Dhat syndrome presenting as a psychiatric emergency: A very rare case report

Dear Editor, Dhat syndrome is a culture-bound syndrome, especially in the Indian sub-continent characterized by psychological distress related to semen loss. The term “Dhat” originated from the Sanskrit word “Dhatu,” which was anciently thought to be the most powerful bodily substance and the source of physical and spiritual strength.[1-3] We report a case of Dhat syndrome that presented to us as a suicide attempt with homicidal tendencies due to a lack of proper diagnosis and evaluation. Mr. X was a 20-year-old unmarried Kashmiri Muslim male who had dropped out early from school. He was from a lower socioeconomic status and was occupationally dysfunctional for the last 1 year. He was brought by the family to the emergency with complaints of recent suicidal attempts, aggression, and homicidal tendencies. As per the informant, the patient started with symptoms of low mood, decreased energy and appetite, staying aloof, and sleep disturbances. He revealed that he loses his semen with urine and that is why he is becoming weak day by day and feels extremely unhappy and worthless. He also said that he could not marry anyone because of this. Over the next several months, he started going to various Hakeems (traditional doctors) for the same issue but the prescribed medications did not help. He was even mocked and made fun of by his friends after he sent his naked picture to a faith healer. This event made him extremely sad and subsequently, his suicidal threats increased and he hanged himself in the attic of the house but he was saved. After returning from the hospital, in a rage, he tried to strangulate his niece stating that if he is not able to start his family because of his sexual weakness, how can his brother have a child? This led to him being brought to our psychiatric institute for treatment. On the Beck Suicide Intent Scale, a score of 26 (medium intent) and depressive features along with obsessional ruminations with deficits in coping and social skills and problems in adjustment in DAPT (draw a person test) and Rorschach’s. The patient was treated with cognitive behavioral therapy and tab sertraline 100 mg od, tab mirtazapine 7.5 mg bedtime, and tab clonazepam 1 mg/day and improved significantly over 2 weeks. Dhat is considered where culture and religion surmise semen as one of the body’s most pretentious fluids. It seems rational that our cultural standpoint shapes the experience and understanding of mental illness and so is the case with Dhat syndrome. This case report demonstrates that Dhat, which is a chronic type of syndrome, with symptoms over several years can lead to acute crises such as suicidal and homicidal tendencies. This also highlights the importance of timely referrals to prevent the precipitation of acute crises and lower financial burdens. Another important factor is the stigma of the illness, which leads to people making fun of the symptoms and subsequent distress in the patients.[4] The role of psychoeducation of traditional healers and doctors from other specialties cannot be underestimated. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.