Imaginary Bug
March 5, 2010 7:11 AM   Subscribe

A good friend is really suffering because of the imaginary bugs that inhabit her house and clothes. I'm afraid she may commit suicide because her trusted (intern) therapist questioned her on their existence. No one else, no doctors or friends, can see them and she is usually careful not to ask others if they believe her. She now seems to be retreating from others. Is there medication that might help her? And what should I do here?

She's had this problem for several years, she spends loads of time sweeping her house, washing her clothes, putting contact paper on the floor to collect the bugs (I've looked under magnification at what she says are bugs and they're NOT! Just dust particles...)

And now she seems to be falling apart...so what's my role here?

thanks.
posted by davoid to Health & Fitness (35 answers total) 2 users marked this as a favorite
 
Get her to a doctor, or the emergency room, ASAP if she's at risk of suicide. Do not hesitate.
posted by Solomon at 7:16 AM on March 5, 2010


If you friend has articulated a plan to hurt herself you need to get her to an emergency room.

You should take any input you get from this forum regarding a diagnosis of whatever mental health disorder your friend may have or whatever medication she should take to treat those symptoms with a grain of salt. Diagnosing of mental health disorders and the recommendation of appropriate psychiatric medications cannot happen via a third party over the Internet.
posted by The Straightener at 7:17 AM on March 5, 2010 [13 favorites]


Seconding The Straightener... this is a case for a mental health professional. HOWEVER, you may find it helpful to read up on delusional parasitosis (http://en.wikipedia.org/wiki/Delusional_parasitosis) - not to diagnose/cure/treat/prevent anything (as the FDA phrases it), but to gain a little insight into a disorder which sounds similar (but may or may not be - I'm no shrink) to what your friend is experiencing.
posted by julthumbscrew at 7:27 AM on March 5, 2010


yes there is medication for this...

Linky for wiki info on parasitosis

there are online support groups, meds, etc.
posted by Jiff_and_theChoosyMuthers at 7:28 AM on March 5, 2010


Your friend isn't on any medication, like say, amphetamines for ADD or weight loss? Amphetamines can be a trigger for this sort of psychosis. Regardless, she needs to see a mental health professional right away.
posted by dortmunder at 7:36 AM on March 5, 2010 [1 favorite]


looked under magnification at what she says are bugs and they're NOT! Just dust particles

Maybe she means they're dustmites. I wouldn't shovel her to the ER unless she makes a threat to kill herself. Maybe you should help her find a therapist that specializes in OCD?
posted by anniecat at 7:41 AM on March 5, 2010


ER NOW. if suicide is a risk DO NOT WAIT!
posted by toodleydoodley at 7:42 AM on March 5, 2010


looking dumb can always be forgiven later. really.
posted by toodleydoodley at 7:42 AM on March 5, 2010 [6 favorites]


Repeating what others have said: If she has threatened to harm herself, this is a medical emergency and you should treat it that way. Get her to a doctor or emergency room right now.
posted by dseaton at 7:43 AM on March 5, 2010


She needs a psychiatrist, not a therapist. Someone skilled in diagnosing and treating mental illness. This sounds like a case for medication, and a therapist can't do that.

If you think she is actually suicidal, then immediate action is needed (like, now).

Poor girl.
posted by SLC Mom at 7:51 AM on March 5, 2010 [1 favorite]


Yes, ER if there is a real risk of her hurting herself. In the meantime, look up a local mental health center to see if they could take her on a voluntary intake basis if she's in a state of psychosis but not actively trying to kill herself at that moment. I also recommend a place like this as they could recommend a new therapist with a bit more empathy and experience!

If you see her become very distressed over another's disbelief, to the point of self-harm or suicide, do not wait to take her to an ER. It sounds like she needs better care than she is getting now, regardless.
posted by motsque at 7:53 AM on March 5, 2010


I'd just like to point out to those saying "rush to the ER" that there's nothing in the question about her threatening suicide; the OP is concerned because she's withdrawing from others and "falling apart." I agree this is serious; I'm not sure that the only answer is to force her to an ER. She definitely needs to see a psychiatrist. You say she's been looked at by doctors - have none of them realized that this is a mental, not physical, illness and that she needs a referral to a psychiatrist? Is she willing to acknowledge that she has a problem and see one on her own? It doesn't sound like it, in which case maybe taking her to the ER is the best thing, if she will go. How do you force someone to see a psychiatrist against their will, other than by having them involuntarily committed, which is not exactly an appealing option, and maybe not possible here?
posted by Dasein at 7:53 AM on March 5, 2010 [2 favorites]


Sometimes, going to the ER is a relief.

