pacan P.Delusions of parasitosis: an update.Ther (Heidelb).2019;9(4):631-638. doi:10.1007/s13555-019-00324-3
Wong JW, Koo JYM.Delusions of parasitosis.Indian J Dermatol.2013;58(1):49. doi:10.4103/0019-5154.105309
Waykar V, Wourms K, Tang M, Joseph V.Delusional infestation: an interface with psychiatry.BJPsych Advances. 2021;27(5):343-348. doi:10.1192/bja.2020.69
Knapp B, Tito E, Espiridion ED.Delusional parasitosis in a patient with alcohol-induced psychotic disorder.Cureus. 2019 Mar 29;11(3):e4344. doi:10.7759/cureus.4344
Lu JD, Gotesman RD, Barghese S, Fleming P, Lynde CW.Treatments for primary delusional infestation: systematic review.JMIR Dermatol. 2022 Mar 30;5(1):e34323. doi:10.2196/34323
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