Penile dysmorphophobia-obsessive compulsive disorder with Koro-like symptoms: a report of two cases

Abstract

Background: Koro syndrome is a cultural manifestation of anxiety and distress seen in certain parts of the world. Its origin in these populations is suggested to arise from penile (related to the penis) dysmorphic thoughts on the background of performance anxiety in sexual situations.Body dysmorphia arises over persistent thoughts about a part of the body being flawed so that the individual worries excessively about it. Its presentation largely mimics obsessive-compulsive disorder (OCD). Methods: Here the authors describe two cases presenting with Koro-like symptoms seen in the southern part of India in a suburban locality which resolved with standard anti-obsessional treatment. Underlying both these cases, prominent penile dysmorphophobia was found (fixation on imagined defects of the penis length). Discussion: The presented cases were young adult males. Fear of impending life events (marriage) was the most likely factor contributing to performance anxiety related to intercourse in both cases. Symptoms typically described in Koro syndrome have an obsessive quality. The existing literature on Koro-like features in patients with OCD has led many authors to classify it as an obsessive-compulsive spectrum disorder and their ideas have been validated in standard classificatory systems. Conclusion: In cases presenting with Koro syndrome, other obsessive symptoms may be co-existent and require to be ruled out. It is also important to explore anxiety in those clients and provide them with treatment-pharmacological and nonpharmacological for anxiety related to performance and penile dysmorphia. It is important to highlight this aspect of the syndrome in future classificatory systems.