Formication is the sensation of feeling insects crawling under and over the skin. It is a form of tactile hallucination. A tactile hallucination is a false sensory sensation and is a form of paresthesia. The individual feels the touch of an imaginary object. This sensory hallucination is an unpleasant, disturbing sensation. It feels as if bugs are crawling inside their body and trying to get out and all over their skin. The sensation may feel itchy and cause the vigorous scratching of skin although there isn’t an itch. The “itching” sensation can be so intense, individuals may viciously tear into their skin trying to relieve it causing serious skin and tissue damage. Tactile Hallucination often occurs in people who abuse amphetamines, cocaine, and other narcotics. It’s a form of Delusions of Parasitosis in which people believe they are infested with parasites.

There are several causes of tactile hallucination.  Some of these include:

  1. Lyme Disease

  2. Parkinsons Disease.

  3. Fibromyalgia.

  4. Substance Abuse.

  5. Perimenopause.

  6. Drug and Alcohol Withdrawal.

Pharmaceuticals & Narcotics That Cause Formication

Alcohol and certain recreational and pharmaceutical drugs can bring on tactile hallucinations during the withdrawal process. This is normally a temporary condition. Drugs reported to trigger this condition include:

  1. Adderall

  2. Ritalin

  3. Crystal Meth

  4. Cocaine

  5. Heroin

  6. Wellbutrin

  7. Lunesta

An intense manifestation of the condition involves drug psychosis. When a condition reaches the psychosis state, all touch with reality is lost. The person has a sensory experience with things that do not exist. They see, feel, or hear things that aren’t real and it is frightening. These symptoms can be severe enough to cause sufferers to lash out and hurt themselves or hurt others.

How Drugs Cause Formication

The reasons why drugs may produce this condition are complex. The root cause can be dysregulation of the dopamine system. Once the drugs have been introduced into the body, they penetrate the Central Nervous System and stimulate it. They then bind to norepinephrine, dopamine, and serotonin. Their activation of the sympathetic nervous system triggers a constant release of monoamines which bring neurological complications. Repeated abuse of these substances causes depleted dopamine reserves and damage to the dopamine and serotonin nerve terminals.

The dopamine system facilitates reward and motor coordination. Drugs like amphetamines abnormally increase dopamine levels, throw the system off center, and can bring on drug-induced psychosis. Constant abuse of stimulants like cocaine sensitize the system to amphetamine and increase the likelihood of chronic methamphetamine-induced psychosis which may manifest as Formication. People who have suffered from drug-induced psychosis have a 70 percent chance of developing the tactile hallucination.

Formication: A Form of Delusional Parasitosis

This condition is a primary form of Delusional Parasitosis (DP). A person exhibiting these hallucinations may not have any other mental health issues. It matches the DSM’s Delusional Disorder, Somatic Type. The secondary DP form is associated with people who also have an existing mental illness like Schizophrenia or Anxiety. The final form is seen in people who have a medical condition like Fibromyalgia or Perimenopause.

The tactile hallucination can appear either while using a drug or during its withdrawal. The creepy, itchy, crawling sensations are commonly experienced on the face, thighs, arms, neck, and scalp. People suffering from this condition aren’t as delusional about the insects they believe are crawling on them as people with some forms of Delusional Parasitosis. While people with some forms refuse to believe the bug or parasites are a figment of their imagination, people with the drug-induced condition can be convinced otherwise.

Since the delusion is high with this condition, therapists must use care and tact in its treatment. Many people who suffer from this tactile hallucination don’t view it as a mental disorder because they believe the bugs are real. Thus, their initial involvement with the medical community when seeking help might be with a general medical practitioner or a dermatologist.

It’s common for some of these individuals to bring evidence of the infestation to show the healthcare professionals. Since the bugs aren’t real, the evidence usually consists of pieces of skin and blood they have extracted from their own bodies to rid themselves of the pestilence. Besides therapy, various forms of treatment for the drug-induced condition are used. In some cases antipsychotic medications are helpful. Pimozide was once the primary treatment for Delusional Parasitosis. But due to its negative side effects, it has been replaced by second-generation antipsychotic medications like Olanzapine.

Other Symptoms of Drug-Induced Tactile Hallucination

Beyond the sensation of bugs crawling inside and outside the body, there are other symptoms associated with the drug-induced tactile hallucination. Some for these are:

  1. Feeling Depressed.

  2. Feeling anxious or agitated.

  3. Body Tremors.

  4. Difficulties focusing and concentrating.

  5. Fatigue and body aches.

Getting Help

Drug-Based Formication is a delusional condition caused by alcohol and drug abuse. A logical first step to cure the condition is to detox from the addicted substance. People who wish to detox should seek advice and care of a healthcare professional or an addiction treatment facility.


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