Mr. Schmidt is a 38 year-old Caucasian man presenting with a 3-month history of extremely bothersome crawling, biting, and stinging sensations. He reported that at times he felt as if “a 1,000 bugs were falling and crawling on my [his] skin.” The patient claimed that no living organisms were involved in causing his skin condition, not only because there was no evidence to suggest this but also because the symptomatology was so bizarre that he knew of no organisms likely to cause this type of discomfort. The onset of these symptoms was not correlated with any particular events or stressors, and he denied recreational drug use. Past medical history was unremarkable. Due to the intensity of the formication, he was very eager to undergo aggressive therapy to reduce these sensations.