A Community-based Study on Epidemiology, Comorbidities, and Clinical Correlates of <i>Dhat</i> Syndrome in India

Background: Dhat syndrome (DS) is a well-known culture-bound syndrome and is widely prevalent in rural areas and lower socioeconomic strata. Though mentioned widely in the mythology and modern medicine, DS has remained a controversial area in psychiatry with relation to its diagnostic validity and nosological status. With this background, this community-based study aimed to explore the epidemiological and clinical correlates as well as the comorbidities associated with this disorder. Materials and Methods: A total of 907 males between 18 and 60 years participated in the study through community-based sampling. Socio-demographics, socioeconomics, and physical parameters were recorded. “Tool to diagnose Dhat Syndrome (DS)” was prepared using the diagnostic criteria of DSM-IV and ICD-10. Those diagnosed with DS were further interviewed in detail for symptoms. All the study subjects with and without DS were studied for psychiatric disorders (MINI Plus) and any disorders related to sexuality, including the International Index of Erectile Function (IIEF) and the Premature Ejaculation Diagnostic Tool (PEDT). Sexual disorder assessment was done only for sexually active males above 18 years. The Statistical Package for the Social Sciences, version 16.0, was used for statistical analysis. Results: This is the first study globally to report the epidemiology of DS in the general population. Our study reports the prevalence of DS in the general population to be 12.5%. DS was more common in the 18–30 age group, particularly among individuals with low education, lower socioeconomic status, and job profiles in agriculture and daily wage work. The prevalence of psychiatric and sexual disorders is about threefold higher in those with DS compared to non-DS subjects. Twenty-five percent and 43% of patients with DS had comorbid depressive disorders and sexual dysfunction, respectively. Most of them attributed the loss of semen to the reason for DS. Backache, weakness, and easy fatiguability were the commonly reported physical symptoms, whereas loss of interest, decreased self-esteem, and guilt were the psychological complaints. The majority perceived thinness of semen, decreased sexual capabilities, and size of testes, as well as tilting of genitals, as a part of the DS. Conclusion: DS, irrespective of its controversial position in the classificatory systems, is a highly prevalent and distressing disorder with multiple comorbidities. Population-based studies such as this help to understand the attributions, risks, and clinical characteristics of patients with this intriguing disorder that can provide useful insights for management.