<P> Extremely anxious sufferers and their family members may resort to physical methods to prevent the believed retraction of the penis . A man may perform manual or mechanical penile traction, or "anchoring" by a loop of string or some clamping device . Similarly, a woman may be seen grabbing her own breast, pulling her nipple, or even having iron pins inserted into the nipple . Physical injury may occur from these attempts . These forceful attempts often lead to injuries, even death . </P> <P> Psychosexual conflicts, personality factors, and cultural beliefs are considered as being of etiological significance to koro . Sexual adjustment histories of non-Chinese victims are often significant, such as premorbid sex inadequacy, sexual promiscuity, guilt over masturbation, and impotence . </P> <P> When considering the biological mechanisms and evolutionary history of koro, it is important to look at it in the larger framework of mass hysteria . While the underlying mechanisms are still poorly understood, it has been suggested that the mirror neurons play a major role in mass hysteria outbreaks . Mirror neurons, which have been found in both human and non-human primates, are neurons that fire when one performs an action and when they observe another individual performing the same action . It is hypothesized that we evolved these mechanisms to learn from observation of others, as well as to facilitate imitation . However, within mirror neurons, there is some form of inhibitory process, which prevents us from blindly mimicking every action we observe others perform . New research into this area suggests that in mass hysteria outbreaks something goes amiss in this inhibitory process . </P> <P> Several criteria are typically used to make a diagnosis of koro . The primary criteria is a patient's report of genital (typically penile or female nipple) retraction despite a lack of objective physical evidence demonstrating retraction . This is accompanied by severe anxiety related to the retraction, fear of death as a result of retraction, and use of mechanical means to prevent retraction . Cases that do not meet all the requirements are generally classified as koro - like symptoms or given a diagnosis of partial koro syndrome . It has been argued that the criteria are sufficient but not necessary to make a diagnosis of koro . Researchers have identified koro as a possible "cultural relative" of body dysmorphic disorder . DSM - IV explains the process of differential diagnosis between these two disorders . </P>

Which of the following is true of koro a culture-related disorder