“Going to” public places can be very difficult for those of us that have social anxiety but “going” in public places can be very difficult for those of us that have a specific kind of social anxiety called Paruresis (par-yoo-ree-sis). Also called “Shy Bladder Syndrome, Paruresis is a condition in which people “freeze up” when they attempt to use public restrooms.
Due to the embarrassment this disorder causes and due to a lack of awareness that there is help for it, it is not really known how many people suffer from Paruresis. “Shy Bladder” is more prevalent than one might think. It is thought that possibly 5 % of both men and women may have at least some degree of difficulty urinating in public restrooms.
The condition results from the brain automatically sending out an abnormal warning that danger is at hand when one attempts to use a public restroom. This warning is characterized by varying degrees of bodily responses including increased heartbeat, rapid, shallow breathing, fear, and a “locking up” of the muscles that enable a person to urinate at will. Repeated avoidance of the fear-producing stimulus, which is typical in people that don’t know what else to do to deal with the fear, sends feedback to the brain’s warning system that the danger is real. As a result, the fear is reinforced and the problem worsens.
The only way that Paruresis can be treated effectively is by using a process called Graded Exposure Therapy, sometimes with the help of anti-anxiety medication. In this type of psychotherapy, a hierarchy of tasks of increasing difficulty is established that the sufferer is asked to perform. The person must be willing to put him or herself in a fear-producing situation, feel the emotional distress, and do nothing to try to relieve it. As you can imagine, this is by no means an easy thing to do. It is against human nature to willingly make ourselves feel uncomfortable or fearful. However, if we can do it, there’s a good chance that we can put the problem behind us.
The Paruretic client that is willing to engage in this type of therapy might start off just by looking at the entrance to a public restroom, allowing himself to feel the fear that is evoked. In advanced cases, just looking at pictures of a bathroom might be enough to evoke the required distress response. Performing an exposure task such as this repeatedly over a period of time causes the brain to desensitize to the fear-producing stimulus and the person eventually feels less distressed. It’s the same way that children get over their fear of the dark – by gradually facing it. Because every individual responds somewhat differently, it is never known ahead of time how long the desensitization process will take. In some cases, the time required can be very long. However, with continued exposure, the person will be able to attempt more and more difficult tasks on his hierarchy, such as walking into the restroom momentarily, followed by standing in the restroom for longer periods of time, standing briefly near a urinal or stall, and so on. When the client’s anxiety decreases sufficiently, the bladder no longer locks up and the person is able to urinate at will.
As we all know, being unable to urinate for long periods of time (perhaps because a restroom is not available) can be very painful. Because of this, many people have to shorten trips away from home or avoid them all together, including important family events. The demands one’s his job can force someone with Paruresis to have to wait long periods of time before returning home to urinate, often causing severe pain. Other factors that must be considered is that many people intentionally dehydrate themselves before leaving home in order to avoid experiencing this kind of pain. Repeated dehydration that is done over a long period of time is a very serious condition that can, and will, lead to a host of other problems, both physiological and psychological.
The good news is that with the help of a therapist that is at least knowledgeable and preferably experienced in treating Paruresis, there is a good chance of overcoming the problem as long as one is willing to follow and stick to the therapeutic regimen that is required for success.
If you are interested in attending a support group for this problem, please contact Alan Carriero, LMSW at 616-940-9091 or aldacar@att.net. A support group for Paruresis is an opportunity for people to informally meet others that truly know what it’s like to live with this disorder in an absolutely confidential setting. It is also an opportunity to share stories about what has helped and what has not and to ask a mental health professional questions about Shy Bladder that the group may not be able to answer itself.
If enough interest is expressed in starting a Paruresis support group, Mr. Carriero will contact you and arrangements will be made to meet at his office or elsewhere in Grand Rapids. The group will meet weekly and be “open-ended,” meaning that members can join or leave whenever they choose to do so. You don’t have to continue letting this problem interfere with your life!
