Debilitating Itching: An Unusual Presentation of Dhat Syndrome Following Recovery from Dermatitis Artefacta

Abstract

Introduction: Dhat syndrome is a culture bound sex neurosis more common in the orient. The condition is primarily characterized by overriding concerns about loss of semen resulting in a variety of physical and psychological problems. Though a variety of modes of discharge of Dhat is described, its discharge through skin lesions, following recovery from dermatologic conditions is not reported so far. Case Presentation: A young, single adult male, hailing from a rural area (Tamil Nadu, a state in South India) was treated adequately for dermatitis artefacta and showed good recovery. He referred to the psychiatry outpatient department with complaints of lassitude and inability to work or concentrate all of which he attributed to the passage of a fluid comprising of semen and pus through the healed skin lesions. His friends reinforced his belief about the nature and origin of his symptoms. There was significant distress and dysfunction in the absence of underlying depression and anxiety. He was effectively managed with a combination of psychoeducation and low dose anxiolytics. Conclusions: Dhat syndrome may present variably with regard to its mode of passage and constituents. Clinicians need to watch for development of Dhat syndrome following recovery from dermatologic conditions. Offering explanations synchronous with patient beliefs about symptoms may result in faster response and greater treatment satisfaction.