Sometimes, when a person is overwhelmed with life, feels like no one believes her and can't seem to find relief, having someone else take control is suddenly very comforting.

It is not a punishment. It is not because she's been bad or you don't believe her. It is because she needs some help right now and this is the best way to help her.

I hope this helps. Thanks for being a good friend.
posted by Sophie1 at 7:54 AM on March 5, 2010 [3 favorites]


Advice might want to center on the OP's role assuming no suicidal ideation -- as that seems to be pure speculation by the OP, not based on any remarks by the friend, and in any event is well covered by the advice that if there is something like ideation it is an emergency.
posted by Clyde Mnestra at 7:54 AM on March 5, 2010


Delusory parasitosis is something that a lot of therapists won't touch with a ten-foot pole. This link might be helpful. Get her help, ASAP.
posted by bolognius maximus at 7:56 AM on March 5, 2010


Make sure, if you take her to the ER, you let the doctors know about the imaginary bugs and the suicide threats. (Out of her hearing, if possible.) Your other option in a psychiatric emergency is to call the police, who can take her to a psychiatric inpatient facility and have her admitted for treatment (as per Britney Spears in California). States can hold patients against their will for varying numbers of days (17 in my state), but long enough, hopefully, to help her.

The thing she probably most needs from YOU is someone she trusts to accompany her to the hospital or even the inpatient facility if allowed to just be with her while she navigates the situation and gets settled. Not even to necessarily do anything, just to BE, to make it less scary.
posted by Eyebrows McGee at 8:02 AM on March 5, 2010


davoid, this will sound harsh, but your 1st role is to take care of yourself and protect yourself from the overwhelming and terrifying feeling of being responsible for someone else's life/death. Unless you're her psychologist/psychiatrist and you have years of training to handle this. You're in a very bad spot here. Been there, done that, and I wish someone would have explained this to me when I was 18.

There's very little you CAN do other than, as people have said, getting her competent help.

That said, I've worked briefly in a mental health setting: An overabundance of dopamine can cause thoughts, imaginings and hallucinations to feel as real as the physical world feels to us. Haldol (generic Haloperidol) is a dopamine blocker and can work wonders for people who have hallucinations and even, in many cases, obsession/compulsions. Haldol gets a bad rap from the media, portrayed in melodramatic films and on TV as a drug for "dangerous psychotics", but I've seen it help people with even mild delusions or even simple magical thinking that they otherwise cannot contain. But obviously it's not your job to get her on the Haldol, although if she describes her condition and asks for it, a helpful psychiatrist or nurse practitioner might agree.

Again, take care of yourself. Get her to some help if possible, then get yourself some distance and perspective. And talk to people about your feelings.
posted by Shane at 8:06 AM on March 5, 2010 [2 favorites]


I read your question as your friend perhaps not having made a specific suicide threat, just that you feel like she's growing despondent and perhaps suicidal. If she is discussing suicide, yes, ER, obviously.

As for how to be a good friend, well, that's hard, but I would think that keeping up regular contact with the outside world would be a good thing for her and giving her general support as you would for any other depressed friend. The Helping Someone With A Mood Disorder from the Depression and Bipolar Support Alliance looks like a good basic guide. As for the bugs, I believe that the recommended course of action is to not call someone out on their delusions or try to prove them wrong. Maybe someone else can offer tips on how to do this...what do you do when someone starts going on and on about the bugs? Make non-committal noises? Get into an enthusiastic bug discussion?

If I were you, I think I'd try to act as normally and casually as possible to engage her on an ordinary friend level. Drop her casual e-mails or texts, meet for coffee, listen to her vent about her day (bugs and all) and vent about yours in return, talk about current events, whatever is typical. Practically speaking, you know that she's agitated and probably feeling out of control, so maybe visit frequently but for short periods of time, which will be easier on both of you. For instance, maybe make plans to bring dinner to her place and watch [title] movie -- that's a set limit of time and a very specific activity.
posted by desuetude at 8:11 AM on March 5, 2010


I once had a friend who seemed to me to be in danger of committing suicide. It was really hard and awkward to do this, but I took steps to get him the help he needed. He ended up committed. He's alive today. That's all I have for you. If you sincerely believe that your friend is a danger to herself, and you can do something to get her help, do it. Even if it feels stupid or risky. Even if you think it might damage your relationship.
posted by prefpara at 8:25 AM on March 5, 2010


You have only the role you give yourself in regards to your friend. Morally and perhaps legally it is entirely up to you. If it were family that might be different.

