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The Secret Social Phobia

Shy Bladder?

The Seeds of Shy Bladder Syndrome continued...


Our society is difficult for anyone prone to paruresis, but particularly for men, says Tom Seehof, a 75-year old recovering paruretic who suffered silently for years, but now runs the California branch of the IPA's support group network.


"The discussion of bodily functions is stigmatized in this country more than others, and yet our men's rooms do not allow for privacy," he tells WebMD.


The ramifications of SBS can be truly devastating, he says.


"First, you feel you're the only one who has it," says Seehof. "You're all alone, you come to the conclusion that you're crazy, and quite often you become depressed."


The result, he says, is that "people with paruresis are very isolated and ashamed, and don't seek help. The symptom becomes the center of their life."


Although paruretics are initially ashamed and don't want to talk about their condition, it's essential to treatment that they do. Once they summon the courage to initiate treatment with a therapist or urologist, "it's a rare case that cannot be helped," says Soifer. "It's actually relatively easy to treat. We do a form of cognitive behavioral therapy, called graduated exposure therapy, where the person is gradually reintroduced to the feared situation."


Graduated exposure therapy could go something like this, Soifer tells WebMD: The therapist has the patient attempt to urinate while a friend waits at a comfortable distance. At first, that could mean in an entirely different building, or down the street. Each time, the friend moves a bit closer, until the patient is able to relax and let go with someone in the next room, then with someone standing right outside the door, and eventually, in a public facility.


Typically, he says, 8-10 weeks of therapy is enough to make a real difference, and many can see significant improvement after only a weekend workshop.


"There are exceptions, of course," says Soifer -- especially for the one-quarter of paruretics with co-existing problems such as depression or panic attacks.


"Sometimes, medication to reduce anxiety is helpful," he says. "The drugs can make the graduated exposure therapy go more easily."


For Seehof, the key to recovery was separating the basic human need to urinate from the complex emotions that had grown up around it. He learned "to focus on the physical, keeping the emotional at bay long enough to do what I need to do."


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