Social Anxiety Phobias: What Is Paruresis or Shy Bladder Syndrome?

In most cases, heading to the public restroom to tend to bodily functions occurs as one, natural and fluid situation without much thought, concern, or worry about it. Unfortunately, for those who have a fear of public toilets or a fear of a negative evaluation by others in relation to using a public restroom, have developed a social phobia called Paruresis or shy bladder syndrome. When in a situation where the individual must use a restroom in public, they will experience a great deal of worry, inconvenience, and sometimes even panic. When the social phobia is severe enough, it can lead to medical complications and completely limit one’s enjoyment of life. This is not to be confused with medical conditions that prevent you from urinating completely, as that would not fall under the social phobia category.

Why Is It Classified As a Social Phobia?

Paruresis is considered a social anxiety disorder that affects both men and women as it causes individuals to experience a significant amount of anxiety over the possibility of being negatively judged by others. Typically, the focal point of the fear that one experiences arsocia centered around the inability to initiate urination. Common judgments that individuals cite being fearful of include

  • Will people think that there is something wrong with me if they do not hear me peeing?
  • Will I be judged as less of a person if I cannot urinate while others can?
  • What if the sound of my pee stream is too weak?

When these fears pop up, the anticipation of not knowing what will happen will exacerbate the anxiety and self-consciousness that one feels which makes the act of urinating quite difficult and thus becoming a self-fulfilling prophecy.

Is There A Known Medical Cause For the Development of Paruresis?

Currently, the medical community does not have a known cause for why individuals develop this social anxiety disorder. In most cases, the disorder will develop during late childhood or during adolescence and often stems from a “beginning event” which had the individual under a lot of pressure to pee with others nearby. The pressure to urinate or to “perform” with others around would have spiked stress and anxiety levels, leading to a consistent pattern of stress during urination while around others. This becomes worse if the individual, at the time, experienced ridicule.

What Are The Triggers for Individuals With Paruresis?

Individuals who live with this social phobia may experience specific triggers that make it more difficult to bare.

  • If the restroom is incredibly busy, this can set off major anxiety.
  • If the restroom lacks the proper privacy partitions or stalls.
  • If you are feeling particularly stressed or pressed for time.
  • If someone is waiting for you while you use the restroom.
  • If you have the perception that others are listening in on you while you go to the washroom.

Is There Treatment Options Available?

Individuals who only suffer from Paruresis and do not have any other social anxiety issues are often prescribed graduated exposure therapy as the treatment plan. This type of treatment therapy helps individuals learn new associations between the feared stimulus (public restrooms) and the extreme anxiety that they feel. Through repetition and repeated exposure, the individual learns to manage the anxiety they feel in public restrooms and thus are better able to retain their brain-bladder connection and thereby are able to use the restroom without heightened anxiety.

If an individual has other social fears, such as self-confidence and self-esteem issues, then it is important that these get addressed in addition to the Paruresis. In some cases, cognitive-behavioral therapy (CBT) may be helpful in reducing the impact that Paruresis has until graduated exposure therapy can be utilized.