[Koro syndrome : when culture interacts with psychopathology]. / Le syndrome de Koro : quand la culture interagit avec la psychopathologie.

Koro syndrome is a psychiatric disorder specific to certain Asian cultures. It is characterized by acute and intense anxiety with fear of a retraction of the penis into the body and resultant death. We report the case of a 43-year-old Moroccan male presenting with persistent anxiety associated with avoidance behaviors and a chronic belief that his genitalia may shrink or disappear and lead to his death. This impacted his professional and family functioning. The diagnosis of culture-bound syndrome was considered although the presenting syndrome was chronic and sporadic. The Moroccan culture, which attributes a great importance to the male sex, would explain this syndrome.

Le syndrome de Koro est un trouble psychiatrique spécifique à certaines cultures asiatiques. Il est caractérisé par la survenue brutale d'une anxiété intense associée à la peur d'une rétraction du pénis dans le corps qui peut mener à la mort. Nous rapportons le cas d'un patient marocain âgé de 43 ans, qui présente une anxiété persistante avec des conduites d'évitement associées à une chronique croyance que ses organes génitaux pourraient se rétrécir ou disparaître et conduire à sa mort, ce qui a impacté son fonctionnement professionnel et familial. Le diagnostic d'un trouble lié aux concepts culturels semble le plus probable, en se référant à la culture marocaine qui attribue une grande importance au sexe masculin, même s'il s'agit d'un cas chronique et sporadique.

[Chronic Koro-like Syndrome (KLS) in recurrent depressive disorder as a variant of Cotard's delusion in an italian male patient. A case report and historical review]. / Un caso di Koro-Like Syndrome (KLS) cronica, come variante di un delirio di Cotard, in un paziente italiano affetto da depressione monopolare cronica. Presentazione del caso clinico con revisione storica della letteratura.

Cotard's syndrome is a delusional syndrome, first described in the 1880ies by Cotard, characterized by a nihilistic delusions about the self and/or the world. In same other cases there is an intense nihilistic belief that the patient's entire body or parts of it are disintegrated or dead. The syndrome is often associated with severe depression, but are also described neurological cases. Koro was described a little later from Asia and consisted in the belief that one's own genitalia are shrinking or disappearing and death will ensue thereafter, but there are many cultural variants and the syndrome may present in an incomplete form. We report on a KLS sharing more features with annihilation delusions, such as Cotard's syndrome. In KLS, the délire de négation may be limited to localized systems or organs. We believe that some complete and incomplete forms of Koro, when embedded in a depressive core, may represent a variant of Cotard's delusion. In fact, our patient did not reach a complete denial of his entire body, but rather focused on sexual identity. We analysed the psychosexual issues of our case according to Kretschmer's 1918 view of a "bipolar setting" between sthenic and asthenic characters of a patient suffering from sensitive delusions of (self-) reference. This view may allow us to relate the personological character to the genetic comprehensibility of the delusion.

[Koro-like symptoms in a recurrent depressive disorder]. / Koro-ähnliche Symptome bei rezidivierender depressiver Störung.

We report the case of a German male with a major depressive episode who also suffered from the terrifying perception that his penis was shrinking. These so-called koro-like symptoms (KLS) had also been present in earlier depressive episodes and subsided in the symptom-free interval of the recurrent depressive disorder. Under sufficient antidepressant medication with venlafaxine and lithium not only KLS but also the depressive symptoms remitted. The course of illness provides further evidence that KLS are not a distinct clinical entity in Western countries, but represent a concomitant syndrome that requires treatment of the underlying illness.

A critical review of Chinese Koro.

Koro is generally considered a culture-bound psychiatric syndrome, the dominant feature of which is anxiety or dissociation. A close examination of koro epidemics in China, where koro cases appear to be more frequent than other parts of the world, shows that koro has a sociocultural component which has not been sufficiently taken into account in previous formulations. This article analyzes koro in the natural environment in which it appears and dispels the notion of koro being individual psychopathology. Koro, at least the way it is manifested in China, is a social malady maintained by cultural beliefs which affect the whole community and not just those diagnosed with it. Further directions for research into the subject are discussed.

Transculturation, psychosis and koro symptoms.

Koro is a clinical syndrome characterized by the conviction of penile retraction and fear of inevitable death upon its disappearance into the abdomen. The syndrome is generally considered culture bound, yet an increasing number of sporadic cases were attributed to psychiatric, systemic or neurologic pathology. In the following article, sporadic koro cases associated with paranoid psychosis or schizophrenia have been assembled, indicating that immigration is an important factor in the pathogenesis of the clinical phenomenon. The interplay between psychosis, transculturation and cultural influence affecting koro development is discussed.