Handling ‘Phantom Biting Pest’ Cases

Editor’s Note: The following article on delusory parasitosis an excerpt from the forthcoming PCT book, “Field Guide to Stinging & Biting Arthropods” written by Stoy Hedges and Dr. Gerald S. Wegner. For more information on PCT-published books, head to https://store.pctonline.com/en/pct-books

© Jeff McGovern

On occasion, pest professionals may receive a call regarding “biting, burrowing or crawling insects” in a home or office setting. More often than not, an inspection results in no biting insects or arthropods being found despite the person’s insistence that bites and other dermal sensations are occurring. Commonly, the sensations are caused by “bugs that can’t be seen” or, if visible, happen to look like animated bits of whatever is found on the skin and nearby surfaces. The pest professional may be shown red marks or scratches on the skin of the person who claims these are bites. The person may also supply pieces of tape or vials or jars with tiny bits of debris in them, claiming that these are causing the bites. Subsequent examination under a microscope usually reveals no arthropods of any kind or, if an insect is found, it is of a type that does not bite. These cases where people insist they are being bitten in the absence of a biting arthropod is generally known as delusions of parasitosis or DOP (a.k.a. delusory parasitosis and Ekbom’s syndrome). Those who describe dermal sensations of biting, crawling and burrowing parasites should not be summarily dismissed as DOP because in some cases, an inspection actually reveals a biting arthropod of some kind. Pest professionals should be initially supportive when talking to such individuals but should insist on being able to find a target biting pest on the premises before applying any treatments.

Possible Causes for Biting Sensations

Delusions of parasitosis are by far the most challenging cases to handle, especially by pest professionals, because typically some type of emotional or psychological issue is involved. Pest professionals have become entangled with such persons to the point they are spending too many hours on the phone discussing their situations and listening to those persons’ self-diagnoses and speculations on potential causes for their problems. Such cases can be a drain on a pest professional emotionally, as engaging the desire to help others in distress. In short, a point is reached where the professional must tactfully withdraw from engagement with the person. Experienced professionals have learned to recognize the signs of persons who may have illusions or delusions of parasitosis and do not engage beyond initial conversations and an inspection.

Causes of Skin Irritations and Rashes

So many things can result in irritation, itches, redness, bumps, lesions, hives and other conditions they cannot be discussed in any detail in this book. The Mallis Handbook of Pest Control has a chapter devoted to this topic that can be consulted for more information. 

Potential causes for skin issues include the following: allergic dermatitis; sensitivity to various chemicals and proteins in the environment; temperature and humidity changes (particularly when changing from air conditioning to heating in the fall); dry skin (caused by many factors); dust and fibers contacting the skin; static electricity; air pollutants; cosmetics; perfumes, colognes and similar products; sun exposure; detergents and soaps; woolen clothing; overactive pores and sweat glands; paper fibers (often referred to as “paper mites” or “cable mites”); poison ivy or exposure to other types of plant chemicals; food allergies; fungal infections; sensitivities to medications; vitamin deficiencies; and medical disorders (including diabetes, thyroid, liver and renal disease, shingles/herpes zoster, chicken pox); and pregnancy.

Psychological Conditions. Last, and most important, the person may have an actual psychological issue or disorder such as onset of dementia, melancholy, entomophobia (fear of insects and arthropods) or schizophrenia. Some sufferers’ delusions are the result of substance abuse and the psychological effect of hallucinogens, methamphetamines (i.e., “meth bugs”) and cocaine (i.e., “cocaine bugs”). These are conditions well beyond the purview of non-medical service providers and are best left to psychiatrists and medical specialists to diagnose; therefore, pest professionals need to be cautious when handling DOP cases. 

The Initial Interview

One cannot overemphasize the importance of the initial conversation with a person who reports “getting bit” in a home or office situation. Typically, the affected person is elderly, but this is not always the case. One case involved a mother whose young son had red marks in his skin, which the mother believed were the result of “bug bites.” Ultimately, no biting arthropods were found, and the mother was advised to take her son to a dermatologist.

