The Secret Social Phobia

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.

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 it.

"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 Association.

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 impossible."

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 in public.

While both sexes are susceptible to paruresis, "nine of 10 who come in for treatment are men," says Soifer.