What is paruresis?

Paruresis is a social phobia defined in the Diagnostic and Statistical Manual for Mental Disorders (DSM - IV). Paruresis causes, can be many, however, reports from sufferers indicate that more often than not, this form of social phobia is caused by a one off "triggering" event. This event is sufficiently traumatic for the individual concerned that it increases anxiety to such and extent that a subconscious connection is made between this trauma and the environment in which it was experienced - usually a public bathroom environment with other people present.

Factors affecting the development of paruresis

Most paruretics are able to recall a specific incident (a "triggering" event) which most likely caused their paruresis. An incident such as this may typically involve a scenario where, for example: little Johnnie is trying to pee at the urinals in the school toilets at break time when in bursts the school bully who starts to taunt and intimidate him. Johnnie is pushed and shoved and made fun of and pees on himself, resulting in total embarrassment and humiliation. This "triggering" event is sufficiently traumatic for Johnnie that it becomes internalised. Johnnie was already quite a timid little boy with the psychological propensity to 'take things to heart'. Ever since the restroom incident, he has become even more timid and withdrawn.

Typically, those individuals who grow up into adults with paruresis or shy bladder syndrome already have a genetic disposition to suffer from social anxiety. The largest study to date, an Australian internet survey of 264 paruretics aged between 18 and 80 years of age reported that individuals scored significantly higher for the following factors:

• private self-consciousness (dwelling on negative aspects of the self)
• neuroticism (tendency to be anxious and worry a lot)
• conscientiousness (completing tasks to a high standard)
• introversion (being shy and withdrawn)

The above are all personal factors that make the individual more susceptible to developing paruresis if they experience a negative event concerning urinating in a public restroom environment. These factors, whilst making the person more vulnerable to developing paruresis, also worsen and become more polarized with the maintenance of the condition. For example, little Johnnie may have been more likely to develope paruresis because he was shy and introverted to start with, but having paruresis has now increased his tendency to be more shy and introverted because he doesn't like going to parties or social events where he has to pee while there might be others boys around.

Paruresis or shy bladder syndrome is a complex social phobia affected by many aspects both internal (individual) and external (environmental) and although it is treatable, there are no quick fixes. Improvements are gained through persistent pracitsing and desensitizing and CBT to help alter irrational thought processes.