Is Morgellons Disease the New "Lyme Disease" of Our Time ?
It seems that most physicians have come across these symptoms in patients. They patient complain and whine that they have chronic pain or other myriad of symptoms. But all the blood tests, scans, and even biopsies keep coming back negative or normal.
Nutcases. Psychotics.
Yet the symptoms persist and the patient keeps returning for follow up visits convinced that they have some horrible disease. We used to call them hypochondriacs but more politely and professionally these patients are diagnosed as having one of 5 different, psychosomatic disorders
. The descriptions of these syndromes of psychosis include;
1. Somatization Disorder - The catch-all diagnosis of multiple unexplained and usually chronic complaints.
2. Hypochonriasis - Unexplained pain/symptoms dominated by a preoccupation with the belief that the cause is a serious disease (i.e. cancer).
3. Conversion Disorder - A sudden loss of normal neurological function (vision, hearing, ability to walk) or abnormal neurological symptoms (seizures) in the absence of a clear cause and usually in the context of a recent severe psychological stressor (i.e. trauma).
4. Pain Disorder - Pain in one or more sites without an obvious physical cause.
5. Body Dysmorphic Disorder - Preoccupation with a physical sign or defect that is not evident to others.
But even deeper is the concern among most physicians that their patients will react very adversely to being told that no physical cause for their symptoms can be found and that in all likelihood they suffer from a psychiatric disorder. I.e. "it's all in your head".
It's not a baseless concern. To have a psychiatric cause for a physical symptom caries very negative connotations in our society. Patients fear that people (including their own family members) will consider them to be "crazy" or be accused of "faking" their symptoms for secondary gain.
However, these patients are neither crazy nor are they faking their symptoms (part of the process of making the diagnosis of somatoform disorder is ruling out malingering i.e. patients who fake pain to get narcotics or win lawsuits). These disorders are as real as depression and now two new studies suggest that reassuring these patients that their symptoms are not caused by some horrible disease can be quite therapeutic.
The first study from Germany found that patients with somatoform disorders were more likely to misunderstand what their doctor is telling them and believe that they have a serious physical illness. The second study found that 10 sessions of cognitive behavioral therapy designed to relieve stress, increase emotional awareness, and become more socially active helped these patients think differently about their symptoms.
The take home point is that clear and direct communication with the patient is essential and that psychotherapy, behavioral therapy, and possibly pharmacotherapy for depression/anxiety should be started as soon as the diagnosis of somatoform disorder is seriously considered.
Obviously these studies have significant implications for those who believe that they are suffering from the hypothetical disease known as "Morgellons". The main problem with Morgellons is that in the absence of any proof of a physical cause for their bizarre symptoms. It is an interesting disease and situation as in the end no one cause disprove that indeed these patients do not have “Morgellons”.
The situation is similar to an illness called Lyme disease. Patients would come to their doctor in the 1990’s claiming that they had disease called “Lyme Disease” which was spread by ticks and they had seen described on TV or in the popular press in such authoritative manuals as “Time magazine’ or Newsweek.
In many cases the physician was either devoid of any knowledge of “Lyme disease”. The patient had no symptoms, the doctor thought that the patient was crazy or a crank or all of the above.
It took a number of years. Now we have a biochemical lab test to diagnose the titers of Lyme disease. We know that Lyme disease is not a physical disease, it is rather quite common and is actually on the rise and increase in incidence.
The same situation may well be the case with Morgellons Disease.
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