Sometimes, the person does have cats or dogs and so believes they have fleas in the house, prompting the pest professional to sell them a flea control service. In a few cases, the flea treatment does not stop the “biting” and so the person requests additional flea treatments. At some point the pest professional will need to demonstrate that fleas are actually present. Such cases may then escalate into a pesticide misapplication and label violation charges involving state regulators and civil litigation, resulting in fines and other legal/regulatory actions. 

Based on the authors’ experiences, the more drawn out and bizarre the persons’ explanation of their biting pest issues, the less likely an actual biting arthropod is involved. For example, the person may start out with a reasonable explanation, but the longer they talk, the more the severity of the situation escalates. In one case, an elderly woman began by saying she thought she had fleas from a dog that a friend had brought over. Her story then switched to having seen tiny flying insects around the trees in her yard. A few minutes later, she stated emphatically that the flying insects were inside the house and that she noticed them on her behind when she used the bathroom. To make the matter more bizarre, the woman’s in-home caretaker agreed with each escalation of the story. Ultimately, an inspection and strategically placed pest monitors revealed no biting arthropods of any kind; rather, all the samples provided by the woman to identify were fibers, dirt and little scabs from her skin.

Triggering Events. Commonly, as sufferers explains their experiences with “bites,” they will mention some type of triggering event such as new carpeting or a new rug acquired from a store, a used rug from a garage sale or a relative, a new bed or mattress; used furniture brought into the house; dust coming from vents when the HVAC is switched on during spring or fall; a roof leak; black mold in the basement; a friend or relative’s pet visiting; another person coming to stay at the house; family returning from a trip or having stayed in a motel or hotel.

The triggering event may also involve a major life change that results in stress to the individual including such things as divorce, loss of a loved one, close friend or beloved pet; loneliness; or working long hours. The person may also be having difficulty at work or have conflict with a relative or neighbor. They may also have anxiety issues, as yet undiagnosed, that manifest into a skin or medical issue.

Tips for Pest Professionals

Gerry Wegner

The only commitments a pest professional should make in potential “phantom biting pest” cases are to (1) be polite and courteous in dealing with the affected person, and (2) take steps through visual inspection and examination of pest monitoring trap captures/contents (Figure 2) to determine if any biting arthropod can be found.

First and foremost, pest professionals should NOT apply any pesticides unless they can find a target pest that requires some type of treatment, such as fleas, bed bugs or bird mites. The type of pest involved and its location will factor heavily into which insecticide products or treatment techniques may be used.

Sufferers may ask the pest professional to look at and diagnose marks, rashes or other issues on their skin. Professionals should decline to do so explaining that they are not physicians/medical professionals and have no knowledge or licensure to identify skin conditions.

Professionals should avoid telling the troubled persons that they must be imagining the bites or that they may have a psychological condition. Again, pest professionals are not medical professionals. The person may then be advised, politely, to see their dermatologist or physician. Note: Occasionally, a caller’s physician (who may be unfamiliar with DOP or personally convinced there is a pest issue at the patient’s home or workplace) will refer that person to a pest professional.  In such cases, the contacted pest professional, having completed the above-recommended protocol, may wish to contact the physician in question and report that no evidence of pests was found at the patient’s home or workplace.  

Gerry Wegner

The sole involvement by pest professionals in these cases should be to determine if some type of biting arthropod is present and, if so, to propose options to control such pests (Figure 3). In the absence of biting arthropods, professionals should politely explain why they cannot provide any treatments — that a target pest needs to be identified before any treatments can be made. Be courteous and explain what was done and what was found. If the person insists on treatment, the pest professional needs to politely decline and disengage completely from the situation. 

These cases are truly challenging and take experience to handle. Having one or two experienced, designated persons in the company to handle “phantom biting pest” cases (which may include those who answer the phones and schedule service calls) is one way to offer consistency in dealing with potential DOP individuals.