Delusional infestation from the clinician perspective: a qualitative study

Abstract

The systematic review provides a narrative synthesis on the existing literature regarding the relationship between trauma exposure and trichotillomania (TTM). Ten studies were identified for inclusion and were analysed using the Joanna Briggs Institute (JBI) Checklist for Analytical Cross-Sectional Studies. Of the included studies, most were of medium quality and displayed significant methodological and analytical heterogeneity. However, despite this variability, all studies suggested a significant association between trauma exposure and the presence of TTM. Exposure to trauma during childhood was assessed by many studies, however some studies also explored other trauma types. Furthermore, other risk factors for TTM external to trauma exposure were also explored. The implications of these findings for clinical practice were discussed, alongside recommendations for future research. Notably, a lack of robust longitudinal research meant that causality between trauma exposure and TTM could not be inferred, which future research may wish to address.  

Delusional infestation is a psychiatric condition where an individual holds a fixed belief that their skin, body, or environment is infested by living or non-living pathogens. It is a rare but highly distressing condition for patients, commonly accompanied by tactile hallucinations such as itching, burning, or crawling sensations. Antipsychotic medication has been cited as the main treatment option for delusional infestation, but many patients are reluctant to seek psychiatric help. As a logical consequence of their fixed delusional belief, patients may be more likely to seek the help of general practitioners, dermatologists, or microbiologists. This study aimed to explore the facilitators and barriers to patient engagement in treatment for their delusional infestation, from the perspective of healthcare professionals who are working, or have previously worked, directly with them. Twelve healthcare professionals participated in a semi-structured interview which lasted between 30 - 60 minutes. Data was analysed using reflexive thematic analysis, with the goal of eliciting key themes, patterns, and common experiences that healthcare professionals have had working with this client group. Analysis yielded thematic analysis of interview transcripts led to the development of five themes in total. The three themes associated with the facilitation of working with delusional infestation were: (A) Multidisciplinary Management of Delusional Infestation, (B) Specific Techniques to Enhance Patient Engagement and (C) Transferable & Interpersonal Skills. The two themes associated with the impedance of working with delusion infestation were: (D) Health Service & Related Issues, and (E) Mental Health Stigmatisation & Subsequent Avoidance. Implications for clinical practice were discussed.

Date of Award	Dec 2024
Original language	English
Awarding Institution	Queen's University Belfast
Supervisor	Emma Berry (Supervisor), Martin Dempster (Supervisor), Rodger Graham (Supervisor) & David Alderdice (Supervisor)