Health Psychology Research / HPR / Volume 11 / Issue 1 / DOI: 10.52965/​001c.70165
GENERAL

Koro Syndrome: Epidemiology, Psychiatric and Physical Risk   Factors, Clinical Presentation, Diagnosis, and Treatment Options  

Yukino N. Strong1* David Y. Cao1 Jessica Zhou1 Maya A. Guenther1 Danyon J. Anderson1 Alan D. Kaye2 Brian E. Blick2 Prathima R. Anandi2 Hirni Y. Patel2 Ivan Urits3
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1 School of Medicine, Medical College of Wisconsin
2 Department of Anesthesiology, Louisiana State University Health
3 SouthCoast Health, SouthCoast Health
Published: 20 February 2023
© 2023 by the Author(s). Licensee Health Psychology Research, USA. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution -Noncommercial 4.0 International License (CC BY-NC 4.0) ( https://creativecommons.org/licenses/by-nc/4.0/ )
Abstract

Koro syndrome is a multi-tiered disease presenting as an overwhelming belief that one’s sex organs are shrinking into their body. Moderate to severe anxiety attacks are associated with the condition, along with a fear of imminent death. Koro is often culturally related and is most seen as an epidemic form in East and Southeast Asia, although it can present anywhere worldwide in its sporadic form. The condition typically affects young males who believe in sex-related myths, and many individuals can co-present with anxiety, depression, or even psychosis. Although most presentations of Koro are self-limiting, the condition is harmful for one’s self-esteem and quality of life, and some individuals may go through extreme, physically injurious measures to prevent genital retraction. Treatments include the use of psychotherapy that has a sex education component, especially if the patient believes in culturally rooted myths. In sporadic Koro, it is believed that if the primary psychiatric disorder is treated with anxiolytics, antidepressants, sedatives, or psychotics, the secondary Koro-like symptoms will also fade. Additional investigation on the prevalence, pathogenesis, factors that correlate with treatment efficacy are needed to fully understand Koro syndrome.

Keywords
Koro Syndrome
organs
psychotherapy
psychiatric disease
genitals
cannabis
alcohol-induced hepatitis
References

1. Durst R, Rosca-Rebaudengo P. The disorder named koro. Behav Neurol. 1991;4(1):1-13. doi:10.3233/BEN-1991-4101

2. Stip E, Nguyen J, Bertulies-Esposito B, et al. Classical Koro and Koro-like symptoms: Illustration from Canada. J Psychosex Health. 2021;3(3):222-235. doi:10.1177/26318318211028845

3. Chowdhury AN, Brahma A. Update on Koro research methodology. Indian J Psychiatry.2020;62(1):102-104. doi:10.4103/psychiatry.indianjpsychiatry_183_19

4. Cheng ST. Epidemic genital retraction syndrome: environmental and personal risk factors in southern China. J Psychol Human Sex. 1997;9(1):57-70. doi:10.1300/j056v09n01_04

5. Ntouros E, Ntoumanis A, Bozikas VP, Donias S, Giouzepas I, Garyfalos G. Koro-like symptoms in two Greek men. BMJ Case Rep.2010;2010:bcr0820080679. doi:10.1136/bcr.08.2008.0679

6. Chowdhury AN. The definition and classification of Koro. Cult Med Psychiatry.1996;20(1):41-65. doi:10.1007/bf00118750

7. Chowdhury AN, Chawla M. Koro in female: A case report and a Mini Review. The European Journal of Psychiatry.2019;33(4):182-185. doi:10.1016/j.ejpsy.2019.06.004

8. Dzokoto VA, Adams G. Understanding genital-shrinking epidemics in West Africa: koro, juju, or mass psychogenic illness? Cult Med Psychiatry.2005;29(1):53-78. doi:10.1007/s11013-005-4623-8

9. Tseng WS. From peculiar psychiatric disorders through culture-bound syndromes to culture-related specific syndromes. Transcult Psychiatry.2006;43(4):554-576. doi:10.1177/1363461506070781

10. Ghosh S, Chowdhury AN. A case of two culture-bound syndromes (Koro and Dhat syndrome) coexisting with obsessive-compulsive disorder. Indian J Psychiatry.2020;62(2):221-222. doi:10.4103/psychiatry.indianjpsychiatry 298_19

11. Atalay H. Two cases of koro syndrome or anxiety disorder associated with genital retraction fear. Turk Psikiyatri Derg.2007;18(3):282-285.

