Ethical and Communicative Challenges in Informing Patients with Delusional Infestation: Insights from Moral Case Deliberation

Delusional infestation is a rare psychiatric condition where patients falsely believe they are infested by organisms, often accompanied by physical symptoms such as pruritus. Communicating the diagnosis and initiating treatment present significant challenges, as healthcare providers must balance honesty, sensitivity, and trust to avoid damaging the therapeutic relationship. This qualitative study explored ethical and communicative dilemmas through interviews and moral case deliberations with 11 multidisciplinary experts. Three themes emerged: the importance of building trust in the doctor-patient relationship, employing sensitive communication strategies, and enhancing multidisciplinary collaboration. Effective approaches include avoiding stigmatizing terminology, focusing on symptom management, and centralizing care in psychodermatology clinics. These findings provide recommendations to improve care outcomes and highlight the need for guidelines on communication strategies in the management of patients with delusional infestation.