Ramadan fasting triggering koro-like symptoms during acute alcohol withdrawal: a case report from Oman.

This article describes a case of koro-like symptoms from Oman associated with alcohol withdrawal and illustrates how the socio-cultural practices of Ramadan-fasting affected the patterning and timing of presentation of severe alcohol withdrawal symptoms. The patient was severely distressed by the delusion that his penis had been amputated. The acute anxiety involving this delusion appears to be conceptually and phenomenologically similar to koro.

A conceptual history of Koro.

Koro is a culture-bound syndrome characterized by a fear that the genitals or breasts will retract into the body and cause death. Here we consider the history of ideas about Koro, from early concepts in traditional Chinese medicine (TCM) to contemporary ideas from medicine and sociology. This conceptual history reveals important issues about the classification (nosology) of Koro. In doing so, it demonstrates the need to integrate standardized phenomenological criteria with etiological models in order to capture the important features of complex behavioral disorders in the cross-cultural setting.

The definition and classification of Koro.

Attempts at defining and classifying Koro have been undertaken by various researchers over at least the last fifty years without any consensus emerging to date. The occurrence of Koro, not only in different parts of the world but also in association with varied morbidities, has of late diluted its primary identity as a culture-bound syndrome. Further, the DSM-IIIR and ICD-10 provisions to include culture-bound syndromes like Koro are open to various diagnostic options. Consideration was given to have it included in DSM-IV. One of the fundamental problems inherent in such attempts is the semantic confusion Koro generates in its basic phenomenological analysis. The present paper deals with some of these issues based on historical analysis of world Koro literature, and with comments on the future research agendum.

[Castration anxiety and oral envy in sexual relations. Analytic studies with ethnological observations]. / Kastrationsangst und oraler Neid im Geschlechterverhältnis. Analytisches Arbeiten mit einer ethnologischen Beobachtung.

Ethno-psychoanalysis is the study of the unconscious in foreign cultures. It can however also be of use in understanding unconscious elements operative in our own culture. To illustrate the point, the author describes the "Koro" epidemic which occurs periodically on the island of Hainan off the south of coast of China. This epidemic largely affects young unmarried men and the author pinpoints the unconscious conflicts underlying this collective phenomenon. It transpires that the epidemic is in effect a species of rite of passage in which a group of young males make the communal attempt to overcome castration anxieties which are themselves the product of covert gender envy. In the second section, Gerlach reports on his psychoanalytic encounter with a young man in Germany displaying similar symptoms. The profounder dimensions of this condition were only comprehensible to the author on account of his knowledge of "Koro".

Koro epidemics in Guangdong, China. A questionnaire survey.

Koro epidemics, characterized by panic due to fear of genital retraction, involving more than 2000 victims, mainly young men, occurred in Hainan Island and Leizhou Peninsula of Guangdong Province, China, in 1984-85 and 1987. A questionnaire survey of 214 victims of these epidemics was conducted in 1988. The survey focused on symptom manifestation, personality profile, life problems, and folk belief. The results of the "koro" group were compared with those of a "clinic" group with minor psychiatric disorder and a "control" group from the non-clinical, non-koro episode population in the epidemic area. The results revealed that the victims of the koro epidemics were characterized by low intellectual endowment and strong acceptance of koro-related folk beliefs. The results support the hypotheses that: a) a koro attack is a psychologically induced anxiety-panic condition; b) the presence of an intensive belief in the culturally related concept of koro makes the subject vulnerable to the attack; and c) social crisis or tension serves as a trigger for the occurrence of the epidemic.