Morgellons Disease as Internet Meme
Centre for Addiction and Mental Health, Toronto, Ontario, Canada Psychosomatics
(Impact Factor: 1.86).
02/2009; 50(1):90. DOI: 10.1176/appi.psy.50.1.90
Available from: Patricia Ryan Recupero
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ABSTRACT: The Internet has grown increasingly relevant in the practice of forensic psychiatry. To a psychiatrist conducting a forensic evaluation, the evaluee's Internet use can be relevant in nearly all aspects of the analysis. An evaluee's Internet presence may help to confirm, corroborate, refute, or elaborate on the psychiatrist's general impression of the person. Questions about the individual's choice of screen names, activities, images, and phrases can be valuable conversational tools to increase candor and self-disclosure, even among less cooperative evaluees. Difficulties in mood or affect regulation, problems with thought process or content, and impaired impulse control may be apparent in the evaluee's behavior in various Internet forums-for example, hostile or provocative behavior in social forums or excessive use of gaming or shopping websites. Discussions about the evaluee's behavior on the Internet can help the psychiatrist to assess for impaired insight and judgment. Perceptual disturbances, such as derealization and depersonalization, may be related to an evaluee's overidentification with the virtual world to the neglect of real-life needs and responsibilities. Furthermore, digital evidence can be especially useful in assessments of impairment, credibility, and dangerousness or risk, particularly when the evaluee is uncooperative or unreliable in the face-to-face psychiatric examination. This discussion will provide illustrative examples and suggestions for questions and topics the forensic psychiatrist may find helpful in conducting a thorough evaluation in this new age of the Internet.
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ABSTRACT: Morgellons disease is a controversial and poorly defined symptom cluster of skin lesions and somatic symptoms, most notably 'fibers' in the skin. Because of widespread coverage in the media and on the Internet, there are an increasing number of patients presenting to dermatologists. We present three patients who believed that they had fibers in their skin. We offer a discussion of delusions of parasitosis to demonstrate similarities between these conditions. It has been suggested by a limited number of healthcare providers that an unknown infectious agent underlies this symptom complex yet no available evidence supports this assertion. Laboratory values that would be reflective of an infectious process (e.g. elevated white blood cells, sedimentation rate, C reactive protein) are routinely normal and biopsies often reflect only nonspecific findings such as acute and chronic inflammation with erosion or ulceration. Patients with Morgellons disease generally lack insight into their disease and reject the need for psychiatric help. The goal is to build trust and refrain from minimizing what the patient experiences. Attentive examination of the patient's skin and fragments they present is necessary to rule out a true underlying pathologic process and to establish a trusting relationship. A supportive, non-confrontational approach is ideal. The patient is best treated by a team of practitioners of several specialties, including dermatologists, psychiatrists, and counselors.
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