Le syndrome de Koro

Abstract

Objective. – To investigate a rare psychiatric disorder called “Koro” which is usually described as a culture-specific syndrome in Asian cultures. This syndrome is manifested by intense anxiety associated with the fear of genital retraction and the belief that complete disappearance of the penis into the abdomen will result in death. Even though some cases have been reported in non-Asian subjects, it is often referred to as a culture-bound syndrome. Method. – A literature and case report review indexed 117 articles or summaries relating to the syndrome of Koro. In addition, the authors report six cases of Koro in Quebec from their clinical practice and open a discussion on clinical, epidemiological and etiological features. Results. – Koro is a relatively rare syndrome that is related to various etiological, clinical, diagnostic and cultural aspects leading to several controversial debates, letters to editors and comments on articles. This also includes the anthropological, psychodynamic and biological point of views. Even though only 19 cases in Hong Kong were diagnosed in fifteen years, this syndrome can sometimes take epidemic proportions as in Singapore where many cases appeared following a porcine infection or in Thailand where a thousand cases were listed after the Vietnam War. In the province of Juandong, two similar phenomena were clearly documented in 1984–1985 and 1987 where a total of two thousand cases were declared. This was also observed in India, a country culturally very different with a mainly Hindu and Muslim population. The authors also describe six cases in Quebec: 1- a 31-year-old man with no history of psychosis with anxiety related to problems in erection and ejaculation that had negative effects on his married life. Shortly after he reported that his penis retracted into his belly. 2- a 32-year-old American-Indian man, with history of violence and alcohol dependence developed Koro symptoms, which caused this patient to use strings around the penis to prevent its retraction into the belly. 3- an 18-year-old male diagnosed with paranoid schizophrenia expressed his extreme concern to see his penis decrease in size and retract during one of his hospitalisations. He believed that only masturbation and sex with prostitutes were capable of preventing this from happening. 4- a 25-year-old patient diagnosed with paranoid schizophrenia since the age of 16 arrived at the emergency with suicidal ideas. Upon interview, the patient was anxious and presented olfactory hallucinations of genital origin. He expressed concerns that his genitals would disappear inside his abdomen. 5- a 25-year-old man with paranoid schizophrenia presented with auditory hallucinations of death threats and fear that his penis would be removed by magic. After one month of hospitalisation, his anguish took an obsessive form that required him to go to the bathroom regularly to examine himself. 6- a 31-year-old man diagnosed with paranoid schizophrenia since the age of 19 arrived at the emergency with suicidal ideations under the influence of command hallucinations. He requested a treatment that would prevent his genitals from disappearing into his belly. Conclusion. – A distinction seems necessary between epidemic cases of Koro that are culture-specific and isolated cases, that given the right setting and stimulus could occur in any culture and are often present in comorbidity with severe psychopathologies or cerebral lesions.