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EV1002

When purity becomes dangerous: a case of extreme genital self-injury in dhat syndrome

WHEN PURITY BECOMES PERIL: A CASE REPORT OF EXTREME GENITAL SELF-HARM IN DHAT SYNDROME

A culturally shaped belief in semen loss, combined with unsuccessful reassurance and concealment, can lead to life-threatening genital self-injury.

The aim was to report a case of dhat syndrome complicated by life-threatening genital self-injury. The patient was a young adult man admitted for cannabis use disorder; during psychiatric assessment, he reported intense distress associated with a persistent perception of penile discharge and the belief that it had permanently contaminated him. His history included longstanding anxiety and rumination about semen loss, repeated consultations with traditional healers, and continued use of local remedies without benefit. Approximately one week before admission, he had tightly tied metal wires around both testicles to stop the perceived discharge, concealing his actions for seven days until the pain became unbearable. On presentation, scrotal edema and developing gangrene were identified; emergency wire removal and management of ischemia were undertaken alongside treatment for cannabis use and initiation of psychotropic medication. Poor insight and overvalued somatic beliefs were prominent in the case formulation; DSM-5 lists dhat syndrome among cultural concepts of distress, while ICD-10 classifies it under other specified neurotic disorders (F48.8). The authors highlight an escalation pathway in which a culturally shaped illness belief, unsuccessful reassurance, and increasing distress culminate in a dangerous corrective action, noting that concealment directly led to the ischemic complication by delaying presentation. Clinical recommendations include asking directly about self-directed genital acts, treating the failure of reassurance as a risk indicator, and screening for co-occurring substance use.

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