Comorbidity in patients with Dhat syndrome: a nationwide multicentric study

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.

Systematic review on somatization in a transcultural context among teenagers and young adults: Focus on the nosography blur

Aims

Somatic complaints are a frequent cause for consultation in primary care. In a transcultural context, somatic complaints are typically associated with psychological distress. A recent review about somatic symptom disorders in adolescence showed some nosographic heterogeneity and outlined various etiological hypotheses (traumatic, environmental, or neurologic), separate from the cross-cultural considerations. Migrants' children encounter specific problems involving cultural mixing-issues of filiation (familial transmission) and affiliation (belonging to a group). This paper aims to provide a systematic review of somatization in transcultural contexts among teenagers and young adults, aged 13 to 24, over the past decade.

Methods

This review adheres to the quality criteria set forth by the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Two authors queried three English databases (Medline, PsycInfo, WebOfScience) about somatization in transcultural contexts (migrant or non-Western population) among teenagers (13-18), young adults (19-24), or both. The methodological process comprised articles selection, data extraction, and then the analysis of emerging themes. Setting selection criteria to limit the transcultural field was difficult.

Results

The study analyzed 68 articles. We present a descriptive analysis of the results, centered on three main themes. First, the literature highlights a nosographic muddle reflected in the combination of anxious and depressive symptoms together with the highly variable symptomatology. Second, discrimination issues were prevalent among the migrant population. Lastly, the literature review points out possibilities for improving a care pathway and reducing the diagnostic delay induced by migrants' hesitancy about Western care and the recurrent use of inappropriate diagnostic criteria.

Conclusion

This review discusses the links between the nosographic muddle described here and the diagnostic delays these patients experience and raises concerns about rigid diagnostic compartmentalization. The work of the psychiatrist Frantz Fanon is here useful to understand externalized symptoms resulting from physical and psychological confinement. Discrimination issues raise questions about the cultural counter-transference health professionals experience in dealing with young migrants. Defining healthcare professionals' representations about somatic complaints in a transcultural context might be a fruitful path to explore in future research.

Protocol PROSPERO registration number

CRD42021294132. Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021294132.

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.

History and mystery of Dhat syndrome: A critical look at the current understanding and future directions

Sexual health, an essential component of individual's health, is influenced by many complex issues including sexual behavior, attitudes, societal, and cultural factors on the one hand and while on the other hand, biological aspects, genetic predisposition, and associated mental and physical illnesses. Sexual health is a neglected area, even though it influences mortality, morbidity, and disability. Dhat syndrome (DS), the term coined by Dr. N. N. Wig, has been at the forefront of advancements in understanding and misunderstanding. The concept of DS is still evolving being treated as a culture-bound syndrome in the past to a syndrome of depression and treated as "a culturally determined idiom of distress." It is bound with myths, fallacies, prejudices, secrecy, exaggeration, and value-laden judgments. Although it has been reported from many countries, much of the literature has emanated from Asia, that too mainly from India. The research in India has ranged from the study of a few cases in the past to recent national multicentric studies concerning phenomenology and beliefs of patients. The epidemiological studies have ranged from being hospital-based to population-based studies in rural and urban settings. There are studies on the management of individual cases by resolving sexual myths, relaxation exercises, supportive psychotherapy, anxiolytics, and antidepressants to broader and deeper research concerning cognitive behavior therapy. The presentation looks into DS as a model case highlighting the importance of exploring sexual health concerns in the Indian population in general and in particular need to reconsider DS in the light of the newly available literature. It makes a fervent appeal for the inclusion of DS in the mainstream diagnostic categories in the upcoming revisions of the diagnostic manuals which can pave the way for a better understanding and management of DS and sexual problems.

Study of Dhat Syndrome in Men in West Bengal: A Clinic-Based Study

Background:

Dhat syndrome is a culture-bound syndrome of the Indian subcontinent. Traditional and cultural teachings through generations, and myths and misconceptions about sex are its principal contributing factors. Although prevalent, there is scarcity in studies on Dhat syndrome, particularly from Bengal.

Aims and objectives:

1. To study the phenomenology of Dhat syndrome in men attending the out patients department (OPD). 2. To study the comorbid sexual and psychiatric disorders associated with Dhat syndrome.

Methodology:

This was a cross-sectional observational study conducted in the psychiatric OPD in a tertiary care medical college hospital in West Bengal. The duration of the study was 18 months. 122 patients were included in this study that fulfilled the inclusion and exclusion criteria. The diagnosis of Dhat syndrome was made as per International Classification of Diseases, Tenth Revision, diagnostic criteria for research (DCR) criteria. A semi-structured pro forma was used to obtain sociodemographic variables along with numerous physical and sexual symptoms. Mini International Neuropsychiatric Interview was applied for psychiatric comorbidities. Data were analyzed using Statistical Package for Social Studies 17 by SPSS Inc., Chicago.

Results:

122 patients met the inclusion and exclusion criteria. Majority of patients were among age group of 20 to 30 years (60.7%). 56.6% were from the Muslim community and 43.4% were from the Hindu community. 54.1% population was unmarried and 39.3% were newly married. Routes of passage were night falls in 62.3% patients, and 52.5% patients pointed toward passage through urine. Many patients reported passage of semen more than one route. All patients (100%) complained about generalized weakness and thinning of semen. 66.4% had generalized body ache, 55.7% complain about headache, 60.7% decreased body glow, 50% had loss of appetite, 98.4% had decreased self-confidence, sleep disturbance was reported in 34.3% patients, 58.2% reported that their penis was becoming smaller, and 49.2% patients reported decreased sexual capability. The most common comorbid condition was sexual dysfunction (39.3%) followed by depressive disorders (27.9%). Premature ejaculation was found in 54.17% patients and erectile dysfunction in 33.33%.

