Culture-Bound Syndromes: Dhat

Dhat syndrome, a term first introduced by N. Wig in 1960, is a culture-bound syndrome of India and its surrounding areas in which men believe they are physically or mentally ill because of the excessive loss of semen. This syndrome is most common among young men and is attributed to excessive masturbation, nocturnal emissions, or premarital or extramarital sexual activity.

The belief that semen is vital to both physical and spiritual health stems from the Hindu religion. Hindus believe that 40 meals create one drop of blood, 40 drops of blood create one drop of marrow, and 40 drops of marrow create one drop of semen. The implication of this process is that the loss of semen is detrimental to one's health. Although the idea that semen loss can be harmful is not unique to the Indian subcontinent, it seems particularly strong in that region.

Common symptoms of dhat syndrome include anxiety or depression, preoccupation, sleep difficulties, sexual dysfunction, exhaustion, headache, loss of appetite, and opaque urine, which the patient believes to contain semen. Other correlates include being a young male, being unmarried or recently married, coming from a rural background, and having a family with particularly conservative views concerning sexual activity.

It is unclear whether the somatic complaints or affective symptoms of dhat syndrome occur before or after the patient begins to believe that his sexual activity has become detrimental to his health or begins to feel guilt over his actions. One case study found that the patient's sexual activity was followed by warnings from friends and family that his actions would be harmful, and these warnings were followed by somatic complaints and anxiety. Regardless of this finding, the etiology of dhat syndrome remains unknown.

It has been suggested that dhat syndrome could be classified as an undifferentiated somatoform disorder according to the criteria listed in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition. Dhat syndrome commonly occurs in patients from [Page 136]rural backgrounds and with less education. Therefore, it may be classified as an anxiety or depressive disorder, conditions that are often expressed somatically in non-Western societies.

Some descriptive reports indicate that dhat syndrome often remits within six months to a year. Others report that education to teach patients that semen loss is harmless or cognitive behavioral therapy are effective treatments. However, because these studies did not include a control group and because dhat syndrome has been shown to remit spontaneously, the efficacy of these treatments remains unclear.

One study looked at two groups of patients with dhat syndrome, one that received medication only and one that received both medication and supportive psychotherapy. Though both groups improved, the combination-treatment group saw greater improvement. However, this single study did not include a control group; therefore, further investigation into these treatment modalities is needed.

Finally, regardless of the treatment used, the therapist or physician is cautioned against immediately confronting the patient's inaccurate beliefs about semen loss. Such disregard for cultural beliefs is the primary cause of the high drop-out rates among dhat syndrome patients.