Ethical and Communicative Challenges in Informing Patients with Delusional Infestation: Insights from Moral Case Deliberation
DOI:
https://doi.org/10.2340/actadv.v105.43511Keywords:
delusional infestation, psychodermatology, ethical approach, patient communicationAbstract
Delusional infestation is a rare psychiatric condition where patients falsely believe they are infested by organisms, often accompanied by physical symptoms such as pruritus. Communicating the diagnosis and initiating treatment present significant challenges, as healthcare providers must balance honesty, sensitivity, and trust to avoid damaging the therapeutic relationship. This qualitative study explored ethical and communicative dilemmas through interviews and moral case deliberations with 11 multidisciplinary experts. Three themes emerged: the importance of building trust in the doctor–patient relationship, employing sensitive communication strategies, and enhancing multidisciplinary collaboration. Effective approaches include avoiding stigmatizing terminology, focusing on symptom management, and centralizing care in psychodermatology clinics. These findings provide recommendations to improve care outcomes and highlight the need for guidelines on communication strategies in the management of patients with delusional infestation.
Downloads
References
Freudenmann RW, Lepping P. Delusional infestation. Clin Microbiol Rev 2009; 22: 690–732.
https://doi.org/10.1128/CMR.00018-09 DOI: https://doi.org/10.1128/CMR.00018-09
Vulink NC. Delusional infestation: state of the art. Acta Derm Venereol 2016; 96: 58–63.
Patel V, Koo JY. Delusions of parasitosis: suggested dialogue between dermatologist and patient. J Dermatolog Treat 2015; 26: 456–460.
https://doi.org/10.3109/09546634.2014.996513 DOI: https://doi.org/10.3109/09546634.2014.996513
Brownstone N, Howard J, Koo J. Management of delusions of parasitosis: an interview with experts in psychodermatology. Int J Womens Dermatol 2022; 8: e035.
https://doi.org/10.1097/JW9.0000000000000035 DOI: https://doi.org/10.1097/JW9.0000000000000035
Kemperman P, Wennekers M, Lepping P, Bewley A, Aboalkaz S, Kazmi A, et al. Risk factors for nonattendance in delusional infestation: a multicenter observational study. Dermatology 2023; 239: 116–121.
https://doi.org/10.1159/000525725 DOI: https://doi.org/10.1159/000525725
Lepping P, Aboalkaz S, Squire SB, Romanov DV, Bewley A, Huber M, et al. Later age of onset and longer duration of untreated psychosis are associated with poorer outcome in delusional infestation. Acta Derm Venereol 2020; 100: adv00261.
https://doi.org/10.2340/00015555-3625 DOI: https://doi.org/10.2340/00015555-3625
Wong S, Bewley A. Patients with delusional infestation (delusional parasitosis) often require prolonged treatment as recurrence of symptoms after cessation of treatment is common: an observational study. Br J Dermatol 2011; 165: 893–896.
https://doi.org/10.1111/j.1365-2133.2011.10426.x DOI: https://doi.org/10.1111/j.1365-2133.2011.10426.x
Kemperman P, Vulink NCC, Feikema FE, Bewley A, Lepping P, Gkini MA, et al. The management of patients with delusional infestation across Europe. J Eur Acad Dermatol Venereol 2024 Dec 11 [Online ahead of print].
https://doi.org/10.1111/jdv.20485 DOI: https://doi.org/10.1111/jdv.20485
Inguaggiato G, Metselaar S, Molewijk B, Widdershoven G. How moral case deliberation supports good clinical decision making. AMA J Ethics 2019; 21: E913–E919.
https://doi.org/10.1001/amajethics.2019.913 DOI: https://doi.org/10.1001/amajethics.2019.913
Stolper M, Molewijk B, Widdershoven G. Bioethics education in clinical settings: theory and practice of the dilemma method of moral case deliberation. BMC Med Ethics 2016; 17: 45.
https://doi.org/10.1186/s12910-016-0125-1 DOI: https://doi.org/10.1186/s12910-016-0125-1
Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care 2007; 19: 349–357.
https://doi.org/10.1093/intqhc/mzm042 DOI: https://doi.org/10.1093/intqhc/mzm042
Moriarty N, Alam M, Kalus A, O’Connor K. Current understanding and approach to delusional infestation. Am J Med 2019; 132: 1401–1409.
https://doi.org/10.1016/j.amjmed.2019.06.017 DOI: https://doi.org/10.1016/j.amjmed.2019.06.017
Heller MM, Wong JW, Lee ES, Ladizinski B, Grau M, Howard JL, et al. Delusional infestations: clinical presentation, diagnosis and treatment. Int J Dermatol 2013; 52: 775–783.
https://doi.org/10.1111/ijd.12067 DOI: https://doi.org/10.1111/ijd.12067
Campbell EH, Elston DM, Hawthorne JD, Beckert DR. Diagnosis and management of delusional parasitosis. J Am Acad Dermatol 2019; 80: 1428–1434.
https://doi.org/10.1016/j.jaad.2018.12.012 DOI: https://doi.org/10.1016/j.jaad.2018.12.012
Lepping P, Huber M, Freudenmann RW. How to approach delusional infestation. BMJ 2015; 350: h1328.
https://doi.org/10.1136/bmj.h1328 DOI: https://doi.org/10.1136/bmj.h1328
Söderfeldt Y, Gross D. Information, consent and treatment of patients with Morgellons disease: an ethical perspective. Am J Clin Dermatol 2014; 15: 71–76.
https://doi.org/10.1007/s40257-014-0071-y DOI: https://doi.org/10.1007/s40257-014-0071-y
Tronto J. Moral boundaries: a political argument for an ethic of care. New York: Routledge, 1993.
Osuji PI. Relational autonomy in informed consent (RAIC) as an ethics of care approach to the concept of informed consent. Med Health Care Philos 2018; 21: 101–111.
https://doi.org/10.1007/s11019-017-9789-7 DOI: https://doi.org/10.1007/s11019-017-9789-7
Mohandas P, Bewley A, Taylor R. Morgellons disease: experiences of an integrated multidisciplinary dermatology team to achieve positive outcomes. J Dermatolog Treat 2018; 29: 208–213.
https://doi.org/10.1080/09546634.2017.1349868 DOI: https://doi.org/10.1080/09546634.2017.1349868
Published
How to Cite
License
Copyright (c) 2025 Patrick M.J.H. Kemperman, Vanessa Saradjzada, Nienke C.C. Vulink, Menno A. de Rie, Yolande Voskes
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All digitalized ActaDV contents is available freely online. The Society for Publication of Acta Dermato-Venereologica owns the copyright for all material published until volume 88 (2008) and as from volume 89 (2009) the journal has been published fully Open Access, meaning the authors retain copyright to their work.
Unless otherwise specified, all Open Access articles are published under CC-BY-NC licences, allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material for non-commercial purposes, provided proper attribution to the original work.
