Dhat syndrome as a functional somatic syndrome: developing a sociosomatic model.

Dhat syndrome is a widely recognized condition from the Indian subcontinent with fatigue and preoccupation with semen loss as the main presenting symptoms. This condition has been considered to be a culture-bound syndrome, but little is known about its illness characteristics and similarities with other conditions with medically unexplained symptoms. In this paper we review the current research on dhat syndrome, discuss its similarities and differences with other functional somatic syndromes, and propose an integrated model that incorporates both psychological and sociocultural factors. Under stress, persons predisposed to amplification of somatic symptoms and health anxiety may focus attention on physiological changes such as turbidity of urine and tiredness, and misattribute them to loss of semen in the light of widely prevalent health beliefs. This attribution may then be confirmed by traditional views as well as by local practitioners subscribing to similar beliefs. The clinical and research implications of understanding this condition as a functional somatic syndrome, the presentation of which is significantly modified by culture, are discussed.