Introduction
According to earlier descriptions, Dhat syndrome is a mental illness that involves a dread of losing semen through ejaculation, nocturnal emission, or other methods. Dhat syndrome, which is most prevalent in the Indian subcontinent, is described as a culture-bound condition by the DSM-V, meaning that its manifestation is closely tied to a particular culture.
Dhat is seen by many Indians as a physiological humor that starts as food and gradually transforms into blood, bone marrow, and semen. As a result, it is believed that losing semen equates to losing dhat, which is equivalent to losing vitality. Dhat syndrome is caused by anxiety related to this loss.
Furthermore, depressive symptoms like weariness and a low mood are linked to the perceived loss of Dhat. Patients with Dhat syndrome are frequently diagnosed with major depression. Therefore, it is suggested that Dhat syndrome is a culturally specific form of depression.
EPIDEMIOLOGY
Dhat syndrome is the most commonly known culture-bound condition, accounting for 76.7% of individuals with culture-bound syndromes in one analysis. Dhat syndrome was identified in 64.6% of 144 male participants with psychosexual problems in prospective research. The Indian subcontinent is where it is most frequently diagnosed. According to a thorough literature analysis, Dhat syndrome patients had an average age of 26 years. Although female Dhat syndrome does exist, these patients are usually male since the illness is characterized by a fear of semen loss. To collect all patient data for the following month, Nashi Khan surveyed 70 medical professionals working in different outpatient clinics.
A total of 1,777 male patients, ages 12 to 65, had their demographics gathered. It was discovered that most Dhat syndrome patients were unmarried, had less education than their contemporaries, and came from lower socioeconomic backgrounds. These characteristics were supported by demographic data collected from new patients sent to a psychosexual clinic in India, which also revealed that 68.1% of them were Hindus and 63.8% were from rural areas.
Please note that Dhat syndrome is not exclusive to the Indian subcontinent. Research conducted by a Spanish urology service between 2006 and 2007 discovered that 32 individuals had symptoms typical of Dhat syndrome.
COMORBIDITY
The connection between Dhat syndrome and widely recognized mental illnesses has not been extensively studied. While some classify it as a functional somatic condition, others contend that it is an example of cross-cultural misunderstanding. A somatization screening index (SSI), a screening version of the illness behavior questionnaire (SIBQ), and a somatosensory amplification scale (SAS) were among the measures used in research by Perme et al. to examine 29 individuals with Dhat syndrome. Each patient’s hospital anxiety and depression scale (HADS) score were then determined using the test findings. The findings indicate that while there is no difference in anxiety scores, people with Dhat syndrome have significantly higher depression scores. These findings led them to hypothesize a substantial correlation between Dhat syndrome and a DSM criterion of depression.
With a frequency of 40–66%, depression is the most often documented comorbidity with Dhat syndrome. Additionally, 21–38% of individuals have anxiety problems. Up to 40% of patients are known to have somatoform and hypochondriacal problems.
Excessive concern over semen loss is a hallmark of Dhat syndrome, and it is believed that this anguish can lead to more severe mental illness. Before fully developed psychotic symptoms appear, patients with schizophrenia frequently have prodromal symptoms of subthreshold positive, negative, affective, or cognitive symptoms. A 23-year-old schizophrenic patient who was first diagnosed with Dhat syndrome at the age of 15 is described in a case study by Kar et al. He began to retreat during this period due to his obsession with ideas of semen loss. He became skeptical six months after his initial concerns. Years later, he was discovered in an unkempt state with self-inflicted neck wounds after going missing from his house for a month due to intense hallucinations. In Dhat syndrome, the stress caused by semen loss is likely to affect the hypothalamic-pituitary-adrenal axis and result in epigenetic modifications. This may be crucial in the development of schizophrenia from the prodromal period.
DIAGNOSIS
According to ICD-10, the symptoms of Dhat syndrome include anxiety or physical issues associated with the dread of semen loss, excessive worry about the crippling consequences of semen passage, and experiencing and interpreting a white discharge in the urine as semen loss.
Although Dhat syndrome is described in ICD-10, there does not seem to be a universally accepted definition, making it challenging to make a conclusive diagnosis. The identical syndromal description is reported by many patients who describe passing dhat in circumstances not covered by the ICD-10 classification. Every diagnosis of Dhat syndrome revolves around the patient’s obsession with removing dhat from their body because they believe it would negatively impact their sexual, mental, and physical health. The meaning of “dhat” itself, however, is still somewhat ambiguous.
There are still many unanswered questions about the diagnosis of Dhat syndrome since it has not been well characterized. It is unclear if it is a single condition or encompasses a number of sub-syndromes, if it is a cultural manifestation of a Western mental illness, or if it is better categorized as a pathology than as an expression of distress. Divergent interpretations of the condition might cause management issues, which is why it is becoming increasingly crucial for both traditional and allopathic practitioners to exchange information and raise awareness.
MANAGEMENT
One possible cause of Dhat syndrome and a hindrance to prompt identification and treatment has been identified as ignorance. According to data gathered by Grover et al., they discovered that patients tended to turn to native healers, particularly those from the Ayurvedic system, for assistance first. The authors hypothesize that the most frequent obstacles to getting help were ignorance, stigma, access issues, and the notion that there are no treatments or that the symptoms are not severe enough to warrant attention.
Patients preferred assistance from friends and family, allopathic doctors, traditional religious healers, or pharmacies, in that order, after indigenous practitioners. The absence of concomitant sexual dysfunction was the only criterion that predicted quicker contact with the psychosexual clinic.
In 2012, a course on cognitive behavioral therapy was created that featured modules on subjects and skills such as cognitive restructuring, relaxation training, imaginal desensitization, basic sex education, and masturbatory training. Although there was a clinically significant decrease in symptoms, this study only included five individuals, and more research is required to ascertain the course’s validity and reliability.
CONCLUSION
Even though there is still much to learn about the causes, symptoms, and management of Dhat syndrome, it is crucial to first comprehend the illness’s cultural importance. Our understanding of mental illness is influenced by our cultural background. The way that people with Dhat syndrome perceive semen loss is influenced by their cultural views on the importance of dhat for health and vitality. Many patients will have physical symptoms such as exhaustion, weakness, and appetite loss, which are typically accompanied by mental health issues like depression and anxiety. When dealing with a patient who exhibits nebulous somatic symptoms in the context of semen loss, it is crucial to consider the potential of Dhat syndrome because these symptoms are prevalent and nonspecific.
It is crucial to understand that Dhat syndrome may occur in various groups, despite the fact that it is more frequently observed in individuals from the Indian subcontinent. It’s critical to treat patients with a nonconfrontational, culturally sensitive attitude, regardless of their place of origin.
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