Delusional Parasitosis

Delusional Parasitosis is the diagnosis offered to explain Laura’s belief that parasites are causing her skin symptoms. The episode keeps two questions in view at once: whether the suspected infestation is physically present, and how real suffering can be treated when the physician rejects the patient’s explanation for it.

Symptoms and the Search for Care

Laura’s distress has visible consequences. After three days and three more bumps, she scratches the third mark on her face until swelling closes one eye. She resists David’s suggestion that she see a doctor because of the insurance deductible, and says she has instead arranged an appointment at a free clinic on Longford Street for Monday. When she is later asleep on the sofa, David makes an urgent appointment with her own physician and persuades her to go that afternoon.

At the consultation, the physician examines Laura’s scraped cheek and asks to see each bump. She answers his questions as best she can, then takes a plastic bag from her purse and explains her theory about a parasite and the evidence she has collected. The physician’s attention changes after he sees the bag: he looks at its contents briefly and sets it aside. The shift matters because Laura has brought the material as proof, whereas the physician will interpret the act of collecting it as part of the condition under discussion.

The Diagnosis and Its Evidence

The physician explains the distinction through what he calls the matchbox sign. In the older version of the pattern, patients presented an empty matchbox as evidence of parasites beneath their skin; now, he says, people may use plastic bags or food containers, or take phone photographs. The supposed specimens, in his account, are dead skin, dust, and lint—small particles mistaken for evidence when a person is intensely focused on the body and searches it for confirmation of an infestation.

This explanation does not make Laura’s sensations imaginary in the sense of being fabricated. The physician tells David that the parasites may be imagined while Laura’s suffering is real. He describes delusional parasitosis as a possible symptom of depression or an early sign of psychosis, and says it can be difficult to treat because patients often refuse help. His emphasis is therefore both diagnostic and practical: Laura is willing to accept treatment, and he urges David not to obstruct it.

Treatment and Its Costs

The physician offers a prescription aimed at what he considers the underlying cause, suggesting that Laura’s skin problems may lessen as her mood improves. David presses for help with the itching itself and asks whether they should see a dermatologist. By then Laura is exhausted and agrees to try the medication. She begins treatment with antidepressants and what her psychiatrist describes as a very mild antipsychotic.

The change is mixed. Laura sleeps progressively longer—first eight hours, then nine, then ten—and takes lengthy afternoon naps. She gains weight, her thick black hair thins, and David often finds her slow and foggy on the stained sofa. At the same time, she scratches much less, and the wound on her face begins to heal. Bumps still appear; David continues to think they are insect bites, but Laura resists scratching them, and they subside after a day or two. The apparent improvement comes with a cost that David experiences as a loss of the person he loved, rather than as an uncomplicated recovery.

Doubt and the Second Opinion

David initially tells himself that Laura is cured, but her diminished state leaves him uneasy. At night he wonders whether something more bodily than unhappiness might be draining her, and whether his account of her private struggles helped the physician dismiss a physical illness and persuade her to endure pain in silence. That doubt sharpens when David asks whether they can seek another opinion and proposes a dermatologist rather than another psychiatrist.

He presents Laura with scientific articles he has printed at work, arguing that genuine skin diseases are sometimes misdiagnosed as psychiatric problems, especially in women. He also challenges the physician’s judgment as shaped by an older generation inclined to treat conditions such as fibromyalgia and chronic fatigue as psychosomatic. His insistence that they find the best doctor does not establish that Laura has a parasite, just as the initial diagnosis does not erase her symptoms. The episode leaves the cause unresolved and makes the diagnostic conflict part of the story: the plastic bag can be read as evidence of infestation by Laura, as debris by the physician, and by David as a reason to fear that the wrong explanation has become authoritative.