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Abstract
A case report is presented of a koro-like syndrome in a 34-year-old Bedouin man living in the Negev desert in Israel. The patient's disturbance is accompanied by voyeurism and the onset appears to be related to his sexual practices. This is the first reported case among Bedouins, who are an Arab nomadic tribe living in Asia and Africa.
Koro syndrome has been considered a culturally specific disorder for hundreds of years throughout Asia, specifically in East Asia and China, where it could appear in epidemic form [ 1-3]. It was first documented in the West in 1895 [4]. It affects mainly men and is characterized by the feeling of the patient that his penis is slowly shrinking to the point where it will recede back into his abdomen and disappear completely. The syndrome is accompanied by a terrible and encompassing fear on behalf of the patient that when his penis disappears completely he will die. Some patients try to stop the phenomenon by pulling on their penis and holding it by masturbation [5]. The literature reports a few dozen cases of koro syndrome including among non-Chinese [6-10].
Cases among non-Asians or those in which certain symptoms are missing have been termed koro-like syndrome or atypical koro. Among these patients comorbidity of koro with other psychiatric disorders such as schizophrenia or panic disorder, depression, body image disorder and depersonalization has been reported [10-16]. Other such patients suffer from HIV or major organic brain disorder such as strokes or epilepsy [7, 8, 10, 17-19]. Drug-induced koro has also been described [20-23].
Koro syndrome has only recently entered formal nosology. ICD-10 includes it under other neurotic disorders. This category includes disorders prevalent among some cultures whose etiology and classification are unknown. According to ICD-10 koro is not considered to be a delusional impairment since it is strongly connected to cultural beliefs [24]. Suggestions were made to include koro as a disorder in DSM-IV [4, 25]. Instead it has been included in Appendix I which includes descriptions of culture-related syndromes with a provision to diagnose it in accordance with the second edition of the Chinese classification of emotional disorders [26].
The following is the first documented case of koro-like syndrome in a Bedouin. Bedouins are an Arab...