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

Sep 29, 2026

Koro-like syndrome (KLS) is a culturally decontextualized variant of Koro, characterized by a persistent false belief that external genitalia are atrophying, retracting, or deteriorating, often with marked anxiety and compensatory behaviors. Unlike classic epidemic Koro, KLS typically emerges in non-endemic settings in individuals with underlying psychiatric illness, including obsessive-compulsive disorder (OCD) and delusional disorders. A case of a 24-year-old male with OCD and somatic delusional disorder is presented, emphasizing diagnostic and treatment challenges when somatic delusions occur outside traditional cultural frameworks.

LanguageEnglish

CategoryHealthcare

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Pages4

Reading Time10 min

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Abstract

Introduction

Classic Koro

Koro-like (secondary Koro)

Case Presentation

Review began 11/28/2025 Review ended 12/04/2025 Published 12/05/2025 © Copyright 2025 Nazir et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited. DOI: 10.7759/cureus.98533 Open Access Case Report A Koro-Like Presentation of Somatic Delusional Disorder in a Young Male With ObsessiveCompulsive Disorder: A Case Report From the United Arab Emirates Mohammed Nazir 1, Joman Alshereida 1, Mohamed M. Elshamy 1, Ali Baldo 1 1. Psychiatry, Al Amal Psychiatric Hospital, Dubai, ARE Corresponding author: Joman Alshereida, [jumana19091@gmail.com](jumana19091@gmail.com) 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. Categories: Psychiatry Keywords: cultural psychiatry, delusional disorder, koro, koro like syndrome, non endemic koro, obsessive compulsive disorder, somatic delusion Introduction Koro-like syndrome (KLS) refers to a clinical presentation in which an individual develops a persistent, false belief that their external genitalia is atrophying, retracting, or deteriorating, often accompanied by marked anxiety or compensatory behaviors. While rooted in the classical syndrome of Koro, a culture-bound disorder first described in Southeast Asia, KLS occurs outside endemic cultural contexts and is most often associated with underlying psychiatric conditions, rather than collective belief systems [1,2] . The classic form of Koro, typically reported in China, Malaysia, Indonesia, and India, is characterized by an acute onset, intense anxiety, and a fear of imminent death due to perceived genital retraction. Patients may engage in urgent behaviors such as grasping the penis, tying it with strings, or seeking immediate medical attention. These episodes are often transient and occur in epidemic patterns, frequently precipitated by cultural beliefs or mass hysteria [2-5]. In contrast, Koro-like syndrome or secondary Koro refers to similar genital-centered preoccupations and behaviors arising in non-cultural settings, typically as a manifestation of primary psychiatric disorders. Reported associations include delusional disorder (somatic type), obsessive-compulsive disorder (OCD), schizophrenia, major depression, and body dysmorphic disorder (BDD) [3,6] . Patients with Koro-like syndrome often present with chronic symptoms, fixed somatic delusions, and engage in manual or mechanical methods to prevent perceived genital retraction [6] . Although neith

FAQs

What distinguishes Koro-like syndrome (KLS) from classic Koro?

Classic Koro is typically acute, anxiety-driven, and often linked to epidemic clusters shaped by shared cultural beliefs. KLS arises in non-endemic settings and is usually seen in individuals with underlying psychiatric conditions without shared cultural narratives.

How did the reported patient’s symptoms manifest?

The 24-year-old male had poor-insight OCD and somatic delusional disorder with persistent preoccupation about perceived testicular atrophy. He attributed this to hormonal imbalance and developed compensatory behavior (including a waddling gait) despite normal medical and hormonal evaluations.

Why are diagnostic and therapeutic challenges important in KLS?

KLS can present outside traditional cultural contexts and may be embedded within broader psychopathology. Recognizing somatic delusions in these settings is essential to adapt treatment toward the underlying psychiatric condition.

Sep 29, 2026

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