12. Silva L, Morgado P. Koro syndrome associated with obsessive-compulsive disorder: clinical case and brief review. J Bras Psiquiatr.2018;67(2):135-139. doi:10.1590/0047-2085000000196

13. Bandinelli PL, Trevisi M, Kotzalidis GD, Manfredi G, Rapinesi C, Ducci G. 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. Riv Psichiatr.2011;46(3):220-226. doi:10.1708/889.9813

14. Faccini L, Tucker J. The return of Koro and the companions in a person with intellectual disability: follow up assessment and dynamics. Sex Disabil.2009;27(4):239-248. doi:10.1007/s11195-009-9124-1

15. Ramirez-Bermudez J, Aguilar-Venegas LC, Crail-Melendez D, Espinola-Nadurille M, Nente F, Mendez MF. Cotard syndrome in neurological and psychiatric patients. J Neuropsychiatry Clin Neurosci.2010;22(4):409-416. doi:10.1176/jnp.2010.22.4.409

16. Stip E, Bergeron T, Lavigueur C, Fabian JL, Bentaleb LA. Koro syndrome. Ann Med Psychol (Paris).2007;165(3):147-153. doi:10.1016/j.amp.2005.04.015

17. Devan GS, Hong OS. Koro and schizophrenia in Singapore. Br J Psychiatry.1987;150(1):106-107. doi:10.1192/bjp.150.1.106

18. Silva L, Raposo-Lima C, Soares C, Cerqueira JJ, Morgado P. Koro Syndrome in an Obsessive-Compulsive Disorder Patient. Eur Psychiatr.2016;33(S1):S496-S496. doi:10.1016/j.eurpsy.2016.01.1825

19. Tau M, Masurkar AV. Koro delusion in mild cognitive impairment due to Alzheimer’s disease. J Neuropsychiatry Clin Neurosci.2020;32(2):204-206. doi:10.1176/appi.neuropsych.19050108

20. Anderson DN. Koro: the genital retraction symptom after stroke. Br J Psychiatry.1990;157(1):142-144. doi:10.1192/bjp.157.1.142

21. Kim J, Kim M, Lee N, Park Y. A case of urethrocutaneous fistula with the koro syndrome. J Urol.2000;164(1):123. doi:10.1016/s0022-5347(05)67465-4

22. Durst R, Rosca-Rebaudengo P. Koro secondary to a tumour of the corpus callosum. Br J Psychiatry.1988;153(2):251-254. doi:10.1192/bjp.153.2.251

23. Cohen S, Tennenbaum SY, Teitelbaum A, Durst R. The koro (genital retraction) syndrome and its association with infertility: a case report. J Urol.1995;153(2):427-428. doi:10.1097/00005392-199502000-00044

24. Wilson S, Agin C. Genital pain associated with genital retraction: a case of Koro syndrome. J Pain Symptom Manage.1997;13(3):176-178. doi:10.1016/s0885-3924(96)00298-9

25. Kalaitzi CK, Kalantzis A. Cannabis-induced koro-like syndrome. A case report and mini review. Urol Int.2006;76(3):278-280. doi:10.1159/000091634

26. Holden TJ. Koro syndrome associated with alcohol-induced systemic disease in a Zulu. Br J Psychiatry.1987;151(5):695-697. doi:10.1192/bjp.151.5.695

27. Kar N. Chronic koro-like symptoms-two case reports. BMC Psychiatry.2005;5(34). doi:10.1186/1471-244x-5-34

28. Yap PM. Koro-a culture-bound depersonalization syndrome. Br J Psychiatry.1965;111(470):43-50. doi:10.1192/bjp.111.470.43

29. Westermeyer J. A case of koro in a refugee family: association with depression and folie à deux. J Clin Psychiatry.1989;50(5):181-183.

30. Agarwal SM, Divakara PG, Pramanik KB. Koro in an industrial setting. Indian J Psychiatry.1994;36(1):36-38.

31. Wylie KR, Eardley I. Penile size and the “small penis syndrome.” BJUInt.2007;99(6):1449-1455. doi:10.1111/j.1464-410x.2007.06806.x

32. Mather C. Accusations of genital theft: a case from northern Ghana. Cult Med Psychiatry.2005;29(1):33-52. doi:10.1007/s11013-005-4622-9

33. Turnier L, Chouinard G. Effet anti-koro d’un antidépresseur tricyclique [The anti-koro effect of a tricyclic antidepressant]. Can J Psychiatry.1990;35(4):331-333. doi:10.1177/070674379003500410

Conflict of interest
The authors declare they have no competing interests.
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