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 Table of Contents    
LETTERS TO EDITOR  
Year : 2020  |  Volume : 62  |  Issue : 2  |  Page : 221-222
A case of two culture-bound syndromes (Koro and Dhat syndrome) coexisting with obsessive–compulsive disorder


1 Associate Professor, Department of Psychiatry, NRS Medical College, Kolkata, West Bengal, India
2 Psychiatrist, Leicestershire Partnership NHS Trust, Thurmaston, England, UK

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Date of Submission29-May-2019
Date of Decision23-Jun-2019
Date of Acceptance14-Jan-2020
Date of Web Publication17-Mar-2020
 

How to cite this article:
Ghosh S, Chowdhury AN. A case of two culture-bound syndromes (Koro and Dhat syndrome) coexisting with obsessive–compulsive disorder. Indian J Psychiatry 2020;62:221-2

How to cite this URL:
Ghosh S, Chowdhury AN. A case of two culture-bound syndromes (Koro and Dhat syndrome) coexisting with obsessive–compulsive disorder. Indian J Psychiatry [serial online] 2020 [cited 2020 Apr 4];62:221-2. Available from: http://www.indianjpsychiatry.org/text.asp?2020/62/2/221/280855




Sir,

Koro is a culture-bound syndrome and is quite prevalent in both epidemic and sporadic forms in South East Asia. Several reports on Koro in the literature have proved that India, after China, is a Koro prone country. India had a massive Koro epidemic in 2010, involving states of West Bengal, Maharashtra, Assam, Tripura, and Kerala.[1],[2],[3],[4],[5] Here, we report a case of Koro from the 2010 epidemic background in West Bengal, who is having two culture-bound syndromes – Dhat and Koro with comorbid obsessive–compulsive disorder (OCD).

An 18-year-old single Muslim unemployed male (who has consented for this study) from a rural community visited the hospital with complaints of perceived excessive semen loss through urine, lethargy, disturbed sleep, and weakness for the past 4 months and an inward pulling sensation of the penis toward the abdomen with severe anxiety and fear of serious illness for the past 3 days. There was an ongoing “Koro” epidemic in his locality for the past 2 weeks, and several others were reported to be having similar symptoms. Mental status examination revealed severe anxiety (hamilton anxiety rating scale (HAM-A)-29) along with strong masturbatory guilt. He was diagnosed as a case of Koro with Dhat syndrome (international classification of diseases-10th revision (ICD 10)-F41.1) and treated with sertraline 50 mg/day gradually increased to 100 mg in a week, clonazepam (1 mg/day in two divided doses), and supportive psychotherapy. The patient reported on an unscheduled visit 5 days later with a new complaint of having recurrent intrusive distressing blasphemous thoughts, the content being vulgar sexual abusive thoughts directed toward Allah (God). He experienced severe guilt and anger and started repeatedly abusing and beating his head to stop the thoughts though the relief was temporary. He was now additionally diagnosed as a case of OCD (ICD-42.0), with yale brown obsessive compulsive scale (Y-BOCS) score 30. The dose of sertraline was increased to 150 mg/day over 2 weeks and clonazepam 0.5 mg thrice daily was reinstituted. He was also referred for cognitive behavior therapy. Improvement was noticed gradually after a month.


   Discussion Top


This is an interesting case of two coexisting culture-bound syndromes along with OCD. Initial examination was not enough to detect the OCD spectrum as it was camouflaged with predominant complaints of Dhat and later Koro-like symptoms. He displayed Koro-like symptoms not classical Koro. The ongoing Koro epidemic at the background increased his vulnerability. It is interesting that both the culture-bound syndromes were related to genital organ and function. The association of Koro and Dhat has also been reported in the literature (2), and they found the role of peer pressure in the development of Dhat syndrome. Furthermore, in one report, there were some hints about the association of Koro with OCD spectrum (4) which focused “continual compulsion to manually pull” penis or ritualistic regular tying of the penis with cloth before sleep and another case (3) focused the thoughts of penile retraction as intrusive and repetitive, with obsessive doubts. Koro has been reclassified in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition as under “other specified obsessive–compulsive and related disorders” (5). In view of these findings, the authors believe that all Koro and especially Koro-like cases (with subacute/chronic presentation) should be screened for OCD spectrum.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Ghosh S, Nath S, Brahma A, Chowdhury AN. Fifth Koro epidemic in India. World Cultural Psychiat Res Rev 2013;8:8-20.  Back to cited text no. 1
    
2.
Kalra GS, Bansod A, Shah N. A case report of Dhat and Koro: A double jeopardy. Asean J Psychiat 2012;13:91-5.  Back to cited text no. 2
    
3.
Nakaya M. Fluvoxamine treatment of a Japanese patient with Koro. J Clin Psychiatry 2002;63:1182-3.  Back to cited text no. 3
    
4.
Silva L, Raposo-Lima S, Soares C, Cerqueira JJ, Morgado P. Koro syndrome in an obsessive-compulsive disorder patient. Eur Psychiat 2016;33:S496.  Back to cited text no. 4
    
5.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorder. 5th ed. Arlington, USA: American Psychiatric Association; 2013.  Back to cited text no. 5
    

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Correspondence Address:
Sayanti Ghosh
Associate Professor, Department of Psychiatry, NRS Medical College, Kolkata, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/psychiatry.IndianJPsychiatry_298_19

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