A Koro-Like Presentation of Somatic Delusional Disorder in a Young Male With Obsessive-Compulsive Disorder: A Case Report From the United Arab Emirates

TL;DR

A young man with obsessive-compulsive disorder and somatic delusional disorder exhibited a koro-like syndrome, believing his testicles were shrinking despite medical reassurance.

Contribution

This case presents a rare koro-like syndrome manifestation in a non-endemic region linked to OCD and somatic delusions.

Findings

The patient's symptoms persisted despite normal medical evaluations and reassurance.

The case illustrates the challenges of diagnosing and treating koro-like syndromes in non-cultural contexts.

It emphasizes the need to address underlying psychiatric conditions in such presentations.

Abstract

Koro-like syndrome (KLS) is considered a non-epidemic, culturally decontextualized variant of Koro, a culture-bound syndrome first identified in Southeast Asia. Classic Koro is marked by acute anxiety and the belief that one’s genitalia are retracting into the body, often occurring in epidemic clusters influenced by cultural and societal beliefs. In contrast, KLS arises in non-endemic settings and is typically seen in individuals with underlying psychiatric conditions - such as obsessive-compulsive disorder (OCD), psychosis, or delusional disorders - without the presence of shared cultural narratives.

We report the case of a 24-year-old Egyptian male with a history of OCD with poor insight and somatic delusional disorder who presented with persistent preoccupation about perceived testicular atrophy. He attributed this belief to a hormonal imbalance and exhibited a waddling gait to avoid pressure on his genitalia. Despite repeated medical reassurances and normal hormonal evaluations, he remained firmly convinced that his testes were undergoing atrophy.

This case highlights the diagnostic and therapeutic challenges of KLS in non-endemic settings, particularly when embedded within broader psychopathology. This underscores the importance of recognizing somatic delusions that occur outside traditional cultural frameworks and adapting treatment approaches to address the underlying psychopathology.