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Reviewed by the researcher, Russell Gibbs
Paruresis (Shy Bladder Syndrome) is the inability to urinate with
others present, a relatively common, but poorly researched and little
understood, specific social phobia. In the largest paruresis study
performed to date, 264 adult paruretic males aged 18 –80 completed
a global, anonymous Internet survey over a 4 month period in 2004.
The sample was well distributed demographically, representing diverse
social strata and geographical location. Seventy percent were university
educated, comprising 44% undergraduate and 26% post-graduate, the
remaining 30% having trade qualifications and a variety of educational
and training backgrounds. Approximately half the sample was either
married or de-facto (44%), divorced or separated (6%), or widowed,
and the remainder (49%) were single. Fifty-one percent were employed
full time, 5% part-time, 13% self-employed, 7% unemployed, and 17%
were students. Country of residence representations comprised 50
from Australia and New Zealand, 120 from North America, 8 from Europe,
55 from United Kingdom, 12 from Canada, and 19 from other nations.
The diverse population from over 20 countries also included Finland,
Switzerland, China, Malaysia, India, British Columbia, Brazil, and
Iceland.
As no established scale to measure paruresis was available, I constructed
the Paruresis Severity Scale (PSQ) specifically for this research.
The PSQ Scale contained 11 items and proved to be a statistically
reliable measure suitable for use in future research. The PSQ Individual Items comprised additional questions about paruresis
history, personal experience, and related issues. The highest scores
on the PSQ scale (answering mostly or always) related to anxiety
when using restrooms (94%), urination failure causing stress (88%),
and feeling judged when voiding (75%), with searching for vacant
restrooms (86%) also scoring highly. Only 2.7% never used stalls
and 74% mostly or always did. The highest scores in lifestyle areas
indicating paruresis was not an issue related to job opportunities
(41.7%), urinating at home (19.3%), and restricting liquid intake
(14.0%), with the remaining scores much lower, meaning that most
men had problems relating to all 11 questions.
Over half those surveyed were unable to urinate successfully at
public urinals, avoided public toilets, and believed paruresis affected
the personal, social, or employment aspects of their lives.
PSQ History revealed that the age paruresis was first experienced
was 12 and below for 45% of respondents, 13 - 18 for 44%, 19+ for
11%, with 43% reported having the problem for over 30 years. Only
25% reported any improvement with age, of whom 51% attributed the
reason to increased coping skills and relaxation. Interestingly,
14% reported familial history of paruresis; however, a large percentage
(61%) of the participants were unsure of any family history. This
suggests there is an hereditary factor.
Although 44% sought treatment the majority of those waited 20 -
30 years before seeking help. The most common treatment methods
were psychotherapy (47%), graduated exposure therapy (36%), self
help group (32%), medication (28%), and cognitive behaviour therapy
(24%). Success rates for these treatments were reported as low:
no improvement 44%, some improvement 38%, great improvement 15%,
and problem overcome only 2%.
PSQ Related Issues revealed that the most commonly reported situation
of first experiencing paruresis was at school (58%). Perceived causes
of developing pauresis placed anxiety, shyness, and embarrassment
as prominent. A Related Issue gaining publicity, particularly due
to its growing incidence in North America, is compulsory urine sampling
under observation, such as in employment related drug screening.
Results revealed that 13% of participants had given a sample, while
93% indicated they would, “...feel stress/anxiety if having
to do so”. The last question of the PSQ, participants’
comments, attracted substantial interest from 181 men who provided
personal experiential information about paruresis amounting to over
15,000 words. This valuable information will be the subject of another
paper.
The psychological questionnaires revealed that the men surveyed
scored significantly higher than the general population on private
self-consciousness (meaning they dwell on negative aspects of the
self as well as having an interest in self-awareness), neuroticism
(tending to be anxious and worry a lot), and conscientiousness (reliable
and complete tasks to a high standard). Another important result,
which contributed to the development of a personality profile of
men with paruresis, was that the sample tended to be introverted
(shy, withdrawn) and aligns with them also being highly self-consciousness.
In summary, these results combined with other findings from the
survey not discussed here, suggest that paruresis was the main social
problem experienced by most of the sample, and that self-conscious
attention to urination performance (more so than physiological anxiety
symptoms) may be the main factor in urination breakdown. The study
presented a self-consciousness model of urination ‘freezing’
as an alternative to the existing ‘fight or flight’
model based solely on high levels of anxiety, and results provided
initial support for this model.
Future treatment programs could therefore benefit from exploring
the cognitive (thoughts and self-talk) aspects involved in the anticipatory
fear and consequential failure to successfully urinate when in the
presence of others. Cognitive Behaviour Therapy (CBT), when combined
with graduated exposure therapy (systematic desensitisation) currently
promoted by Professor Steven Soifer and the International Paruresis
Association (IPA), paruresis organisations in Australia (PAA), Britain
(UKPA), and Europe (EPA), may result in greater success in treatment
sessions and relapse prevention (misfires). Established CBT methods
used in psychology to change irrational beliefs can be applied to
paruresis (e.g., I’m abnormal because I cannot pee in public
facilities), negative self-talk (e.g., I’m hopeless and will
always have trouble urinating), and unfounded beliefs (e.g., no
one would understand – I’ll have to suffer alone), are
strongly suggested based on the results of this comprehensive study
on paruresis.
Australian people experiencing paruresis (Shy Bladder Syndrome)
are welcome to contact me for professional advice and treatment
therapy. Paruresis need not be a lifetime burden, as has been demonstrated
in testimonies from those who have learnt to manage or overcome
it (see Paruresis
Association of Australia website: http://www.paruresis.org.au/).
For appointments contact:
Russell E Gibbs
B.Psyc (Honours)
Intern Psychologist
(Reg. No PS0093701: NSW)
Associate Member of the Australian Psychological Society
Email: gibbs.psychology@bigpond.com
Phone: 02 65856311
Mobile: 0427 240 576
Postal address:
Russell E Gibbs
Gary S Grant & Associates
Consultant Psychologists
Suite 2/5 High Street
Wauchope NSW 2446. Australia
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