History

A 45 yrs old male patient presented to the casuality with acute onset palpitations, chest pain, tremors and breathlessness. Complete cardiac evaluation was done and found to be normal. The patient gives history of feeling very depressed and suicidal for the past few days and has been on psychiatric treatment for the past 4 years for the same symptoms and with little improvement.

Mental status examination

Patient gives history of losing mother at the age of 4 after which was brought up by a punitive and conservative father, stayed in boys hostel for many years during his childhood where he underwent physical and sexual abuse .the patient did not have any avenue to express his distress and had developed intense fear of losing semen and getting ill because of the same. He was also addicted to porn from a very young age and was distressed because of the same as he was very guilty. He got married and though was able to have a child was very apprehensive in being physically intimate with the wife for fear of losing semen. The patient developed severe depression and guilt for the same and tried to harm himself whenever he found accidental loss of semen .he had developed extreme anxiety symptoms during the time of presentation at the casuality.

Therapy

Patient was diagnosed to have severe depression with suicidality and dhat syndrome.dhat syndrome is a culture bound syndrome where men have abnormal belief of getting some major physical illness on loosing semen which interferes with their normal sexual life and socio occupational dycfunstion.patient was treated with anti-depressants and anti-suicidal medications.patinet was given insight oriented psychotherapy for his fear of losing semen. Couples therapy was initiated to improve the interpersonal relationship with the wife. Motivational interviewing was done to decrease the porn addiction .patient slowly was able to get over his fears, got rid of his depression and was able to improve the physical intimacy with the wife. Patient is on regular follow up and is well functional both in his job and personal life.

Clinical pearl

Maternal deprivation, childhood trauma can cause abnormal fears which may lead to depression and anxiety symptoms .Dhat syndrome is a taboo to be discussed in the society because of which young men can develop depression, poor socio occupational functioning and anxiety symptoms .the anxiety symptoms can mimic an acute cardiac event and present to the casuality.