Koro in a native born citizen of the U.S

[The syndrome of genital retraction from a transcultural psychiatric point of view. Chinese suo yang, Indonesian koro and non-Asian forms (koro-like symptoms)]

The present article reviews the syndrome of genital retraction (SGR) from the perspective of transcultural psychiatry. It is best known as a culture-bound syndrome in Asia, e. g. koro in Indonesia or suo yang in Southern China, where it can be also observed in so-called epidemics. The syndrome is characterised by the sensation that the genitals are shrinking and being pulled back into the abdomen; this perception is associated with fear of death, because the subjects expect to die as soon as the genital has disappeared completely. Particularly in the case of suo yang, the involvement of local traditional concepts of illness can be established. In the Western world, however, SGR is observed only in single cases. The symptoms are less dramatic and do not show a particular cultural context. This form of SGR is called "koro-like" (koro-like symptoms, KLS). In contrast to the Asian form, KLS are not observed in healthy subjects, but as an unspecific syndrome related to other neuropsychiatric illnesses. In this review, we compare both forms of the SGR in terms of symptoms, cultural aspects and therapeutic strategies.

The definition and classification of Koro

Attempts at defining and classifying Koro have been undertaken by various researchers over at least the last fifty years without any consensus emerging to date. The occurrence of Koro, not only in different parts of the world but also in association with varied morbidities, has of late diluted its primary identity as a culture-bound syndrome. Further, the DSM-IIIR and ICD-10 provisions to include culture-bound syndromes like Koro are open to various diagnostic options. Consideration was given to have it included in DSM-IV. One of the fundamental problems inherent in such attempts is the semantic confusion Koro generates in its basic phenomenological analysis. The present paper deals with some of these issues based on historical analysis of world Koro literature, and with comments on the future research agendum.