Ebkom Syndrome: Types, Cuases, Symptoms, Diagnosis and treatment by Sophia Jiongy Li

Ekbom Syndrome: Types, Causes, Symptoms, Diagnosis and Treatment

By: Sophia Jiongy Li

Introduction

Ekbom syndrome, also known as delusional parasitosis (DP) or delusional infestation, is an uncommon psychiatric condition characterized by an individual’s persistent belief that they are infested with parasites, despite medical evidence not supporting this belief. This condition can cause significant emotional distress and affect an individual’s quality of life.

Ekbom syndrome is generally classified into primary and secondary forms, with secondary cases sometimes further divided into functional and organic causes. Although it can affect anyone, it is more commonly reported among middle-aged and older adults, particularly women. Understanding Ekbom syndrome is important because appropriate evaluation and evidence-based treatment can help improve the quality of life of those affected (Mindru et al., 2024).

Types and Causes

Delusional parasitosis is commonly classified into primary and secondary forms.

Primary Delusional Parasitosis

In primary delusional parasitosis, an individual experiences a persistent belief that they are infested with parasites without another underlying psychiatric or medical condition adequately explaining the belief (Reich et al., 2019).

The exact cause of primary delusional parasitosis remains unknown. One hypothesis suggests that changes in dopamine signaling in certain brain regions may contribute to the condition (Ngan, 2021).

The basal ganglia are interconnected structures within the brain that contribute to movement, learning, and other cognitive processes. However, the precise relationship between dopamine activity in these structures and delusional parasitosis requires further research (Cleveland Clinic, 2022).

Secondary Delusional Parasitosis

Secondary delusional parasitosis occurs when the condition is associated with another medical, neurological, psychiatric, or substance-related cause. Some literature further distinguishes functional secondary cases from organic cases, in which an underlying physical illness or neurological condition may contribute to the symptoms (Reich et al., 2019).

Several possible causes have been reported.

Table 1. Examples of medical and other causes associated with secondary delusional parasitosis

Category	Examples
Medical conditions	Hypothyroidism, vitamin B12 or folate deficiencies, neuropathy, and diabetes
Neurological conditions	Dementia, stroke, multiple sclerosis, encephalitis, and meningitis
Substance-related causes	Methamphetamine use, alcohol withdrawal, and cocaine use
Infectious diseases	HIV, tuberculosis, leprosy, and syphilis
Medication-related causes	Certain medications, including topiramate, ciprofloxacin, amantadine, corticosteroids, ketoconazole, and phenelzine

Source: Adapted from Ansari and Bragg (2021). These are examples, and their relevance depends on the individual’s medical history and clinical evaluation.

Symptoms and Diagnosis

A thorough diagnostic evaluation is essential because several medical and psychiatric conditions can produce similar symptoms.

Before diagnosing Ekbom syndrome, healthcare professionals should investigate whether a genuine parasitic infestation or another medical condition could explain the individual’s symptoms. A negative test alone does not establish the diagnosis; the person’s history, symptoms, examination findings, and other relevant investigations must also be considered (Mindru et al., 2024).

Possible symptoms and associated behaviors include:

• A persistent belief of being infested with parasites despite medical evidence that does not support the belief.
• Abnormal skin sensations, such as itching, biting, or crawling sensations.
• Tactile or visual hallucinations associated with the perceived infestation.
• Skin injuries, including excoriations and erosions, that may result from attempts to remove perceived parasites.
• Skin irritation or damage caused by repeated cleansing or scratching.
• Depression, distress, or social isolation.
• Seeking repeated inspections or treatments for pets because of concerns about infestation.
• Attempts to convince family members or healthcare professionals that an infestation is present.

The symptoms experienced can vary between individuals (Reich et al., 2019).

The Matchbox Sign

Some individuals may bring a container, bag, or matchbox containing dust, skin flakes, fibers, or other material they believe provides evidence of an infestation. This behavior is known as the “matchbox sign” or “specimen sign.”

The material may be examined as part of the diagnostic assessment, but the presence of this behavior alone does not confirm the diagnosis (Reich et al., 2019).

Shared Delusional Beliefs

In some cases, a similar belief may develop in someone who has a close relationship with the affected individual. This phenomenon has been described as a shared delusional disorder.

Separating the individuals may sometimes reduce the shared belief, although treatment needs vary and professional assessment is important (Reich et al., 2019).

How Common Is Ekbom Syndrome?