Conclusion:

Dhat syndrome is a common culture-bound syndrome in Bengal. It is widespread in the Muslim community also. The importance of exploration of sexual comorbidities in Dhat syndrome is very much needed.

Sexual Disorders: Progress Made and Way Ahead

Although sexuality has a long history in the Indian literature, it is not discussed openly due to various reasons. Although sexual medicine has seen a reasonable growth in the last 70 years, somehow, psychological factors associated with the development of various sexual dysfunctions have not received due importance. Cultural factors which contribute to development and persistence of sexual disorders have not been evaluated properly. In terms of training, there is a wide variation across different centers in this country. There are very few indigenously designed instruments for the assessment of sexual disorders and there is limited data on well-evaluated indigenously designed interventions for the management of various sexual disorders. There is a need to homogenize the training and liaise with other specialists working in this area. Centers with well-developed services for sexual disorders need to start observerships and postdoctoral fellowship programs to train the interested clinicians. There is a need for multicentric studies to generate national-level data.

Prevalence and correlates of sexual health disorders among adult men in a rural area of North India: An observational study

Background and Objectives:

Sexual health disorders are an important but less researched public health issue in India. We aimed to estimate the prevalence of sexual health disorders and their associated factors among adult men in a rural community of Haryana, India.

Materials and Methods:

A community-based cross-sectional study was conducted among adult men aged 18–60 years using a multistage stratified random sampling. Information pertaining to sociodemographic characteristics, lifestyle and sexual practices, and self-reported sexual problems were collected. Sexual health disorders were defined based on International Statistical Classification of Diseases-10 classification of mental and behavioral disorders. Step-wise logistic regression was carried out to identify factors independently associated with sexual disorders.

Results:

At least one sexual health disorder was reported by 81% of the men. The most commonly reported disorder was self-perceived defect in semen (64.4%), followed by loss of libido (21%), masturbation guilt (20.8%), erectile dysfunction (5%), and premature ejaculation (4.6%). Factors significantly associated with sexual health disorders among all men were being never married (odds ratio = 2.04; 95% confidence interval: 1.51, 2.77), smoking (1.57; 1.16, 2.14), cannabis use (4.20; 1.68, 10.48), diabetes (2.40; 1.22, 4.73), and hypertension (3.17; 1.12, 8.92).

Interpretation and Conclusions:

A high burden of sexual health disorders was identified among the rural men. Wider recognition of this issue is needed among the health-care providers and policymakers.

Where Lies the Fault in Diagnosing Dhat Syndrome among Females? Understanding through a Case Study

Dhat syndrome is a culture-bound syndrome of South-East Asia, common in young men. However, similar entity has also been described in female patients who attribute their symptoms to nonpathological or physiological vaginal discharge. The current diagnostic system for psychiatric illnesses does not encompass Dhat syndrome in females, and so these group of patients receive alternative diagnoses such as somatoform disorder or depression. As a result of which the focus of unique Dhat syndrome-centered management gets weakened, affecting the clinical outcome. This case study focuses on the diagnostic dilemmas related to Dhat syndrome in females and pitfalls in the current diagnostic system.

Phenomenology and beliefs of patients with Dhat syndrome: A nationwide multicentric study

AIM

To assess the phenomenology and associated beliefs in patients with Dhat syndrome.

METHODS

A total of 780 male patients aged more than 16 years were recruited from 15 centers spread across the country and were assessed on Dhat Syndrome Questionnaire.

RESULTS

The most commonly reported reasons for passage of Dhat were excessive masturbation (55.1%), sexual dreams (47.3%), excessive sexual desire (42.8%) and consumption of high energy foods (36.7%). The most common situation in which participants experienced passage of Dhat were as 'night falls' (60.1%) and 'while passing stools' (59.5%). The most common consequence due to passage of Dhat was weakness in sexual ability (75.6%). In terms of psychological and somatic symptoms, the common symptoms included bodily weakness (78.2%); feeling tired or having low energy (75.9%); feeling down, depressed, or hopeless (67.9%); and little interest or pleasure in doing things (63.7%). In terms of treatment expectations, about half of the patients (49.1%) expected that energizing medications like vitamins/tonics/tablets were required and more than one-third (38.2%) expected that there was a need for taking energizing injections.

CONCLUSION

Present study shows that Dhat syndrome is a distinct clinical entity seen all over India, with its characteristic features.

Dhat syndrome: Evolution of concept, current understanding, and need of an integrated approach

Dhat syndrome has often been construed as a culture-bound sexual neurosis of the Indian subcontinent. Symptoms similar to that of Dhat syndrome has been described in other cultures across different time periods. The present paper looks at the evolution of the concept of Dhat syndrome in India. The review also takes an overview of the current understanding of this syndrome in terms of nosological status as a distinct entity and its “culture-bound” status. The narrative finally attempts to discuss the integrated approach for the treatment of this disorder.