Assessment of Pathways to Care, Personality Traits and Quality of Life among Patients with Dhat Syndrome: A Cross-sectional Study

Introduction: Dhat syndrome, a culturally specific psychosomatic disorder, predominantly affects young men in South Asian countries. It is characterised by a constellation of somatic complaints, anxiety, and depressive symptoms, all attributed to the perceived loss of semen, a substance that has been traditionally considered vital for health and vitality in South Asian cultural contexts. Rooted in centuries-old beliefs, Dhat syndrome is often accompanied by profound psychological distress and misattributions regarding semen loss through nocturnal emissions, masturbation, or urination. This study seeks to comprehensively assess the clinical manifestations, care-seeking pathways, predominant personality traits, and Quality of Life (QoL) among individuals diagnosed with Dhat syndrome, thereby assessing critical gaps in culturally competent psychiatric intervention. Aim: To study the pathways of care and phenomenology among patients with Dhat syndrome, at-risk personalities, and the QoL in these patients. Materials and Methods: The present cross-sectional study was conducted at a tertiary care hospital in North Karnataka, India, involving 47 male patients diagnosed with Dhat syndrome per ICD-10 criteria. Data were collected using a semi-structured proforma for socio-demographic profile, World Health Organisation (WHO) Pathways Interview Schedule, International Personality Disorder Examination (IPDE) screening module and the World Health Organization Quality of Life - brief version (WHOQOL-BREF) questionnaires. Statistical analysis included descriptive statistics and correlation tests. Results: The study comprised 47 male patients diagnosed with Dhat syndrome, predominantly young adults (mean age 24.91±5.11 years), unmarried 31 (65.96%) and from rural 29 (61.7%) and low-income backgrounds 26 (55.3%). The mean duration of untreated illness was 3.95 years, with patients consulting 1.6 (mean) providers before reaching psychiatric care, reflecting significant delays and fragmented pathways. Cluster C personality traits were predominant in 87.2% of participants, indicating heightened anxiety, dependency, and obsessive-compulsive tendencies. The WHOQOL-BREF scores revealed that physical (46.57±18.76) and psychological health (45.26±17.22) were most affected, followed by the environmental domain (54.20±13.62) and social relations (53.17±18.28). Delays in psychiatric care were associated with poorer physical (r=-0.581, p<0.001) and psychological health (r=-0.589, p<0.001). The findings underscore the need for early psychiatric intervention, targeted psychoeducation, and culturally sensitive care to mitigate prolonged delays and associated socioeconomic and psychological burdens. Conclusion: The present study revealed prolonged careseeking pathways, with a mean duration of untreated illness of 3.95±2.21 years. Poor QoL was significantly associated with longer illness duration. The findings underscore the urgent need for culturally sensitive psychoeducation, targeted interventions for at-risk personality profiles, and integrated mental health services to address the socio-cultural and economic barriers in managing Dhat syndrome effectively.