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December 12, 1966

The Art of Self-Mutilation: II. Delusions of Parasitosis

Author Affiliations

From the Division of Dermatology, University of Oregon Medical School, Portland.

JAMA. 1966;198(11):1207. doi:10.1001/jama.1966.03110240115039

In this form of self-induced lesions of the skin, patients have the unshakable conviction that they are infested with some insect of microscopic size. Excoriations and scars attest to the vigilance with which the pests have been searched for and destroyed with fingernails, knives, and caustics. A physician is consulted not to heal the wounds but to better identify and combat the invading parasites.

Insignificant defects in normal skin are pointed out as harboring the parasite. Before the observing eye of the physician, the patient will demonstrate exactly how the search for and destruction of the parasite is accomplished. Fear of the parasite is surprisingly not part of the pattern, but rather it consists of an obsessional preoccupation accompanied by no little satisfaction when a likely bit of skin has been removed. As with "neurotic excoriations," lesions are predominantly in readily accessible areas such as the outer aspects of the