The Concept And Epidemiology Of Dhat Syndrome
The last three decades have witnessed an increased interest in the field of trans-cultural psychiatry. Trans-cultural psychiatry mainly delineates the cultural factors in the occurrence, symptom patterns, recognition, course and outcome of psychiatric disorders1. The concept of ‘culture-bound syndromes, initially introduced by Yap2 in the 1950’s and 1960’s, refer to psychopathological entities having a geographically defined prevalence, and are largely determined by the beliefs and assumptions prevalent in the native culture. In most cultures including Indian culture, sexual adequacy in man is the hallmark of masculinity, virility, personal adequacy and fulfillment3. Semen loss related psychological distress has been reported consistently in Asian and western cultures. Dhat syndrome-a term coined by Wig (1960)4, is deemed a common culture-bound preoccupation regarding semen-loss among patients in the Indian sub continent. This condition strictly speaking is not a psychosexual dysfunction but a sex-related disorder and often considered a culture-specific sexual neurosis5.
Ayurveda teaches the physiology of the production of semen. According to that, there are seven essential constituents of the body (the seven Dhatus: chyle, blood, flesh, fat, bone marrow and semen), which are produced through a cycle of successive internal cooking and transformations. After ultimate distilling, the most concentrated elixir among the constituents of the body is semen (Dhatu). Its preservation guarantees health, longevity, and supernatural powers6.
PATIENT’S KNOWLEDGE, ATTITUDE AND EXPECTATIONS TOWARDS DHAT SYNDROME
Regarding the composition of Dhat, a majority of patients belonging to Indian sub-continent believe that it is semen, followed by those who believe it to be pus, sugar, concentrated urine, infection or not sure of its composition5. Masturbation and/or excessive indulgence in sexual activities, venereal diseases, urinary tract infections, overeating, constipation or worm infestation, disturbed sleep or genetic factors are believed to be the main etiological factors5,19. Majority of these patients get the information about Dhat syndrome from friends, colleagues or relatives whereas some get information from posters, advertisements in mass media, magazines or quacks. Therefore, these patients prefer to visit STD clinics, urologists and physicians rather than approaching psychiatrists.
The management of Dhat syndrome needs serious attention. This syndrome has become the domain of traditional therapeutic resources i.e. quacks, ayurvedic or Unani practitioners. The understanding of this condition by the modern medicine fails to impress most patients and the explanation and reassurances offered prove to be not of much use26. Some research workers 26 recommended emphatic listening, a non-confrontational approach, reassurance and correction of disbeliefs, along with the use of placebo, antianxiety and anti-depressant drugs, wherever required. Avasthi and Gupta (1997) 27 have developed a standardized treatment package for single males presenting with Dhat syndrome that mainly includes sex education and relaxation exercises. Sex education mainly focuses on anatomy, physiology of sexual organs, their functioning with reference to masturbation, semen, nocturnal emissions, and the functioning of genito-urinary system etc. Relaxation therapy includes Jacobson’s Progressive Muscular Relaxation Technique combined with Bio-feed back (so as to facilitate objective evidence and mastering of anxiety by the patient), which should be practiced 2-3 times/day regularly, especially after therapy sessions are over. If there is the presence of associated anxiety or depressive symptoms that may impede the process of therapy, anxiolytics or/and antidepressants can be added for the least possible time and in the least possible doses. Not surprisingly, Lorazepam was found to be most useful at the end of 4 weeks of treatment5.
There is sufficient clinical evidence to support Dhat syndrome as a culture specific problem. Due to the contribution of Professor Wig and other researchers, this syndrome was included in the Tenth edition of the International Classification of Diseases (WHO, 1992) 28 under other specified neurotic disorders (F48.8) with the provision of further research. Apparently, this syndrome has a varied clinical picture. Some have the pure form of the disorder; others have concomitant diagnosable depression and anxiety disorder. Dhat syndrome may also have co-morbid psychosexual dysfunction ranging from concern about potency to frank impotence and premature ejaculation either alone or in combination. However, its phenomenology, long term course and prognosis need to be studied further before this entity is accorded international acceptance.
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