The Secret Social Phobia
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
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
"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
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."