Ekbom syndrome is considered uncommon. A review by Mindru et al. (2024) discusses estimates of approximately 1.9–3.7 new cases per 100,000 people per year in some studies, while a separate estimate of 27.3 per 100,000 refers to prevalence.

These figures represent different measures and should not be interpreted as interchangeable. Because the condition is uncommon and can be difficult to identify, accurate diagnosis requires an individualized clinical assessment.

Treatments

Treatment depends on the underlying cause, the severity of symptoms, and the individual’s needs. Identifying any contributing medical conditions, neurological disorders, medication effects, or substance-related causes is an important part of treatment planning.

Cognitive Behavioural Therapy

Cognitive behavioural therapy (CBT) may be considered as part of an individualized treatment plan. It can help individuals explore the connections between thoughts, emotions, and behaviors while developing strategies to manage distress.

Building trust between the individual and healthcare professional is especially important. Treatment should be approached respectfully, without dismissing the person’s distress or arguing confrontationally about their beliefs.

Medication

Antipsychotic medications may be prescribed by a qualified healthcare professional to help manage persistent delusional symptoms. Medications such as risperidone and olanzapine have been used in treatment.

If an individual also experiences depression or other mental health symptoms, additional treatment may be considered depending on their clinical needs. Medication choices, potential side effects, and monitoring requirements should be discussed with the prescribing clinician (Reich et al., 2019).

When an underlying medical condition or medication-related cause is identified, addressing that cause may also be an important part of treatment.

Raising Awareness of Ekbom Syndrome

Raising awareness of Ekbom syndrome is important because the condition remains uncommon and can be misunderstood. The exact causes of primary delusional parasitosis are still uncertain, and further research is needed to improve understanding and treatment.

Individuals affected by this condition may experience significant distress, social isolation, skin injuries, and difficulty accessing appropriate medical care. Stigma surrounding mental health conditions can make these challenges even more difficult.

Awareness initiatives can help by:

• Promoting education: Sharing accurate information about the condition and its effects.
• Encouraging research: Supporting scientific efforts to understand possible causes and develop better treatments.
• Reducing stigma: Promoting respectful conversations about mental health and the experiences of affected individuals.
• Encouraging medical support: Helping people understand the importance of seeking professional assessment and appropriate care.

Through education, advocacy, and research, communities can help improve understanding of Ekbom syndrome and support those affected by it.

Conclusion

Ekbom syndrome, also known as delusional parasitosis or delusional infestation, is an uncommon condition involving a persistent belief of parasitic infestation that is not supported by medical evidence. It can have physical, psychological, and social consequences, making appropriate diagnosis and treatment important.

The condition may be associated with underlying medical or neurological disorders, medication effects, or other contributing factors. A careful evaluation helps healthcare professionals identify possible causes and develop an appropriate treatment plan.

Raising awareness can reduce stigma, encourage people to seek professional help, and support further research into the condition. Through education, advocacy, and compassionate care, it is possible to improve understanding of Ekbom syndrome and help affected individuals access appropriate support.

Works Cited

Ansari, M. N., and Bragg, B. N. (2021). “Delusions of Parasitosis.” StatPearls. National Center for Biotechnology Information. https://www.ncbi.nlm.nih.gov/books/NBK541021/

Cleveland Clinic. (2022). “Basal Ganglia: What It Is, Function & Anatomy.” https://my.clevelandclinic.org/health/body/23962-basal-ganglia

Cleveland Clinic. (2026, July 9). “Delusional Parasitosis (Ekbom Syndrome): Causes & Treatment.” https://my.clevelandclinic.org/health/diseases/delusional-parasitosis

Hinkle, N. C. (2009). “Ekbom Syndrome: The Challenge of ‘Invisible Bug’ Infestations.” Annual Reviews. [Verify the publication details and working URL before publication.]

Logsdon, A. (2023). “Organic Mental Disorder Causes and Treatment.” Verywell Mind. https://www.verywellmind.com/organic-mental-disorders-2162516

Mindru, F. M., Radu, A.-F., Bumbu, A. G., Radu, A., and Bungau, S. G. (2024). “Insights into the Medical Evaluation of Ekbom Syndrome: An Overview.” International Journal of Molecular Sciences, 25(4), 2151. https://doi.org/10.3390/ijms25042151

Ngan, V. (2021). “Delusions of Parasitosis.” DermNet. https://dermnetnz.org/topics/delusions-of-parasitosis

Reich, A., Kwiatkowska, D., and Pacan, P. (2019). “Delusions of Parasitosis: An Update.”