Paruresis

Paruresis (pronounced /pærjəˈriːsɪs/) is a type of phobia in which the sufferer is unable to urinate in the (real or imaginary) presence of others, such as in a public restroom. It can affect both males and females. The analogous condition that affects bowel movement is called parcopresis.

Impact

Many people have brief, isolated episodes of urinary difficulty in situations where other people are in close proximity. Paruresis, however, goes well beyond simple shyness, embarrassment, or desire for privacy in that it is much more severe and may cause unnecessary inconvenience because the inability to urinate, although psychological in origin, is physical in its effect and not under the control of the sufferer. Paruresis may be a type of social anxiety problem although not all clinicians agree on this.

Paruresis can be mild, moderate or severe. In mild cases, paruresis is an occasional event, like a form of subconscious performance anxiety. For example, a man at a public urinal may be surprised to find it difficult to urinate when flanked by other men, perhaps due to a subconscious feeling of vulnerability (i.e., a fear of being defenseless if attacked), or possibly because he is worried that others may see his penis. A woman in a crowded public bathroom may suddenly tighten up because she thinks she is taking too long. Once this has happened at least once, the fear may be of being judged for not being able to urinate. Other people may find that they are unable to urinate while in moving vehicles, or are fixated on the sounds of their urination in quiet restrooms or residential settings. In severe cases, a person with paruresis can urinate only when alone at home or through the process of catheterization.^[1]

Although most sufferers report that they developed the condition in their teenage years, it can strike at any age. Also, because of the differing levels of severity from one person to another, some people's first experience of the problem is when, for the first time, they "lock up" attempting to produce a sample for a drug test. Many women are unaware that they, too, are subject to paruresis; articles about women and urination emphasize other female urinary dysfunctions, such as urinary incontinence or frequent urination.

Some people cope by deliberately holding in their urine, by refraining from drinking liquids, or locating unoccupied or single-occupancy public bathrooms.

Severe cases of this disorder can have highly restricting effects on a person's life. In moderate to severe cases, overcoming paruresis can be extremely difficult without the help of a psychologist, therapist or support groups. Severe sufferers may not be willing to travel far from their home or be able to form intimate relationships. Others cannot urinate even in their own home if someone else can be heard to be there.

Origin of the term

The term Paruresis was coined by Williams and Degenhart (1954) in their paper "Paruresis: a survey of a disorder of micturition" in the Journal of Psychology 51:19-29. They surveyed 1,419 college students and found 14.4% had experienced paruresis, either incidentally or continuously.

Other names

Paruresis is also known by many colloquial terms, including bashful bladder, bashful kidneys, stage fright, urophobia, pee-shyness, and shy bladder syndrome. It is also known as psychogenic urinary retention.

General recognition

There is growing recognition of the condition by the UK's National Health Service (NHS) and government. The condition is catered for in the rules for mandatory urine testing for drugs in UK prisons, and UK Incapacity Benefit tribunals also recognise it. It is listed in the NHS on-line encyclopaedia of conditions and disorders.^[2] It is now reported to have been accepted as a valid reason for jury service excusal.^[3] From 1 August 2005, the guidance on the rules relating to the testing of those on probation in the UK explicitly cites paruresis as a valid reason for inability to produce a sample which is not to be construed as a refusal.

The condition is recognised by the American Urological Association, who include it in their on-line directory of conditions.^[4]

It has, from time to time been the topic of advice columns such as Ann Landers, to which sufferers have written in and been counselled on their problem.

In the US Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) TR, it is classified as social phobia also known as chronic social anxiety, but that is disputed by some clinicians.^[5]

Context and urine samples

There can be serious difficulties with workplace drug testing where observed urine samples are insisted upon, if the testing regime does not recognise and cater for the condition. In the UK, employees have a general right not to be unfairly dismissed, and so have an arguable defence if this arises, but this is not the case everywhere.

There is growing evidence to suggest that some drug testing authorities find paruresis a nuisance, and some implement "shy bladder procedures" which pay no more than lip service to the condition, and where there is no evidence that they have conducted any real research into the matter.

The codes and procedures for drug testing in sports are set by the World Anti-Doping Agency (WADA). Enquiries to WADA reveal that their doping codes do not cater for the condition at all, and they say they have never had any reports of problems with it.^{[citation needed]}

References

External links

• International Paruresis Association
• Social Anxiety Anonymous/Social Phobics Anonymous International Nonprofit, provides free support groups for paruresis and other social anxiety problems
• European Paruresis Association
• Paruresis Advice & Community Site
• United Kingdom Paruresis Trust (UKPT)
• Looks easy enough... but not for everyone
• Paruresis - A Bladder Problem
• Comunità Italiana Paruretici
• Bathrooms Make Me Nervous: A Guidebook for Women with Urination Anxiety (Shy Bladder)
• A place for people with shy bladder