Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Art & Psychiatry
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Conference Oration
Conference Summary
Continuing Medical Education
Cosmetic Dermatology
Current Best Evidence
Current Issue
Current View
Derma Quest
Dermato Surgery
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
Editor Speaks
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Miscellaneous Letter
Net Case
Net case report
Net Image
Net Letter
Net Quiz
Net Study
New Preparations
News & Views
Observation Letter
Observation Letters
Original Article
Original Contributions
Pattern of Skin Diseases
Pediatric Dermatology
Pediatric Rounds
Presedential Address
Presidential Address
Presidents Remarks
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Review Article
Review Articles
Revision Corner
Self Assessment Programme
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Special Article
Specialty Interface
Study Letter
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Therapeutic Guideline-IADVL
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapy Letter
View Point
What’s new in Dermatology
View/Download PDF

Translate this page into:

Case Report
PMID: 17642642

Folie a Famille: Delusional parasitosis affecting all the members of a family

Elizabeth Daniel1 , Tirupati N Srinivasan2
1 Department of Psychiatry, Kasturba Medical College, Mangalore, India
2 University of Newcastle and Hunter Mental Health, Newcastle, NSW - 2300, Australia

Correspondence Address:
Tirupati N Srinivasan
James Fletcher Hospital, PO Box - 833, Newcastle, NSW - 2300
How to cite this article:
Daniel E, Srinivasan TN. Folie a Famille: Delusional parasitosis affecting all the members of a family. Indian J Dermatol Venereol Leprol 2004;70:296-297
Copyright: (C)2004 Indian Journal of Dermatology, Venereology, and Leprology


Delusional parasitosis (Ekbom syndrome) is an uncommon psychiatric disorder that presents with a delusion of being infested with parasites. Treatment of this condition is difficult as patients with this paranoid disorder reject psychiatric diagnosis and treatment and often consult a dermatologist. Sharing the delusional beliefs of the paranoid patient by other people living in close emotional bonding with him/her could occur. We report here the clinically interesting phenomenon of delusion of parasitosis occurring simultaneously in all the members of a family. There was a pathological bonding between the members of the family who all presented to the dermatologist and rejected treatment. Dermatologists need to be aware of this uncommon clinical picture.
Keywords: Ekbom syndrome, shared psychotic disorder


Delusions of parasitosis (DP) or Ekbom syndrome is a psychiatric disorder in which the patient has a fixed, false belief that he or she is infested by parasites. These patients generally reject psychiatric referral or treatment and often present to a dermatologist because they are convinced of having a dermatological problem.[1],[2]

DP can manifest as a shared psychotic disorder,[3] a type of ′folie a deux′. This is a rare condition where members living with the patient also share the false belief. The essential feature of this condition is a delusion that develops in an individual who is involved in a close relationship with another person termed as the "inducer" or "primary case". The relationship is usually a prolonged one, often unhealthy and the affected members live in relative social isolation.[4] Folie a famille, where all the members of a family share the delusion, is an especially rare disorder.[5]

We present here a family with folie a famille who consulted a dermatologist for pruritic skin lesions. The report is made for the rarity of this interesting psychodermatologic disorder.


A 44-year-old man presented to the dermatologist with a six-year history of itchiness over the arms, abdomen and back. He had consulted a number of physicians but experienced temporary relief with anti-scabies treatment and steroids. Examination revealed itchy erythematous papules over the trunk and limbs. No primary dermatological diagnosis was made. Investigation revealed no infection or infestation.

The patient revealed that his wife as well as his two daughters aged 18 and 16 years also suffered from similar complaints for many years. All the family members had skin lesions similar to the index case. The skin complaint started first in the wife after she developed a delusion of persecution that certain people (her neighbors and relatives) were out to harm her and the family. She believed that her "persecutors" inflicted a worm infestation on her and the other members of the family that resulted in their skin lesions. The husband and the two daughters also subscribed to this delusion.

The psychiatrist diagnosed paranoid disorder in the wife and shared psychotic disorder in the other members of the family. The wife was described as the dominant partner who decided all the activities of the family members as well as influenced their attitudes. The daughters shared a symbiotic relationship with the mother and an unhealthy bonding with the father. There was growing social isolation of the family from the social network of neighbors and relatives. The father, along with his children, did not support the wife′s beliefs initially but later shared her delusional thinking. The mother had refused all treatment right from the outset and the family also joined her in refusing to take any psychiatric treatment. Concerted efforts by the dermatologist and the psychiatric team to get the family to understand the need for medication or even counseling were futile.


DP can present as the sole psychiatric symptom or it may be associated with an underlying psychiatric disorder.[6] It occurred as a part of a paranoid disorder in the primary case here. There have been a number of reports from India on DP.[7] The occurrence of this disorder as a shared psychotic disorder is an uncommon phenomenon. Only about 5 to 15% of such cases were found in an analysis of 1223 case reports.[8] We did not find any earlier report on this phenomenon involving all the family members.

The abnormal emotional bonding and interaction observed among the affected members of this family was described.[5] In our case, the primary case was the wife, the dominating member of the family. The husband and children were submissive, socially and culturally isolated and were drawn into sharing the delusion of the primary patient. The refusal to take any psychiatric treatment was often reported among patients with DP.[2] In our case this went further as the "primary" case influenced the refusal of treatment by other members of the family as well.

The occurrence of pruritic skin lesions simultaneously in all members of a family is common. But the absence of any specific dermatological disorder and history of failure with dermatological treatments should arouse the suspicion of some rare psychogenic disorder, as we experienced with this family.

Koo J, Lee CS. Delusions of parasitosis. A dermatologist's guide to diagnosis and treatment. Am J Clin Dermatol 2001;2:285-90.
[Google Scholar]
Zomer SF, De Wit RF, Van Bronswijk JE, Nabarro G, Van Vloten WA. Delusions of parasitosis. A psychiatric disorder to be treated by dermatologists? An analysis of 33 patients. Br J Dermatol 1998;138:1030-2.
[Google Scholar]
Bourgeois ML, Duhamel P, Verdoux H. Delusional parasitosis: folie a deux and attempted murder of a family doctor. Br J Psychiatry 1992;161:709-11.
[Google Scholar]
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (4th Ed.) (DSM IV). Washington DC: American Psychiatric Association; 1994.
[Google Scholar]
Manschreck TC. Delusional Disorder and Shared Psychotic Disorder. In: Sadock BJ, Sadock VA, editors. Kaplan and Sadock's Comprehensive Textbook of Psychiatry, vol 1. 7th Ed. Philadelphia: Lippincott William & Wilkins; 2000. p. 1257-8.
[Google Scholar]
Driscoll MS, Rothe MJ, Grant-Kels JM, Hale MS. Delusional parasitosis: a dermatologic, psychiatric, and pharmacologic approach. J Am Acad Dermatol 1993;29:1023-33.
[Google Scholar]
Srinivasan TN, Suresh TR, Jayaram V, Fernandez MP. Nature and Treatment of Delusional Parasitosis: a different experience in India. Int J Dermatol 1994;33:851-5.
[Google Scholar]
Trabert W. 100 years of delusional parasitosis. Meta-analysis of 1,223 case reports. Psychopathology 1995;28:238-46.
[Google Scholar]

Fulltext Views

PDF downloads
Show Sections