Psychological correlates and psychiatric morbidity in patients with Dhat syndrome

Dhat Syndrome: Epidemiology, Risk Factors, Comorbidities, Diagnosis, Treatment, and Management

Dhat syndrome is a culture-bound psychiatric syndrome most commonly found in the Indian subcontinent. It has been characterized as the experiential fear of losing semen through ejaculation, nocturnal emission, or other means. While Dhat syndrome is common in the Indian subcontinent, given the lack of representativeness, generalizability, and closer connection to Ayurvedic system, there have been limited studies or recognition of symptoms among healthcare providers around the world. In this review, we describe Dhat syndrome, its epidemiology, risk factors, comorbidities, diagnosis, treatment, and its management. For patients with Dhat syndrome, it becomes important to appreciate how generalized depression and anxiety may persist alongside the disorder and those symptoms can be common and non-specific. Related to its strong cultural connection with South Asia such as the belief on Dhat's role in health and vitality influence, it also becomes important to recognize that the syndrome can be found in other populations and the importance of cultural humility and nonconfrontational approach for patient care. In summary, this review provides an informative understanding of Dhat syndrome for non-Indian clinicians who may not be prepared for a patient encounter with vague somatic symptoms in the context of semen loss. Treatment for Dhat syndrome is the same as treatments for major depressive disorder.

Quality of Life and Disability in Patients with Dhat Syndrome: A Cross-Sectional Study

BACKGROUND

Dhat syndrome (DS) is considered a culture-bound syndrome of South East Asia. It is often associated with multiple sexual and psychiatric comorbidities. We aimed to assess the quality of life (QoL) and disability in patients of DS with and without comorbidity.

METHODS

This cross-sectional study included 117 patients with DS and 117 matched controls. DS was diagnosed based on the International Classification of Diseases, 10 version, Diagnostic Criteria for Research diagnostic criteria. Comorbidities were assessed on MINI 6.0.0, and the patients were divided into two groups (with and without comorbidity). The QoL and disability were estimated and compared between patients with and without comorbidity and their respective control groups consisting of healthy volunteers, using standardized tools.

RESULT

Most of the patients were unmarried males aged 18 to 25 years and from rural backgrounds. Most of the patients (72.64%) had comorbidities (psychiatric/sexual). The QoL of patients with DS was poor compared to healthy individuals. The QoL of patients with comorbidity was worse than that of those without them (P < o.ooo). The disability of patients with DS was more than that of healthy individuals (significant in all domains of the World Health Organization Disability Assessment Schedule [WHODAS]).

CONCLUSION

Patients having DS had poor QoL and higher disability than healthy controls. Patients having psychiatric or sexual comorbidities had less QoL and higher disability compared to healthy controls and those without comorbidities.

A 47‐year‐old man passing putrid semen through saliva and sweat: A case of Dhat syndrome

Dhat syndrome is a culture‐bound syndrome in which patients believe that they pass Dhat (semen) with their urine, feces, sweat, and saliva that causes lethargy, apathy, dysphoria, and depression. Here, we report a case of a 47‐year‐old man who presented with complaints of burning sensation in the whole body, especially in the pubic region, and insomnia for the last 5 years. This case could be enlightening for clinicians in South Asia in daily clinical practice and family physicians in Western countries where immigrants from Dhat syndrome prevailing countries could present with complex cultural myths and superstitious beliefs.

Dhat syndrome is a culture‐bound syndrome in which patients believe that they pass Dhat (semen) with their urine, feces, sweat, and saliva that causes lethargy, apathy, dysphoria, and depression. Here, we report a case of a 47‐year‐old man who presented with complaints of burning sensation in the whole body, especially in the pubic region, and insomnia for the last 5 years. We consider Dhat syndrome as the patient has the belief that he has been losing his semen through his saliva, sweat, feces, and urine, which is the reason for his current illness.

Dhat syndrome: Systematic review of epidemiology, nosology, clinical features, and management strategies

BACKGROUND

Dhat syndrome is a culture-bound syndrome prevailing in the Indian subcontinent, first described in the 1960s. Over time, newer studies are exploring various aspects of Dhat syndrome, including its epidemiology, nosology, clinical features, and management predominantly in South Asia. We aimed to review the epidemiology, nosology, clinical presentation, and management of Dhat syndrome over the last six decades through a systematic review of studies.

METHODS

We searched PubMed and Scopus using the following search terms - "Dhat syndrome," "Semen loss syndrome," "Semen loss anxiety" together with the Boolean operator OR. We collected the articles from inception till March 2021. We included articles in the English language published in peer-reviewed journals.

RESULTS

A total of 89 articles were included in the analysis. Most of the articles were published in the last decade (2011-2020). Most of the publications were cross-sectional studies and of unsatisfactory quality. Most of the studies lack representativeness of the population; hence the generalizability of the findings was poor. Most of the articles discussed phenomenology (64%), overview (52.8%), and cultural basis of Dhat syndrome. The comorbidities associated with Dhat syndrome were discussed in 37.1% of the articles. The nosological status of Dhat syndrome and management of Dhat syndrome was discussed in 18% of publications each; whereas, the outcome of Dhat syndrome was discussed in 5.6% of articles.

CONCLUSION

Though Dhat syndrome is a commonly diagnosed entity in the South Asian population, the research on Dhat syndrome is sparse and of poor quality.

Dhat Syndrome: A Review and Update

Dhat syndrome is known as a culture-bound syndrome of South East Asia. Its manifestations mimic the phenomenology of neurotic spectrum disorders. Myths related to semen loss are the core belief around which anxiety, depressive as well as somatic symptoms develop. Often the patients respond to psychoeducation focusing on resolving the sexual myths and misconceptions. There is an ongoing controversy regarding the nosological status of Dhat syndrome. Extensive research on Dhat syndrome may provide an answer to this controversy through understanding about the entity. This review is a synthesis of literature on Dhat syndrome from its inception till date.

Burden of Misconception in Sexual Health Care Setting: A Cross-Sectional Investigation among the Patients Attending a Psychiatric Sex Clinic of Bangladesh

Background

Bangladesh is a country in South Asia with about 160 million people and achieved health related Millennium Development Goals (MDG) significantly. But sexual health is still an untapped issue with predominant myths and misconception.

Objective

We aimed to look into the proportions of patients attending sexual health care services due to misconceptions.

Methods

The descriptive, cross-sectional study was conducted among 110 patients attending Psychiatric Sex Clinic (PSC) of Bangabandhu Sheikh Mujib Medical University. Respondents were included in the study with convenient sampling from November 2016 to March 2017. Data were collected through face-to-face interview with semistructured preformed, pretested questionnaire and analyzed by SPSS software 16.0 version.

Results

Most of the patients (93%) were male, 60% were married, 62% were urban habitant, 42% were under grade 10, and 33% were service holder. Total 55% of the patients had misconceptions and 29% visited only for misconception; 14% had Premature Ejaculation; and 12% had desire disorder. 32% of the patients had psychiatric disorders and among them depression was most common, 13%.

Conclusion

Positive openness in sexual health and appropriate strategy should be taken to improve the quality of sexual life as well as reduce the misconception in the people of Bangladesh.