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Dhat syndrome
Dhat syndrome is a folk diagnostic term used mainly in India and surrounding areas to refer to severe anxiety that is associated with the discharge of semen, the whitish discoloration of the urine, and feeling of weakness and/or exhaustion. Dhat syndrome has been variously described as a culture–bound sex neurosis, a culture–bound anxiety state, a hypochondriacal neurosis, and a symptom of depression. However it is often cited as an example of a classic culture–bound syndrome. It is included in the major classificatory systems such as ICD-10 (World Health organization, 1992) and DSM-IV (American Psychiatric Association, 1994).

Culture-Bound Syndromes
Culture-bound syndrome is a term that was coined by a Chinese psychosis, Yap, in 1951. Culture-bound syndrome has gone through many definitions over the years however it is basically defined as “a collection of signs and symptoms(excluding notion of cause) which are restricted to a limited number of cultures primarily by reason of certain psychosocial features.”

Not everyone agrees about culture-bound syndromes. Some say that being culture-bound syndromes are not always bound to that culture, but is heavily related to to certain cultural traits and cultural factors in a geographical area. Another way to see culture-bound syndromes is a way for locals to explain their illnesses using labels from their beliefs.

Symptoms
Dhat syndrome has a wide range of complex symptoms. There has been 62 symptoms that is associated with Dhat syndrome. These symptoms are listed in the Dhat Syndrome Symptom Checklist (DSSC). The main symptom is preoccupation with semen loss. Here is a short list of other symptoms that are associated with Dhat syndrome: fatigue, weakness, anxiety, sleep issues, exhaustion, headache, preoccupation, loss of appetite, somatic symptoms, guilt, and sexual dysfunction that include premature ejaculation. Usually the symptoms are contributed to masturbation or overindulgence in sexual intercourse. Patients with dhat syndrome report that they are losing semen through the urine and complain of a whitish discharge, despite the lack of clinical evidence. Typically this syndrome affects males of low socioeconomic class who has been marries or is recently married. Dhat syndrome is a well documented syndrome that is largely, but not exclusively, from the Indian subcontinent.

It is currently unclear whether or not the affects of Dhat symptom comes before or after the person starts believing that their sexual activities can become harmful to their health. Studies have shown, however, that the symptoms usually start occurring after family and friends warns the offender of the potential harm semen loss can be to their health.

Who is Affected
Dhat syndrome usually affects married or recently married India men between the ages of 20-38 years. They are usually of low class in with little education. However, Dhat syndrome have also been documented in women. It is also found in Chinese and Western cultures

History
The term Dhat is derived from the Sanskrit word dhatu meaning ‘metal’, and also ‘elixir’ or ‘constituent part of the body’. Dhat syndrome, a term first introduced by N. Wig in 1960, is most common among young India men. Written accounts date as far back between 5000 BC.

Causes
The causes are attributed to excessive masturbation, nocturnal emissions, or premarital or extramarital sexual activity. This illness affects those of Hindu religion the most. In the Hindu religion it is believed that semen is vital to the physical and spiritual health. It is believed that 40 meals are needed to create one drop of blood, 40 drops of blood are needed to create one drop of marrow, and 40 drops of marrow will in turn create one drop of semen. With this belief, it is seen that the loss of semen is harmful to one's health. This belief of food needed to be converted to semen can cause anxiety and can develop into a sense of doom if any semen is loss.

The fear of losing semen is strengthen by the advertisements on sexual problems in newspapers and magazines. When a young man walks down the street he is bombarded with advertisement by a variety of quacks that would further enhance sexual fears and guilt about semen loss.

Studies
A study of 144 cases of Dhat syndrome showed that 66 were married, 9 were illiterate, and 93 complained of Dhat as their major symptom. 99 of the 144 patients showed depression as the most common symptom. All patients were between 20 to 38 years of age. 20.8% showed anxiety, 6.3% had depression with psychotic features, and 2.1% had phobias. According to 45.1% of the patients, masturbation was the cause. The patients were divided into four groups for treatments: antianxiey drugs, antidepressant drug, placebo, or counseling. After four weeks, those who recieved the antianxiety or antidepressant drugs showed the most immprovment over those who were placed on the placebo or in counseling. 40.6% of the patients dropped out of the counseling group before the end of the four weeks.

Another study involved 30 patients between the ages of 20 and 40. 64.2% were unmarried, 70% were educated only until the 5th class or higher, and 66% of the patients met the criteria for depression. They were started on fluoxetine, a selective serotonin reuptake inhibitor, and all showed improvement.

Treatments
Many treatments are suggested, but those with antianxiety or antidepressant drugs coupled with education and counseling seem to be the best treatment.