The Incredible Case of the Shrinking Penis: A Koro-Like Syndrome in an Person with Intellectually Disability

Abstract

The rare syndrome of Koro is presented in a case of an individual with intellectual disability (ID) and fixated pedophilia. No prior cases of Koro-like symptoms have been reported in an ID population. The Koro-like symptom of a disappearing penis developed when a male with fixated Pedophilia tried to explore and limit his deviant arousal. He reported that a baby, inside his head, forced his compliance to engage in infant/child-like activities with the threat that it would shrink his penis if he did not comply. This experience was finally managed by focusing on him engaging in his “new me” behavior of being an assertive leader which contributed to a rapid restabilization. The dynamics of the Koro-like symptom could be understood as a tactic used by an internalized imaginary companion, which embodied the entrenched deviant arousal, to resisted modification.