Acarophobia: Phobia or Delusions of Parasitosis?

Despite its name, many experts disagree with classifying acarophobia as a phobia. Some experts suggest the term “delusions of parasitosis” instead, though others feel the condition is a form of paranoia, mania, dementia, or neurosis. “Ekbom Syndrome” has gained popularity in the last decade as a replacement for these older terms.

This disagreement stems from a phobia being an excessive fear of an object or situation. While the fear usually seems unreasonable, the object of the phobia is real. This is not the case with acarophobia. Some researchers have even discussed separating the condition into two types: the fear of small insect infestations and the delusion of an insect infestation.

Professionals who accept acarophobia’s current classification typically feel that it is a specific phobia. This is a subtype of phobia that stems from a specific event or object.

For a fear to qualify as a specific phobia, it must have a noticeable impact on a person’s life. Specific phobias usually trigger behavioral changes, such as doing everything possible to avoid the subject of the phobia. They can also cause physical symptoms, like nausea, dizziness, sweating, and difficulty breathing.

In recent years, a greater number of researchers have supported the notion of acarophobia being a delusion and have named the condition "Ekbom Syndrome." By approaching the condition in this way, health care workers hope to provide better management options. Additionally, this research has uncovered a greater number of shared behaviors and symptoms.

The main characteristic of acarophobia is a fear of or a delusion that the skin is infested with small insects or similar crawling organisms. Those who experience delusions have both tactile and visual hallucinations. This often causes people with the condition to scratch at their skin, either to satisfy an itching sensation or to “remove” the insects.

Experts have also found that individuals with acarophobia tend to view things like lint, thread, or dirt as insects.

In addition to the common characteristics, people with acarophobia often share several other behaviors and symptoms. These include several beliefs:

• “Bugs” are initially black and white, other colors are visible later
• “Bugs” can jump
• “Bugs” can infest hair
• “Bites” develop that cause a strong itching sensation
• “Bugs” come out of items like makeup, toothpaste, and other containers
• “Bugs” can infest a home, sometimes forcing a person to move out

Experts who view acarophobia as a specific phobia often believe the condition stems from a traumatic experience with insects. It is also possible that genetics influence the development of specific phobias.

Those who view acarophobia as a delusion or similar mental health condition have discussed a range of possible causes. Some feel it stems from issues with body image and self-identity. Others argue that it is likely a form of sexual guilt and an internal sensation of being “unclean.” Older research indicates social isolation as a potential trigger.

Acarophobia can have several possible complications. Primarily, the constant scratching can lead to severe bodily harm. Additionally, case studies note some people use sharp objects like knives to scrape away the “bugs.” Individuals with the condition have also used dangerous pesticides or cleaners in an attempt to resolve the infestation. The condition may become severe enough to trigger thoughts of self-harm or suicide.

The prevalence of acarophobia is unknown and difficult to gauge. Though most people think of acarophobia as a rare condition, current research indicates that it is actually quite common.

Acarophobia is hard to recognize because of the poor understanding of the condition, which results in a low number of reported cases. Additionally, people who have the condition are not aware that they are experiencing delusions and will attempt to resolve the issue without a clinical diagnosis.

Recognizing acarophobia is relatively simple, though diagnosing it is much more difficult. A physician must first rule out the presence of any arthropods or other parasites. Then, they must eliminate side effects from medications or illicit drugs that cause similar symptoms and skin sensations. Because a person with acarophobia is not aware they are experiencing delusions, they often visit an entomologist or dermatologist first.

Doctors have advocated for several neuropharmacological drugs and therapies to treat acarophobia. However, some people who have acarophobia exhibit signs of paranoia, while others refuse to believe their issues are psychological. These characteristics make it difficult to refer patients to psychiatrists or other mental health professionals. Regardless, therapy and medications appear to eliminate symptoms, even if the individual continues to believe they are experiencing an infestation.