Sir,
Dhat syndrome (DS) is prevalent in 12.5S% of the population from low socio-economic and educational backgrounds in the Indian subcontinent, with varied symptom duration and characterized by emotional, physical, and sexual symptoms attributed to non-pathological penile discharge (PD) in males and vaginal discharge (VD) in females.[1–3] There are many unusual presentations of DS,[4,5] but no literature regarding seasonality and sharedness.
Here we describe Six cases from a rural area of West Bengal with a low socio-economic and educational background who were diagnosed with DS by two psychiatrists using the ICD-10 (F48.8). Their demographic details and phenomenology have been described in Table 1. All reported episodic, non-foul-smelling, watery, and scanty PD (Cases B and E) or VD (Cases A, C, D, and F), and none reported dysuria, pelvic pain, fever, itching, or pain in the genitalia, or in their spouses. None of them took regular OCP for any reason. Case F sometimes used barrier contraceptives without reporting any reactions. Cases A and D never experienced sexual intercourse, and the others were faithful to their spouses. None of them had any known medical, surgical, or psychiatric co-morbidities. Premorbidly, Cases A and F were anxious by nature, Case C was dominant and decisive, Case D was anxious-avoidant-introvert, and the rest were well adjusted. On mental status examination, all were anxious or apprehensive about their PD or VD and attributed it to their physical complaints. All patients were worked up in liaison with gynecologists and venereologists by local examination, routine and microscopic examination of urine, stool, cervicovaginal swab (Case C and F; not done in Case A and D complying with Indian laws), PD (Case B and E), VDRL, ICTC, and no pathology yielded. They initially visited quacks and local practitioners; later, they visited our hospital. Written, informed consent was obtained from patients regarding this publication.
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Table 1: Demography and Phenomenology of the cases
From history, examination, and diagnostic work-up, we found all of our patients to have non-pathological discharge; their sexual symptoms are also associated with cognitive (all were preoccupied with their symptoms, in addition, poor concentration, poor memory, and worthlessness in Cases A, D, and E), affective (anxious affect in all), behavioral (poor sleep in cases A and F, loss of interest and low appetite in case B & D low libido in cases C and E) and somatic symptoms (vague bodily pain and headache in case A & D tiredness, fatigue, lethargy, and weakness in cases B, C, E, and F) argue for their stand as DS.[2,3]
There is a lack of consensus for assessing seasonality in non-communicable diseases. However, the episodic occurrence of our cases near particular seasons every year [Table 1] points towards seasonality.[6] Studies show the influence of weather and temperature on psychological well-being[7] as well as evidence of seasonality in other non-communicable diseases, particularly in mood disorders, neurotic disorders, and schizophrenia.[8] supporting our argument for the possibility of seasonality in our cases. Also, in a qualitative study, patients reported that the season was the main maintaining factor for DS.[9]
Pathological sharedness is common in psychosis, involving common sexual themes and a few associated beliefs.[10] Our patient’s Case C and D presented with similar symptoms, and they held similar beliefs explaining their symptoms. [Table 1]: Though the aetio pathomechanisms underlying sharedness are unknown, in cases C and D, their age, gender, presence of stressful life events, presence of vulnerable personality traits (anxious-avoidant-introverted in case D), and the length and nature of their relationship [Table 1] might have contributed.[11] In addition, sharedness was also reported in neurosis,[12] reinforcing our belief that sharedness can be found in conditions other than psychosis, as in our case. Although more observations, psychodynamic exploration, and analytical studies are required for assessing the association of seasonality and sharedness in DS.
From our observation, we can suggest that every patient with DS should be enquired about seasonality and sharedness.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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