In a quiet therapy room at Baho Smile Institute in Kigali, a young woman named Chadia sat in silence. Her legs were paralyzed, her voice lost, her body wracked with unexplained pain. Medical scans and neurological tests revealed no clear diagnosis. And yet, her suffering was severe. Chadia, 25, is just one of several patients who are now part of a developing clinical observation that may redefine how trauma and relationships are understood in Sub-Saharan Africa. The condition, temporarily named Relationship Disappointment Stress Syndrome (RDSS), was explored in a case study by Dr Celestin Mutuyimana, a clinical psychotherapist and founder of Baho Smile Institute, a psychotherapeutic and research centre in Rwanda. ALSO READ: Mental health awareness: Understanding behavioral changes, building supportive relationships The research, which was published by the US National Institutes of Health (NIH) on April 18, explained how unmet romantic expectations, particularly in post-traumatic individuals, can trigger a range of distressing psychological and physical symptoms. This syndrome appears to arise at the crossroads of trauma and culture. In many African societies, including Rwanda, marriage is seen not just as a union between two individuals but as a sacred remedy—a symbol of healing, success, and social elevation. ALSO READ: Researchers list 7 tricks to help prevent depression in everyday life “Young people grow up believing that a spouse will complete them, heal their pain, and offer a future free from past wounds,” said Dr Mutuyimana in a virtual interview with The New Times. “But for those carrying emotional scars from childhood, such hope can become an emotional trap.” The Baho Smile Institute received ten such cases in a few months. Three were selected for closer observation and treated with compassion-focused therapy (CFT), a culturally adapted psychotherapy model grounded in human values like Ubuntu (humanity). Chadia’s case illustrates the core features of RDSS. She had already survived a childhood marked by abuse. Her belief that marriage would offer peace was shaped by community narratives and reinforced by elders. She married young, hoping for stability and love. But the reality she faced was far from the dream, an emotionally and physically abusive husband, a miscarriage due to violence, and eventually, a complete emotional collapse. She began experiencing headaches, neck pain, stomach problems, and temporary paralysis of her legs. Her voice disappeared. Multiple hospital visits revealed nothing physiologically wrong. Treatments ranged from steroids to physiotherapy, but little progress was made until she was referred to a psychotherapist. Her symptoms, including losing trust in others, diminished sexual desire, obsession with relationships, and a loss of life purpose, did not align neatly with diagnoses like PTSD or depression. She scored low on conventional screening tools such as the PHQ-9 and the International Trauma Questionnaire. Her case, instead, pointed to something culturally specific and previously unnamed. Through 12 CFT sessions over three months, Chadia slowly began to recover. By engaging in therapy that emphasized compassion, trust, and cultural values like Ubumuntu (humaneness), she regained her speech and began walking with assistance. Her journey back to wellness was not linear. After a brief relapse, she returned to therapy and eventually launched her own business, independent from her husband. “I feel truly fulfilled,” she told her therapist. “I have found my purpose in life.” This emerging syndrome, RDSS, may be unique in its presentation. While depression is typically characterized by hopelessness and fatigue, RDSS is marked by somatic complaints, interpersonal withdrawal, and purpose-related despair, particularly linked to relationship expectations. These patients are often trauma survivors who, rather than showing classic PTSD symptoms like re-experiencing or avoidance, exhibit intense emotional and physical distress tied specifically to romantic disappointments, according to Dr Mutuyimana. Cultural beliefs play a powerful role. In many parts of Africa, marriage is elevated as a form of personal and spiritual redemption. Survivors of trauma may idealize future relationships as the sole path to healing, placing unrealistic weight on romantic success. This mindset can result in passive optimism, a form of wishful thinking that replaces concrete life planning with the illusion that love will solve all wounds. Such expectations are not random. Dr Mutuyimana noted that traumatic experiences can shape three types of expectations: ideal, normative, and predicted. Ideal expectations, driven by vision and desire, often become intensified when cultural norms support them. In this context, marriage becomes more than a partnership—it becomes a perceived salvation. The consequences can be devastating when reality doesn’t measure up. The disappointment can shake one’s identity, sense of human connection, and even the will to live. RDSS patients often exhibit physical symptoms that mimic neurological conditions, leading to misdiagnosis and inappropriate treatments. In one of the cases, traditional healers were consulted after medical options had been exhausted, illustrating how confusion and stigma around mental health persist. Despite these challenges, the case study shows promise for healing. Compassion-focused therapy, when aligned with communal values, appears effective in restoring the sense of Ubuntu—reawakening a person’s connection to others, self-worth, and purpose. This approach may hold particular relevance in collectivist cultures, where identity is tightly woven into relationships and community. While most of the observed patients were women, the researchers noted that silence around male suffering may have unbalanced the findings. In many African settings, men are discouraged from expressing emotional pain, which could mask the true extent of RDSS across genders. This highlights the need for future studies to explore gender dynamics more thoroughly. The study suggested a conversation about premarital counseling and emotional healing before marriage. Participants revealed that “heart wounds” from past trauma were often unaddressed, and that entering relationships without emotional clarity led to disappointment. The researchers suggest that community-based programmes could help young people process emotional pain before stepping into romantic partnerships. Although RDSS has not yet been formally recognized in diagnostic manuals, its unique presentation highlights the need for further investigation. The team behind this case study recommends an assessment tool and randomized controlled trials to validate the proposed therapy and clearly define the syndrome’s parameters. According to Dr Mutuyimana, the condition is a cultural and post-traumatic phenomenon observed in Sub-Saharan Africa, referred to for the first time as Relationship Disappointment Stress Syndrome, and is characterized by four main clusters of symptoms. Somatic symptoms such as headaches, neck pain, and occasionally pseudo-paralysis. Interpersonal symptoms include loss of trust and interest in others, reduced sexual desire, and a reduced sense of empathy or human connection. Relationship-centered symptoms such as excessive preoccupation with romantic or personal relationships. Existential symptoms involve a sense of failure in life’s purpose and persistent, unanswered questions about the future. “This condition arises in a cultural context where marriage is highly romanticized and often intersects with traumatic life experiences,” Dr Mutuyimana said. “RDSS is frequently misdiagnosed as depression, PTSD, or neurological conditions. What pushed me to do this research is my clinical work. I received patients with similar symptoms. Many of them were treated and diagnosed with PTSD or depression as they were trauma survivors. “Most of my patients told me they weren’t depressed or traumatized, just disappointed. Their risk factors and symptoms didn’t match any known disorder, and standard PTSD or depression treatments didn’t help. That led me, in 2020, to investigate this issue further and realize it’s a different condition.” To explore whether the disorder was a local problem, he followed cases from Kenya and Tanzania and found similar symptoms. He consulted psychotherapists in the three countries, and they confirmed similar patterns. He explained that RDSS is very prevalent. Although it is a new disorder introduced in literature, clinical work and testimonies revealed that this disorder is quite common in Rwanda. The main risk factor is that marriage is exaggerated, and people set the bar very high for what they expect to receive. “As many of the patients had experienced traumatic exposure, they expected to find rest and healing within their families,” he said. “However, this feeling existed on both sides, leading to a high level of disappointment. One can also argue that there is a correlation between the divorce rate observed during this time and RDSS.”
