Dhat Syndrome

Volume 7 Issue 2 February, 2017

The term “Dhat syndrome” was coined by Prof. N. N. Wig to explain the distress resulting from semen loss in people belonging to South East Asian culture. It is considered as a culture bound syndrome of the South East Asia. The 10th edition of International Classification of Diseases (ICD-10), considers it as a distinct diagnostic entity under psychiatric disorders.

In South East Asian culture, the ancient religious texts describe semen to be highly precious. It is considered that semen is formed from food extract, through multiple steps of ultrafiltration; hence much emphasis was given in its
preservation. Loss of semen is considered as a threat to the physical as well as mental wellbeing.

Usually, the patients with Dhat syndrome are having poor level of education and often belong to low to middle socioeconomic strata. They are young males, who are unmarried or newly married. Over past several decades, researchers attempted to understand the phenomenology of Dhat syndrome. Patients with Dhat syndrome often present with various psycho-somatic symptoms. The clinical manifestations of Dhat syndrome can be classified in following domains.

Psychological symptoms: Anxiety, low mood, worry, apprehension, lack of interest in pleasurable activities, hopelessness
Somatic symptoms: Decreased energy, fatigue, feeling tired, disturbance of sleep & appetite, sexual dysfunction, burning micturition, weakness, backache, non-specific pain symptoms
Cognitive symptoms: Forgetfulness, lack of concentration, illness preoccupation

Often patients attribute their symptoms to semen loss in urine, during nocturnal emission, during defecation, and by
masturbation. Atypical symptoms are also been reported, where patients wrongly perceived their mucoid discharge
per anum as semen and expressed their undue distress to its loss. An entity similar to dhat syndrome is also being
discussed in females of same culture. It has been reported that females of reproductive age give undue significance to
non-pathological vaginal discharge and manifest with above mentioned symptoms. They attribute their symptoms to
loss of genital secretion. This entity is described as “Female Dhat syndrome”.

Psychiatric co-morbidities are very common in patients with Dhat syndrome. Recent multi-centric study on Dhat
syndrome revealed sexual dysfunction to be the most common co-morbidity followed by depression and anxiety
disorders. As symptoms of patients with Dhat syndrome simulate with depressive disorder, somatoform disorder and
anxiety disorder, it is often misdiagnosed. A long term follow up study attempted to see the diagnostic stability of Dhat
syndrome. It was found that the diagnosis changes in about two third of patients in long term follow up.

Due to phenomenological resemblance with other psychiatric disorders, instability of diagnosis in long term and high
association of co-morbidities, it struggles to maintain its place in the diagnostic system as a distinct diagnostic
category.

Suggested readings:

Udina M, Foulon H, Valdés M, Bhattacharyya S, Martín-Santos R. Dhat syndrome: A systematic review. Psychosomatics. 2013 Jun 30;54(3):212-8.
Kar SK, Sarkar S. Dhat syndrome: Evolution of concept, current understanding, and need of an integrated approach. Journal of human reproductive sciences. 2015 Jul 1;8(3):130.
Grover S, Avasthi A, Gupta S, Dan A, Neogi R, Behere PB, Lakdawala B, Tripathi A, Chakraborty K, Sinha V, Bhatia MS. Phenomenology and beliefs of patients with Dhat syndrome: A nationwide multicentric study. International Journal of Social Psychiatry. 2016 Feb;62(1):57- 66.