Fictional vignette for education. Any resemblance to a real person is coincidental.
Maria's story
Maria is a 52-year-old office manager who started noticing small, crawling sensations on her arms a few months ago. At first she thought it was dry skin. Then she began to feel that something was moving under the surface, especially at night.
She bought a new lotion, then a different laundry detergent, then changed her bedding. The sensations didn't go away. She started checking her skin with a magnifying glass and saving tiny flecks she was sure were insects in a sealed bag to show her doctor.
Her family noticed she was scratching often and seemed anxious. When they suggested it might be stress, Maria felt hurt and stopped talking about it with them. She was convinced they didn't believe her.
When she finally saw a clinician, she was calm, organized, and clear about her history. She was not confused, and her work and relationships were otherwise mostly intact. Her doctor checked for medical causes, including thyroid function, medication side effects, and a skin exam, and ordered tests that came back normal. Maria was frustrated that no one had "found the bugs."
What is going on?
Maria's story illustrates delusional disorder, somatic type, often called delusional infestation or delusional parasitosis. The core feature is a fixed, false belief, in this case that insects or parasites are living in or under the skin, that persists despite normal exams and tests. Outside of that one belief, thinking is usually clear and daily functioning is often largely intact, which is what distinguishes this from the psychosis seen in schizophrenia.
A real-life comparison
Think of someone who feels a phantom phone vibration in their pocket. The sensation is real to the nervous system, even when the phone isn't there. Now imagine that sensation never stopping, and every normal test result feeling like proof that no one looked hard enough. That is closer to what Maria lives with. The itch and crawling are real experiences. The explanation her brain settles on is what's off.
Why how we respond matters
Arguing about whether the bugs are real usually pushes people away and delays care. Maria's clinician took a different path: listening, validating how distressing the sensations were, and explaining that the discomfort was real even if the cause was not what she believed. Over several visits they worked on sleep, stress, and a plan to reduce skin irritation, and talked about treatment options. Feeling heard made it easier for Maria to keep coming back.
A thorough medical workup still matters, since thyroid problems, medication effects, skin conditions, and substances can all produce similar sensations. Once those are ruled out, treatment may include medication along with support for sleep, stress, and skin care.
The takeaway
When someone's distress is real but their explanation is fixed and unlikely, a respectful, trusting relationship makes a meaningful difference.
We're here to help
If you or someone you love is dealing with persistent, unexplained sensations, anxiety, depression, ADHD, or OCD, NextGen Psyche and Wellness offers in-person care in San Diego (Balboa Ave) and El Segundo, plus telehealth across California. Call or text (626) 371-3053, or book online.
Educational content only. Not a substitute for individual evaluation. In an emergency, call 911 or 988.