EKBOM SYNDROME (DELUSIONAL PARASITOSIS): A 9 YEAR LONG CASE REPORT.

Abstract

Background: Delusional Parasitosis (DP), or Ekbom Syndrome, is a rare psychodermatological condition marked by a fixed false belief of infestation with parasites despite the absence of objective evidence. Patients often resist psychiatric referral and frequently disengage from mental health services. Complex identity factors, including professional roles, may complicate insight and treatment engagement. This report presents a longitudinal case of a female psychotherapist with DP who remained engaged with psychiatric services for nine years, offering an opportunity to explore the ethical and therapeutic implications of professional identity in the context of psychosis.

Subjects and methods: A retrospective case analysis of a 58-year-old psychotherapist with DP, incorporating clinical observations, interdisciplinary input, and critical review of current literature.

Results: The patient exhibited classic DP features and underwent multiple antipsychotic trials, with varying adherence and outcomes. Her status as a mental health professional presented unique challenges, including denial of psychiatric pathology, ethical conflicts, and difficulty establishing a therapeutic alliance. Despite persistent delusional conviction, a longitudinal therapeutic relationship was maintained through multidisciplinary strategies and adapted communication. Clozapine was considered but not initiated.

Conclusions: This case illustrates that sustained psychiatric engagement is possible even in treatment-resistant DP and emphasizes the need for individualized care, especially when professional identity intersects with psychosis. The case contributes to emerging perspectives on interdisciplinary management and therapeutic alliance in chronic psychodermatological conditions.