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A recently widowed 76-year-old woman presented with her son to her general practitioner complaining of diffuse itchiness all over her body, particularly her arms. She attributed this to having recently spring-cleaned her flat. She thought she may have disturbed some mites, which were biting her. Further questioning of the patient and her son revealed that the patient had become more socially withdrawn over the last four weeks, was having trouble sleeping and was reluctant to invite people to her flat or to meet friends in case she "infested them".

The woman denied lowered mood and said that she was coping well with the loss of her husband. She believed that if her doctor could just get rid of her "rash" and the son could help her fumigate her flat, she would be fine.

On examination there was evidence of recent weight loss but no sign of any rash or bites. She was otherwise physically well and taking no medication. On mental state examination, she was found to have rather flat, slightly irritable affect, no thought disorder and intact cognitive function. She had no insight into the possibility that her itch may have had a psychological basis.

Her general practitioner correctly suspected a depressive disorder with somatic delusions in the setting of unresolved grief. He referred her to a psychogeriatrician, who treated the depression with a selective serotonin reuptake inhibitor. Grief counselling was also an essential component of her management.

Within eight weeks she had made a total recovery, but (quite typically in these circumstances), although she realised that she had been depressed and that the medication and talking had helped, she was unable to accept that the disappearance of both itch and infestation was connected with her emotional state.

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