Is a culture-bond syndrome that is prevalent in the Indian subcontinent Characterized by complaints of whitish discharge (Dhat) passage in urine. Is it a neurotic disorder
CONCEPT OF DHAT:
The word “Dhat” derives from the Sanskrit language (the mother of Indo-Aryan languages) word dhatu, meaning “metal,” “elixir” or “a constituent part of the body” which is considered to be “the most concentrated, perfect and powerful bodily substance, and its preservation guarantees health and longevity.” The disorder related to this dhatu, i.e., semen, is mentioned in the ancient treatise “Susruta Samhita” as shukrameha (Shukra = sperm; + meha = passage in urine).
Condition found in the cultures of South Asia (including Pakistan, India, Bangladesh, Nepal, and Sri-Lanka)
The discharge of this “vital fluid,” either through sex or masturbation, is associated with a marked feeling of anxiety and dysphoria. The patient also mentions the loss of white fluid when going through the urine. On other occasions, there are noticeable feelings of shame associated with what the patient feels is “excessive” masturbation.
Sign and symptoms:
Premature ejaculation and impotence are commonly seen. Other somatic symptoms like
- Easy fatiguability
- Low mood
Males sometimes report a subjective feeling that their penises have shortened. These symptoms are usually associated with an anxious and dysphoric mood state.
Patients having Dhat syndrome can be further divided into three categories:
- Dhat alone – Patients attributed their symptoms to semen loss; presenting symptoms – hypochondriacal, depressive or anxiety symptoms.
- Dhat with comorbid depression and anxiety – Dhat was seen as an accompanying symptom.
- Dhat with sexual dysfunction.
The length of the onset presentation of these patients ranges from less than three months to one year and up to 20 years. These patients reported that they had lost their semen in sleep, urine, masturbation, hetero / homosexual sex.
Erectile dysfunction (22-62 percent) and premature ejaculation (22-44 percent) were the most frequently associated psychosexual dysfunctions; while depressive neurosis (40-42 percent), anxiety neurosis (21-38 percent), somatoform / hypochondriasis (32-40 percent) were the most commonly identified psychiatric disorders in patients diagnosed with Dhat syndrome.
Urine examination of these patients showed no abnormality except oxaluria (10 percent) and phosphaturia (6 percent). They also showed significant differences in illness-related beliefs and behaviors compared to controls and similarities with other functional somatic syndromes.
After follow-up, the majority of patients recovered (66 percent), while the rest either improved (22 percent) or remained unchanged (12 percent). Dissatisfaction with the medical diagnosis can be extrapolated, as most of them did not attend after the initial visit.
A good response has been reported with anti-anxiety and antidepressant drugs compared to psychotherapy. Depressive symptoms of this syndrome have shown an effective response to selective serotonin reuptake inhibitors along with regular counseling.
Available intervention studies suggest that the management of Dhat syndrome involves sex education, relaxation therapy, and medication.
Sexual education focuses primarily on the anatomy and physiology of sexual organs and their functioning with regard to masturbation, semen, and nocturnal emissions. It also includes the development of a genitourinary system independent of the gastrointestinal tract, etc. Relaxation therapy consists mainly of Jacobson’s Radical Muscular
Relaxation therapy, which can be paired with biofeedback (to promote reliable confirmation and management of the patient’s anxiety). Relaxation therapy should be done two to three times a day on a regular basis, particularly at the end of therapy sessions.