Pee shyness (paresis)
Feel embarrassed using public toilets?
have to use the cubicles?
cant go if you hear even the slightest noise?
Have to try to think of something else to keep your mind off?
been really bursting but had to walk out of toilet because you couldn't go?
had to wait for the cubical even know the urinal was totally free?
feel Anxious?
Paruresis (pron.: /ˌpɑrəˈriːsɪs/ PAR-ə-REE-sis) is a type of phobia in which the
sufferer is unable to urinate in the (real or imaginary) presence of others,
such as in a public restroom. The analogous condition that affects bowel
movement is called parcopresis.
Impact
Some people
have brief, isolated episodes of urinary difficulty in situations where other
people are in close proximity. Paruresis, however, goes beyond simple shyness,
embarrassment, fear of exposure, or fear of being judged for not being able to
urinate. Other people may find that they are unable to urinate while in moving
vehicles, or are fixated on the sounds of their urination in quiet restrooms or
residential settings. In severe cases, a person with paruresis can urinate only
when alone at home or through the process of
catheterization.
Although
most sufferers report that they developed the condition in their teenage years,
it can strike at any age. Also, because of the differing levels of severity from
one person to another, some people's first experience of the problem is when,
for the first time, they "lock up" attempting to produce a sample for a drug
test. Many women are unaware that they, too, are subject to paruresis; articles
about women and urination emphasize other female urinary dysfunctions, such as
urinary incontinence or frequent urination.
Some people
cope by deliberately holding in their urine, by refraining from drinking
liquids, or locating unoccupied or single-occupancy public
bathrooms.
Severe cases
of this disorder can have highly restricting effects on a person's life. In
moderate to severe cases, overcoming paruresis can be extremely difficult
without the help of a psychologist, therapist or support groups. Severe
sufferers may not be willing to travel far from their home or be able to form
intimate relationships. Others cannot urinate even in their own home if someone
else can be heard to be there.
Origin of
the term
The term
paruresis was coined by Williams and Degenhart (1954) in their paper "Paruresis:
a survey of a disorder of micturition" in the Journal of General Psychology
51:19-29. They surveyed 1,419 college students and found 14.4% had experienced
paruresis, either incidentally or continuously.
Other
names
Paruresis is
also known by many colloquial terms, including bashful bladder,"wandering
bladder", bashful kidneys, mental cloggery, stage fright, pee fright, urophobia,
pee-shyness, the slow dribbles, creeping pee-pee, public piss syndrome, shy
bladder syndrome.
General
recognition
There is
growing recognition of the condition by the UK's National Health Service (NHS)
and government. The condition is catered for in the rules for mandatory urine
testing for drugs in UK prisons, and UK Incapacity Benefit tribunals also
recognise it. It is listed in the NHS on-line encyclopaedia of conditions and
disorders. It is now reported to have been accepted as a valid reason for jury
service excusal.[3] From 1 August 2005, the guidance on the rules relating to
the testing of those on probation in the UK explicitly cites paruresis as a
valid reason for inability to produce a sample which is not to be construed as a
refusal.
The
condition is recognised by the American Urological Association, who include it
in their on-line directory of conditions.
It has, from
time to time been the topic of advice columns such as Ann Landers, to which
sufferers have written in and been counselled on their
problem.
In the US
Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), it is
classified as a form of social phobia also known as being a type of chronic
social anxiety, but that is disputed by some
clinicians.
Context and
urine samples
Observed urine tests can be problematic
for those with paruresis.
There can be serious difficulties with workplace
drug testing where observed urine samples are insisted upon, if the testing
regime does not recognise and cater for the condition. In the UK, employees have
a general right not to be unfairly dismissed, and so have an arguable defence if
this arises, but this is not the case everywhere.
There is
growing evidence to suggest that some drug testing authorities find paruresis a
nuisance, and some implement "shy bladder procedures" which pay no more than lip
service to the condition, and where there is no evidence that they have
conducted any real research into the matter. In the U.S. Bureau of Prisons, the
Code of Federal Regulations provides that "An inmate is presumed to be unwilling
if the inmate fails to provide a urine sample within the allotted time period.