You must take care of yourself, which in some small way you did by asking this room of strangers what to do. Be ready for things to get worse. Offer to help your friend get professional help then back off. And know backing off might be saying goodbye. Good luck.
posted by eccnineten at 8:27 AM on March 5, 2010 [1 favorite]


dasein from OP:

I'm afraid she may commit suicide

hence our chorus of ER, NOW
posted by toodleydoodley at 8:44 AM on March 5, 2010


Emergency psychiatric visit. Now. I cannot believe she's been suffering from this for so long without medical care.

It's ok to go ahead and ask your friend if she is feeling suicidal. Of course, take her answer with a grain of salt. But it's not unlikely she will tell you straight out.
posted by kitcat at 8:54 AM on March 5, 2010


Seconding prefpara. She may hate you for it (temporarily), but you need to get her help, up to being committed for a time, if she is important to you.
posted by WeekendJen at 9:15 AM on March 5, 2010


Yeah, I got that, toodleydoodley, my point was that it was a fear that wasn't grounded in any particular threats, which is what some people in the thread seem to be assuming, e.g. "let the doctors know about the imaginary bugs and the suicide threats."
posted by Dasein at 9:52 AM on March 5, 2010


I used to work in a psychiatric hospital, but am currently not licensed to provide diagnoses, nor can I provide diagnoses over the internet. Therefore, this is not a diagnosis.

From only the information you provided, this sounds like some type of psychosis (the parasitosis linked above is an example). Seeing/hearing/feeling bugs is a common hallucination. The fact that you said that she seems to be retreating from others tells me that something about the psychosis is getting worse (it may be voices, visual hallucinations, or just intrusive thoughts...who knows). Many people that are slowly having a psychotic break know that something is wrong but it scares them and they withdraw so that no one else will see how "crazy" they are, or think they can withdraw from the thoughts/feelings they are having. It can get pretty scary for them.

For your friend...reassure her that you are there to help her. Ask her what you can do to help. If she wants you to verify the existence of bugs (or voices or any other hallucinatory examples), reassure her that you are having trouble seeing exactly what she is seeing, but that it sounds frightening and that you will do what you can to help her deal with the bugs (or whatever). Be careful in saying "they don't exist". In her mind, they do. If she thinks dragons are about to kill her, then you can say "There are no dragons here, dragons are not about to kill you, you are safe". Outright denying that her hallucinations don't exist tends to scare them even more unless they are fearing for their life at the moment (think about how you would handle a small child afraid of a monster under the bed. Similar approach).

There are medications for this...a psychiatrist can prescribe. The ER or her family doctor is a good resource if the situation is emergent and you can't get her in to a psychiatrist. Therapy doesn't work until the meds have straightened out the brain chemistry enough to allow more rational thoughts to prevail. Do what you can to convince her to see a doctor. Her therapist may be helpful (is the therapist in a practice with a psychiatrist? They usually can get the psychiatrist to prescribe pretty quickly if they are being actively seen). Encourage her to tell the therapist exactly what's going on...she may be covering up symptoms during sessions so that the therapist doesn't have the full picture.

There are ways for you to get info to the therapist without breaking privacy laws. Easiest way is to call the clinic she is being seen at, and say "I have a friend who I'm really concerned about. Is there a therapist available that can give me some advice or something?" (it doesn't have to be her therapist). Once you get a therapist on the phone, say something like "I know that privacy laws prevent you from giving out information and I'm not asking for you to break any privacy laws. But I need to share a concern I have about someone who is being seen in your practice." Then just tell them what you know. There's nothing in the laws that say a therapist can't listen and take notes...they will just never acknowledge that they recognize the name you give them and speak to you about "your friend". A good therapist will know exactly how to handle this conversation.

Good luck. I know how hard it is to care for someone going through something like this. Remember to not neglect yourself in this process...you aren't responsible for her life/death...there's only so much you can do.
posted by MultiFaceted at 10:30 AM on March 5, 2010 [5 favorites]


You know, this is a pretty unrelated approach to everything else that's been discussed here, but have you considered believing her? I'm not dismissing the obvious psychiatric problems here, but perhaps there's a more physical trigger as well. Could there be something wrong with her vision, some kind of weird double vision that's she's interpreting as "bugs"? Does she see the bugs all the time? If it's off and on, maybe she's having sensory seizures.

Why don't you offer to take her to a neurologist, to see if a doctor can find proof that, even though no one ELSE is seeing these things, she IS seeing them.

