Cultural Expressions of Koro Syndrome: A Case Series From North India

Koro syndrome is a culture-bound psychiatric condition that is characterized by panic that one's genitals are pulling inward and that they are likely to die or develop sexual dysfunction. Southeast Asia has historically documented the epidemic and acute forms of Koro syndrome, while day-to-day practitioners continue to observe sporadic forms. We report three clinical cases of young adult men (22-27 years old) from North India who presented with distressing, overvalued ideas of penile retraction associated with moderate to severe anxiety (Hamilton Anxiety Rating Scale scores: 20-27). Each presented with a characteristic cultural or psychosocial precipitant: exposure to cold in a factory laborer, masturbatory guilt and work-related stress in a software engineer, and a traditional remedy (use of cow dung) in a construction laborer. All the patients exhibited impaired socio-occupational performance, with normal physical examinations and investigations. Treatment consisted of selective serotonin reuptake inhibitors, short-term anxiolytics, psychoeducation, and supportive psychotherapy. On short-term follow-up (from two weeks to one month), the three patients exhibited partial to significant improvement of anxiety and functional recovery with improved insight into the psychological etiology of the symptom. This case series illustrates that Koro syndrome continues to be a clinical entity within contemporary Indian psychiatry, occurring beyond epidemic contexts and influenced by diverse cultural triggers. There should be recognition of such presentations and the use of culturally appropriate methods that include a combination of drug therapy, psychoeducation, and psychotherapy.