Casey Mc Murray
Dhat Syndrome
Description:
Dhat syndrome is a condition that is found in the Indian cultures in which male patients report that they suffer from premature ejaculation or impotence (erectile dysfunction). Male’s also believe that they are passing semen threw their urine. The condition is commonly recognized clinically in India and South East Asia and is also widespread in Nepal, Sri Lanka, Bangladesh and Pakistan. Dhat syndrome is a true culture bound sex neurosis quite common in natives of the Indian subcontinent. Culture bound syndromes (CBS) were defined by Littlewood and Lipsedge as ‘episodic and dramatic reactions specific to a particular community.’
‘Dhatderives from the Sanskrit word dhatu meaning ‘metal’, and also ‘elixir’ or ‘constituent part of the body’. First described in Western psychiatric texts by Wig (1960), dhat comprises vague somatic symptoms of fatigue, weakness, anxiety, loss of appetite, guilt and sexual dysfunction attributed by the patient to loss of semen in nocturnal emissions, through urine and masturbation.
The disorders of ‘Dhatus’ have been elucidated in the Charak Samhita, which describes a disorder called ‘Shukrameha’ in which there is a passage of semen in the urine. In China, anxiety following semen loss (Shen-K'uie) has been associated with epidemics of Koro, which is another culture bound syndrome in which the individual holds the belief that his penis is shrinking into his body and disappearing from sight. Tissot's paper in 18th century stating that even an adequate diet could waste away through seminal emission gained popularity amongst the emerging middle class and led Western Europe to an era of masturbating insanity.
The classification of the diseases ICD-10 classifies Dhat syndrome as both a neurotic disorder (code F48.8) and a culture specific disorder (Annexe 2) caused by ‘undue concern about the debilitating effects of the passage of semen.’
Dhat Syndrome is characterized primarily with complaints of loss of semen through urine, nocturnal emission or masturbation, accompanied by vague symptoms of weakness, fatigue, palpitation and sleeplessness. The condition has no organic etiology. It may sometimes be associated with sexual dysfunction (impotence and premature ejaculation) and psychiatric illness (depression, anxiety neurosis or phobia).
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Dhat syndrome ("semen loss"-related psychological distress) is a culture-bound syndrome (CBS) seen in the natives of Indian subcontinent, but it is also prevalent in other cultures. This syndrome involves vague and multiple somatic and psychological complaints such as fatigue, listlessness, loss of appetite, lack of physical strength, poor concentration, forgetfulness and other vague somatic troubles.

These symptoms are usually associated with an anxious and dysphoric mood state. These patients may also present with or without psychosexual dysfunction. The management of Dhat syndrome needs serious attention. The understanding of this condition by most doctors and/or clinical facilities fails to impress most of the patients who are experiencing these Dhat like symptoms, and the explanations and reassurances offered prove to be not of much use.

A person suffering from this condition may feel a little embarrassed when communicating with their sex partner or respective doctor. To communicate and let your spouse know that you have Dhat like symptoms might make them disinterested in sexual contact with you. It may be a little difficult to talk to a doctor of some sort when the average person who suffers from these symptoms is around the age of 19, may feel embarrassed and think that something like this should not affect a person at that young of an age.

In conclusion, Dhat syndrome is a very common culture bound sex neurosis, widely prevalent in India. Though the origin of this condition is deeply rooted to the overvalued role of semen as a vital substance of the human body, sexual awareness and improved literacy rates have still not been able to convince the general population of its non organic nature. Dhat syndrome can result in premature ejaculation and impotence, weakness, insomnia, low mood, quilt and anxiety, easy fatigability, and others that I’ve listed above. People who suffer from this condition are typically 19 year old males from the Indian subcontinent cultures.

Symptoms:
`Young males are most often affected, though similar symptoms have been reported in females with excessive vaginal discharge or leucorrhea (discharge of white mucous material from the vagina; often an indication of infection), which is also considered a "vital fluid".
`Premature ejaculation and impotence are commonly seen. Other somatic symptoms like weakness, easy fatigability, palpitations, insomnia, low mood, guilt and anxiety are often present. Males sometimes report a subjective feeling that their penises have shortened.

Treatment:
`Cognitive behavioral therapy is the mainstay of treatment (cognitive behavioral therapies or CBT) is a psychotherapeutic approach, a talking therapy, that aims to solve problems concerning dysfunctional emotions, behaviors and cognitions through a goal-oriented, systematic procedure. The title is used in diverse ways to designate behavior therapy, cognitive therapy, and to refer to therapy based upon a combination of basic behavioral and cognitive research.
`At other times counseling, anti-anxiety and antidepressant medications have been shown to be of use.

Clinical Implications and Limitations:
CL:
· Clinicians should embed psychiatric symptoms in their cultural context.
· Culture-bound syndromes are neither exotic nor rare, and often span different cultures.
· Researchers should not rely only on epidemiological data.
L:
· Historical data may be scanty and biased.
· Culture-bound syndromes such as dhat do not explain somatisation disorders.
· Culture-bound syndromes may reflect a culturally specific idiom of distress.

Interesting Facts:
`Similar conditions have been described under various names from China (Shen K'uei), Sri Lanka (Prameha) and other parts of South East Asia (Jiryan). Malhotra and Wig called ‘Dhat’ ‘a sexual neurosis of the Orient’.
`This is based on an old Hindu belief that it takes forty drops of blood to create a drop of bone marrow and forty drops of bone marrow to create a drop of sperm.
`Dhikav et al.(2008) studied 30 patients with Dhat syndrome and found that the mean age of onset was 19 years, with mean duration of the illness being 11 months. Twenty out of 30 patients met the diagnostic criteria for depression. A majority of the cases were unmarried (64.2%). Ten patients (33.33%) were found to have a co-morbid problem of premature ejaculation and ten patients (6.6%) reported erectile dysfunction.
References:
Lipsedge M, Littlewood R. Transcultural psychiatry. In: Granville-Grosman, editor. Recent advances in clinical psychiatry. 3rd ed. Edinburgh: Churchill Livingstone; 1985.
Wig, N. N. (1960) Problems of the mental health in India. Journal of Clinical and Social Psychiatry (India), 17, 48 -53.
Malhotra HK, Wig NN. Dhat syndrome: A culture bound sex neurosis of the orient. Arch Sex Behav.1975;4:519–28.
Sumathipala A, Siribaddana SH, Bhugra D. Culture bound syndromes: The story of Dhat syndrome. Br J Psychiatry. 2004;184:200–9.
Dhikav V, Aggarwal N, Gupta S, Jadhavi R, Singh K. Depression in Dhat syndrome. J Sex Med.2008;5:841–4.
British Association for Behavioural and Cognitive Psychotherapies: What are Cognitive and/or Behavioural Psychotherapies? Retrieved on 2008-11-1.