June 11, 2001 -- Your friends are planning a day out at the
ballpark, or the museum, or the mall. You'd love to join them, but instead, you
make up an excuse and decline. You feel ashamed, unhappy, and utterly alone,
but you will not reveal your secret: an inability to urinate in public
restrooms that won't let you stray too far from home.
At the heart of a phobia, there is anxiety. There are three main types of phobias:
Specific phobia, a persistent, irrational fear of particular objects or situations, such as snakes, spiders, heights, blood, flying, or elevators.
Social phobia, or social anxiety disorder, a persistent, irrational fear of situations where you may be scrutinized or criticized or embarrassed by other people.
Agoraphobia, a fear of leaving home, being alone, or being away from home in a situation...
If you're one of the 17 million Americans with shy bladder
syndrome, or paruresis -- especially if you're one of the estimated 1 to 2
million whose social and professional lives are severely hampered by it -- the
scenario is all too familiar. If you're not, you're probably a bit baffled. You
may even be laughing. But SBS is anything but funny to those struggling with
"Shy bladder syndrome is considered a social phobia by
[mental health professionals], because the person who has it knows it's
irrational," says Steven Soifer, MSW, PhD, author of the new book The
Shy Bladder Syndrome: Your Step-By-Step Guide to Overcoming Paruresis.
"It's this awful feeling that even if someone held a gun to
their head, they couldn't go," says Soifer, a professor of social work at
the University of Maryland and president of the International Paruresis
In the workshops he conducts, Soifer has "talked to people
who've held their bladder for 12, 16, 20 hours because they could not find a
'safe' bathroom. Unless you've experienced it, it's difficult to understand how
this can be."
Soifer understands, because he's been there himself.
"People [with SBS] get anxious and fear that others may be
watching, listening, or waiting," he tells WebMD. "It's a classic
mind-body problem. If you perceive danger, your body reacts in certain ways.
For people with paruresis, the internal sphincter shuts and urination is
The Seeds of Shy Bladder Syndrome
Granted, almost no one prefers a public facility over the
comfort of home, but for most people, if you've gotta go, you go. It may not be
pleasant, but it is certainly not frightening. So why do paruretics, people
with SBS, feel afraid?
While some paruretics trace their first symptoms to emotional,
physical, or sexual abuse, and others to a particularly anxiety-provoking
toilet training experience, the vast majority blame a specific, traumatic event
in early adolescence.
"The typical story is of being teased, harassed, or hurried
by classmates at a sensitive age, usually around puberty, while trying to use
the restroom," says Soifer. To keep from feeling that anxiety again, the
person avoids public bathrooms, a behavior which ultimately becomes ingrained.
Eventually, it's no longer a choice. The person is physically unable to urinate
While both sexes are susceptible to paruresis, "nine of 10
who come in for treatment are men," says Soifer.