ABSTRACT
Koro syndrome is a multi-tiered disease presenting as an overwhelming belief that one's sex organs are shrinking into their body. Moderate to severe anxiety attacks are associated with the condition, along with a fear of imminent death. Koro is often culturally related and is most seen as an epidemic form in East and Southeast Asia, although it can present anywhere worldwide in its sporadic form. The condition typically affects young males who believe in sex-related myths, and many individuals can co-present with anxiety, depression, or even psychosis. Although most presentations of Koro are self-limiting, the condition is harmful for one's self-esteem and quality of life, and some individuals may go through extreme, physically injurious measures to prevent genital retraction. Treatments include the use of psychotherapy that has a sex education component, especially if the patient believes in culturally rooted myths. In sporadic Koro, it is believed that if the primary psychiatric disorder is treated with anxiolytics, antidepressants, sedatives, or psychotics, the secondary Koro-like symptoms will also fade. Additional investigation on the prevalence, pathogenesis, factors that correlate with treatment efficacy are needed to fully understand Koro syndrome.
ABSTRACT
RESUMO A síndrome de koro é uma síndrome psiquiátrica ligada à cultura, que se caracteriza por um episódio de ansiedade súbito e intenso relacionado com a crença de que o pênis (nas mulheres, mamilos e grandes lábios) estar a retrair-se para o interior do organismo, podendo conduzir à impotência, esterilidade e, eventualmente, morte. É mais frequente nos países do Sudoeste Asiático e no sexo masculino. No Ocidente é rara, embora existam descrições de koro-like secundárias a perturbações neurológicas, psiquiátricas ou orgânicas. No Diagnostic and Statistical Manual of Mental Disorders-5 é classificada como um "Transtorno Obsessivo-Compulsivo e transtornos relacionados com outra especificação". Este artigo descreve um caso raro de um doente com síndrome de koro secundária a um transtorno obsessivo-compulsivo. Neste artigo, apresenta-se a descrição de um caso clínico e revisão bibliográfica, com base na pesquisa de artigos publicados, desde 2000, no PubMed, com as palavras-chave: "koro syndrome", "obsessive-compulsive disorder" e "koro-like symptoms". Analisaram-se alguns artigos anteriores ao ano 2000 para contextualização histórica. Doente com síndrome de koro secundária a transtorno obsessivo-compulsivo, com boa resposta à terapia farmacológica associada à terapia cognitivo-comportamental. O conhecimento desse diagnóstico e da sua gestão clínica é importante para identificar as condições subjacentes e otimizar o tratamento.
ABSTRACT Koro's syndrome is a psychiatric culture-bound syndrome characterized by an episode of sudden and intense anxiety related to the belief that the penis (in women, nipples and labia majora) is retracting into the body, leading to erectile dysfunction, sterility and, eventually, death. It is more common in Southeast Asia and in males. In the West it is rare, although there are descriptions of koro-like secondary to neurological, psychiatric or organic disorders. In the Diagnostic and Statistical Manual of Mental Disorders-5 it is classified as an "Obsessive-Compulsive Disorder and disorders related to another specification". This article describes a rare case of a patient with koro's syndrome secondary to obsessive-compulsive disorder. In this article we present the description of a case report and review of the literature by searching articles published in PubMed since 2000, with the keywords: "koro syndrome", "obsessive-compulsive disorder" and "koro-like symptoms". Articles prior to 2000 were also analyzed for historical considerations. A patient with koro's syndrome secondary to obsessive-compulsive disorder with good response to pharmaceutical and cognitive behavioral therapy combination. Being aware of this diagnosis and its clinical management is essential to identify the underlying conditions and optimize treatment.
ABSTRACT
Koro syndrome is a psychiatric disorder specific to certain Asian cultures. It is characterized by acute and intense anxiety with fear of a retraction of the penis into the body and resultant death. We report the case of a 43-year-old Moroccan male presenting with persistent anxiety associated with avoidance behaviors and a chronic belief that his genitalia may shrink or disappear and lead to his death. This impacted his professional and family functioning. The diagnosis of culture-bound syndrome was considered although the presenting syndrome was chronic and sporadic. The Moroccan culture, which attributes a great importance to the male sex, would explain this syndrome.
Le syndrome de Koro est un trouble psychiatrique spécifique à certaines cultures asiatiques. Il est caractérisé par la survenue brutale d'une anxiété intense associée à la peur d'une rétraction du pénis dans le corps qui peut mener à la mort. Nous rapportons le cas d'un patient marocain âgé de 43 ans, qui présente une anxiété persistante avec des conduites d'évitement associées à une chronique croyance que ses organes génitaux pourraient se rétrécir ou disparaître et conduire à sa mort, ce qui a impacté son fonctionnement professionnel et familial. Le diagnostic d'un trouble lié aux concepts culturels semble le plus probable, en se référant à la culture marocaine qui attribue une grande importance au sexe masculin, même s'il s'agit d'un cas chronique et sporadique.