Dhat syndrome: past and present - the journey of an Indian culture-bound syndrome across the globe

Dhat syndrome, originally thought to be a culture-bound syndrome restricted to the Indian subcontinent, has now been found to be spread worldwide. This “semen-loss anxiety” is excessive preoccupation with loss of vitality resulting from loss of semen either through urination, nocturnal emission, or masturbation. Semen has been linked to strength and power in the Ayurveda. The ethno-cultural beliefs of a community are important in shaping the expression of underlying psychological disturbances. In developing countries, the repressed emotions usually find expression through somatic symptoms. The presentations can range from depression, anxiety, fatigability, sexual dysfunction, and other somatic symptoms. Dhat syndrome is akin to shen-k-uei in China and Taiwan and shukra prameha in Sri Lanka. Even in the seventeenth century west, the nobility distinguished themselves from the common by way of sexual sanctity. This poses a question to the usual assumption that Dhat syndrome arose in the east and was prevalent among the less educated classes only. The lack of understanding of the phenomenology and a deficient universal language of reporting has made it difficult to be placed under any specific category in the diagnostic system. The tenth revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) mentions Dhat syndrome under other unspecified neurotic disorders (F48.8) while the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) mentions it under “the cultural concepts of distress.” A better understanding of the disorder requires a comprehensive approach and integration with allied system of medicine as well as community awareness is required to address this problem.