Is 'Pure' Dhat Syndrome a Stable Diagnostic Entity? A Naturalistic Long Term Follow Up Study from a Tertiary Care Centre.

Abstract

Very little is known about the long term diagnostic stability of Dhat (semen loss) syndrome owing to a dearth of follow up studies on this condition. The aim of the study was to assess the diagnostic stability and naturalistic long term outcomes in a group of pure Dhat syndrome cases. The study was carried out in the outpatient psychiatry department of a tertiary care hospital in South India, using a retrospective cohort design. Forty one cases of 'pure' Dhat syndrome (with no other concurrent diagnosis) were selected by a chart review of patients attending the outpatient Psychiatry department. Out of this initial cohort, follow up interviews were held for 36 patients. Direct clinical interviews were held with all participants to assess change in diagnosis. Those who no longer qualified for Dhat syndrome were interviewed with the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) to generate other diagnoses. For analysis, the patients were divided into two groups - those who positively endorsed symptoms of Dhat syndrome at follow up (DSP group) and those who no longer did (DSN group). These groups were compared using chi-square test for categorical variables and student t-test for continuous variables to look for significant differences. Frequencies and percentages were used to depict socio-demographic data and the follow up diagnoses. Data was analysed using SPSS for Windows, Version 16.0 (Chicago, SPSS Inc.). The mean duration of follow up was 6±3.5 years. Nearly two-thirds of the sample no longer fulfilled criteria for Dhat syndrome in follow up. The most common revisional diagnosis in these patients was somatoform disorders. Age, marital status and literacy distinguished the two groups. About a quarter of the sample (26.07%) was in complete remission. Even the purest variety of Dhat syndrome is not a stable diagnosis in the majority of patients. The condition may be better conceptualized as a subtype of somatoform disorder with culturally determined explanation for somatic symptoms. Clinicians should look at explanations of semen loss as fluid cultural idioms of distress rather than as a standalone diagnostic entity.