In addition to the physical manifestations of bedbug bites, patients can experience significant psychological distress. The stigma that bedbugs are related to poor hygiene (however inaccurate) can lead to poor self-esteem, avoidance of family and friends, and suspension from work.37–39 Management of an infestation can be stressful, costly, and disruptive to everyday life. Worry can lead to insomnia, depression, anxiety, and even delusional parasitosis.37
The size of bed bug bites varies with a number of different factors. Bed bugs inject an anti-coagulant along with their saliva when they pierce the skin to take a blood meal. This anti-coagulant is mostly responsible for how a person reacts to the bite and determines the size of the bug’s bite. Since people will have various sensitivities to the bed bug’s bite, the size of the bite will vary, as well. Another factor that influences the size of a bed bug reaction is the number of times a person is bitten. Bite reactions of people bitten many times are also variable, and their response may be either more or less intense as the number of bites increases.