Even if you DON'T believe her, humoring her in a constructive way could prevent her from feeling so suicidal. This would give you, her, and (maybe a new) therapist time to deal with her problems more thoroughly.
posted by sunnichka at 11:57 AM on March 5, 2010 [1 favorite]


Even if you DON'T believe her, humoring her in a constructive way could prevent her from feeling so suicidal.

I think this is not good advice. Humoring her in this way is likely just as bad as confronting her and telling her the bugs don't exist. The idea that she might be perceiving sensory seizures as bugs which no-one else can see is one pretty rare looking zebra in a whole herd of stampeding delusional parasitosis horses. The OP should be involved as little as possible in someone else's untreated mental illness; it is unlikely to be good for either OP or the person in question.

OP should try to arrange an emergency psychiatric visit if the person in question is suicidal. Other than that, entertaining any sort of involvement other than helping to find a psychiatrist who can treat this

Really, getting involved in a significant capacity in other people's untreated mental illnesses rarely has good results.
posted by Justinian at 1:42 PM on March 5, 2010


Oh, someone else alluded to this kinda but I'll spell it out:

If I had a friend exhibiting this behavior, I would be very concerned that they had a serious methamphetamine addiction. It's such a cliche that there is a pretty well known play (and movie) about it called Bug.
posted by Justinian at 1:50 PM on March 5, 2010


Question posed to us during our first week in the psychiatric rotation of nursing school: how can you tell if someone is thinking about hurting or killing herself?

Answer: ask her if she's thinking about hurting herself. she won't lie. really - she will not lie.

Don't be afraid that you're going to 'make her suicidal' by asking. You won't.

If she answers yes, take her to the hospital. If she says no, there's not much you can do except support her.
posted by lambchop1 at 1:53 PM on March 5, 2010


Your role, as a close friend, is to make sure more qualified people know about the seriousness of her condition, since it is obviously very worrisome to you (I mean "qualified" in the sense of "being able to make treatment decisions for another person." You are being a very kind friend).

Yes, if you think she is in imminent danger of suicide, call 911 right now.

If the situation is less dire, and you are concerned that it may soon become dangerous:
1. Does she have parents, family, or a partner who could help here? Call them and share your concerns.
2. If she is all alone, either suggest that she share with her therapist how upset she is feeling, or call the therapist and let him/her know yourself. The therapist will probably not be able to confirm or deny that they are treating your friend, let alone give you information to ease your mind, but they will know what to do to escalate treatment for your friend, since they are familiar with her situation.
3. Don't confirm or deny the existence of her bugs, simply state your concern for her well-being: "It sounds like this is a really upsetting situation for you, I think it would be helpful to (talk to therapist, go to ER or urgent care, call mom/dad/partner)." That way you're not getting entangled in the delusion, but you're still letting her know you want to help.

The best you can do, as her friend, is make sure she's safe and that the proper people have been notified that she needs help. I'm sorry this is happening; it is so upsetting to see people we care for struggling like this and not be able to just fix it! You are a good friend to be so concerned for her. I hope it turns out for the best.
posted by Fui Non Sum at 3:55 PM on March 5, 2010


Other than that, entertaining any sort of involvement other than helping to find a psychiatrist who can treat this

Yeah, but the bugs are going to be mentioned, and to only repeat "see a doctor see a doctor" in lieu of any other interaction is probably not a great way to keep her engaged in the outside world.

This is what I meant when I wondered about reaction strategies. I've had very close friends who were bipolar (some more receptive than others on being called out on mania and despondency) and another close friend many years ago who believed that she had multiple personality disorder brought on by satanic abuse, yes really. At some point, things that you may not consider "real" do become an acknowledged given.
posted by desuetude at 5:17 PM on March 5, 2010


desuetude: But there's a big difference between someone who is bipolar and someone who is exhibiting worsening paranoia. I'd be much more worried about my own well-being in the latter case.
posted by Justinian at 6:19 PM on March 5, 2010


bolognius maximus: "Delusory parasitosis is something that a lot of therapists won't touch with a ten-foot pole."

Please don't say this to people. It's hard enough to get someone to get up enough courage to go to a therapist without making them think the therapist will automatically hate them. I got the whole "many therapists refuse to treat borderline personality disorder because it's too hard" when I was diagnosed but guess what, I've never had trouble finding a therapist and never been refused/dismissed from therapy over it.
posted by IndigoRain at 6:45 PM on March 5, 2010


Would you be able to update us on her / your status?
posted by kitcat at 9:42 AM on March 6, 2010


think methamphetamine
seriously
posted by dougiedd at 5:25 PM on March 26, 2010


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