Overcoming Pain

Why people experience chronic pain, and the power they have to de-intensify it

Pee-Shy: When You Don’t Go When You Gotta Go

The pain of the shy bladder.

For many experts, paruresis is most easily defined as an inability to urinate in public restrooms, particularly when other persons are present or may enter the room, that is often associated with considerable avoidance behavior, and is therefore best classified as social phobia behavior. After all, studies in sub-clinical samples have found higher values of self-reported interpersonal anxiety and performance anxiety in subjects suffering from paruretic symptoms, in contrast to control subjects. One study of male college students found a strong relationship between paruretic symptoms and body shyness, and found that the more intensely a student experienced paruresis, the more intense were accompanying feelings of fear and general body shyness.

However, other views of this condition are held, as some researchers have emphasized the “functional” nature of having a “shy bladder,” describing it in terms such as “psychogenic urinary retention.” This take on pee-shyness as not being a psychiatric diagnosis has further support by the fact that sufferers of paruresis do not usually respond to the pharmacologic interventions that are effective for some forms of social anxiety.

Research, results of which were published in 2006 in the “Journal of Anxiety Disorders,” was born from a desire to examine possible similarities and differences between subjects suffering mainly from paruresis and subjects suffering from common social phobic symptoms. A sample of 226 subjects completed different questionnaires concerning paruresis, social phobic symptoms, lower urinary tract symptoms and depressive symptoms. These individuals were divided into four groups: no symptoms, suffering primarily from paruresis, non-generalized social phobia and generalized social phobia. It was found that the paruretic group differed significantly in all symptom variables from both the non-generalized and the generalized social phobia groups. When sophisticated statistical analysis was applied to the separate groups, it appeared that the interference with daily life can be mainly explained by paruretic symptoms in the paruretic group, or by social anxiety and depressive symptoms in the social phobic groups.

Maybe the shy bladder never did belong in the Diagnostic and Statistical Manual.

Unfortunately, studies of paruretic patients have been difficult, due to the lack of solid diagnostic criteria, which make it difficult to recruit subjects who are truly appropriate subjects. Recognizing the paucity of reliable and valid measures for assessing this problem, reserarchers did attempt to address this limitation by investigating the psychometric properties and validity of a new measure of paruresis: the Shy Bladder Scale (SBS). Publishing their results in 2012 in the journal “Cognitive Behavioral Therapy,” in two undergraduate samples, the SBS demonstrated excellent internal consistency and a stable factor structure assessing difficulty urinating in public, impairment and distress, along with paruresis-related fear of negative evaluation. Undergraduate students evidenced very low levels of paruresis-related concerns. In contrast, SBS scores were markedly elevated among individuals recruited from an online support network who appeared to meet diagnostic criteria for paruresis-specific social phobia. It would seem that the SBS has potential utility as a measure of paruresis in clinical and research contexts.

This might allow for more research to be performed on an under-studied subject, which hopefully would result in more therapeutic options for those who suffer the pain of paruresis.

It is about time the shy bladder come out of that last stall in the men’s room.

Mark Borigini, M.D., is a board-certified rheumatologist who has devoted his career to treating illnesses that cause chronic pain and disability.

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