What Is Paruresis?

Men's public restroom
Fear of using public restrooms can significantly interfere with your life.. Pixabay / Myjanitors

Definition of Paruresis

Paruresis is the inability to use public restrooms without any medical cause. Paruresis may also be known as urophobia, shy kidney, shy bladder, or bashful bladder syndrome (BBS). Paruresis is found in both women and men of all ages and when severe and untreated can lead to medical complications. 

Paruresis is considered to be a social phobia, and if severe and limiting is generally diagnosed as social anxiety disorder (SAD).

However, there is some research evidence to suggest that explaining paruresis simply as part of social anxiety disorder may not account for all of its unique features.

In general, people with paruresis fear negative evaluation by others. If you suffer with a medical condition that prevents you from being able to urinate, you would not be classified as having paruresis.

Causes of Paruresis

It is unlikely that there is one cause underlying paruresis.

  • Some people with this problem may have experienced childhood bullying or had parents who were overly critical.
  • Others may have experienced a traumatic episode in which they were unable to urinate when required to do so—for example when asked to provide a urine sample.

Common Triggers

There are a number of common triggers which may make it more difficult for people with this social phobia to use a public restroom.

If you suffer with paruresis, you probably find it more difficult to use a restroom if the following are true:

  • it is very busy
  • the stalls lack proper partitions for privacy
  • you are feeling particularly anxious, fearful or pressed for time

People with paruresis may even imagine that there is someone waiting and listening while they urinate.

Effects on Daily Life

Paruresis can cause difficulty with

  • travel
  • social obligations
  • professional commitments

Many people with paruresis will develop coping strategies such as

  • drinking less
  • urinating frequently while at home or before leaving the house
  • running the tap or flushing so that others cannot hear

Usually fears are centered around public restrooms, but may extend to the homes of friends or relatives, or even your own home if visitors are nearby.

The impact of paruresis can range from mild to severe. Those with mild problems are unable to urinate in certain circumstances but capable in others. Those with more severe problems are only able to urinate at home.

Paruresis is generally a progressive problem, with fear increasing and generalizing over time to more and more locations.

Treatment of Paruresis

The most common form of treatment for paruresis is graduated exposure therapy. Other treatments include cognitive therapy and anti-anxiety medications. Although exposure therapy can be very effective, it is important to consider whether paruresis is the only symptom, or one of a collection of social fears.

If you suffer with a number of social fears, your treatment should address any problems with self-esteem, self-confidence and beliefs about your abilities.

In addition, before you begin any psychological treatment for paruresis, physical causes should be ruled out by a medical professional.

Sources:

International Paruresis Association (IPA). About Avoidant Paruresis. Accessed February 27, 2016.

Vythilingum B, Stein DJ, Soifer S. Is "shy bladder syndrome" a subtype of social anxiety disorder? A survey of people with paruresis. Depress Anxiety. 2002;16(2):84-7.

Hammelstein P, Soifer S. Is "shy bladder syndrome" (paruresis) correctly classified as social phobia? J Anxiety Disord. 2006;20(3):296-311.

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