Delusional infestation. A psychopathological proposal, the "typology of the contaminated"

Delusional infestation is a rare disease, the impact on quality of life of patients is major, but its management is complex. If the clinical picture was widely described by the literature, the psychopathological view still remains unknown. To give familiarity to this population of patient we don't very often meet, the objective of our work is to propose a typology. In a case study approach, we have recruited four patients suffering from delusional infestation in the dermatology and parasitology departments of the Nice university hospital from april 2016 to July 2017. Our clinical observations led us to consider delusional parasitosis as a trouble on the borderline between delusional disorder, anorexia nervosa and factitious disorder. The anamnese highlights the presence of a grave somatic disease with real-life experience of shame and unworthiness, previous to the appearance of the disorder. The delirious parasitosis could express itself during the meeting between this traumatic event, a vulnerable subject on the identity plan and a personal experience or cultural with the parasite. We identified one "typology of the contaminated". It is expressed by a hypochondriac presentation, with a sensitive personality, systematic interpretations, mixed hyperthymia and pathomimic attitude. The biographical history reveals the presence of psychological trauma in childhood, the personality traits are organized around a complex of shoring and dependence, with impulsiveness, aggressiveness, tendency to conformism and addiction. The context before the infestation allies a sexual break to a medical surgical background fixing shame and unworthiness, engendering an operative functioning. The clinical aspect was modulated by culture. Although descriptive, our observations suggest a psycho-socio-cultural typopogy on which new strategies to improve the holistic care of this patients could depend on. Indeed, we keep in mind that no satisfactory therapeutic exist while it was very widely requested by the authors of all specialties, themselves worried to ensure good quality service. The level of care requires, in our times, novel solution, means and approaches. (C) 2019 Elsevier Masson SAS. All rights reserved.