The Secret Social Phobia
The Seeds of Shy Bladder Syndrome continued...
"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.
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.