An inmate may rebut this presumption during the disciplinary process." Although
U.S. courts have ruled that failure to treat properly diagnosed paruresis might
violate prisoner's constitutional rights, the courts have also "routinely
rejected suspicious or unsubstantiated attempts to invoke it in defense of
failure to complete drug testing," particularly when there were no medical
record or physician testimony to back up the claim of paruresis.[8] The
International Paruresis Association stresses the importance of medical
documentation of one's condition since "the person who is unable to produce a
urine sample is presumed guilty in the absence of any evidence." Some prisons
have offered the use of a "dry cell" — i.e., a cell with no toilet facilities,
but only a container for the prisoner's waste — as an accommodation to inmates
who are hindered by paruresis from providing an observed urine
sample.
The codes
and procedures for drug testing in sports are set by the World Anti-Doping
Agency (WADA). Enquiries to WADA reveal that their doping codes do not cater for
the condition at all, and they say they have never had any reports of problems
with it.
Treatment
Monroe Weil,
Ph.D., a psychologist, has described a method he developed for treating
paruresis by the use of breath holding combined with in vivo desensitization.
The International Paruresis Association, an important resource for paruretics,
has information about this method on their website. Also, many videos have been
posted to YouTube by various individuals demonstrating their approaches to this
method. Medication is also an option, SSRI drugs like Prozac, Zoloft, Paxil,
etc. can be beneficial, and benzodiazepines such as Xanax, Valium, or Klonopin
can be used before the drug test or while in public to relax the muscles and
bring the anxiety level down enough to where you can produce a
sample.
In popular
culture
Video-x-generic.svg This film-related list is incomplete; you
can help by expanding it.
The
condition has been occasionally portrayed in popular culture, sometimes for
comedic effect or parody. Examples of this include:
Throughout the comedy
series Scrubs, the central character, Dr. John "J.D." Dorian, suffers paruresis
whenever he is in the presence of his mentor, Dr. Perry Cox.
A series 5
episode of the TV show Screenwipe presented by Charlie Brooker uses paruresis as
a subject in a parody of 'mission-documentaries' fronted by Konnie Huq. Although
the concept of mission-docs is being lampooned, it appears that information
about and interviews with sufferers of the condition are genuine.
In the
children's TV cartoon Chowder in the episode "The Vacation", the titular
character is shown to have severe paruresis when he becomes locked in a bathroom
with Mung Daal and Schnitzel while having to urinate, but can't do it because of
the lack of privacy. In a comedic scene, Chowder makes the other two turn
around, cover their eyes, and even sing out loud to drown out the noises of the
urination, but it doesn't work, causing Chowder to then inflate to a huge size
with urine. They then all fear that Chowder will "explode" and the other two
characters will drown in urine, and the rest of the episode focuses on this
fictional crisis.
In the 2011 comedy movie The Change-Up, the protagonists
Mitch and Dave, who have switched bodies paranormally after urinating in a
fountain and wishing they had each other's lives, have to urinate in the same
fountain again to revert to their original bodies. They find the fountain has
been moved to the inside of a shopping mall, where they have to expose
themselves and do this in full public view with security guards in pursuit.
Mitch in Dave's body has trouble urinating claiming to be completely "locked up"
because of all the horrified onlookers. Once the two characters resolve their
conflicts, Mitch in Dave's body is then released from the paruretic symptoms and
they complete the wish to change back. After this, the lights all go out, giving
them an escape. (It remains unclear whether the paruresis was associated with
Mitch's consciousness or Dave's body.)
In the 2008 comedy Sex Drive, the
main character Ian has to urinate into the radiator to fix the car they are
traveling in, but is unable to do so. His friend Lance refers to this as "stage
fright". Later in the movie when the two get arrested, Ian overcomes this and is
able to go freely in the holding cell. Lance praises him for overcoming the
phobia.
In the 2006 comedy Clerks 2, Jay is behind the restaurant where he
tries to urinate, referring to it as "public piss syndrome". He asks Silent Bob
for complete silence where Bob gives him an awkward look and Jay tells him to
look away and not look at his penis. Directly after, twice, he gets hit with the
door by both Dante and Randal and then again by Becky where it is revealed that
Becky is pregnant and Dante has told Randal.
In the 2003 comedy The In-Laws,
Jerrey is confronted in a public toilet and claims to have shy bladder.
In
the 2005 comedy Waiting..., Calvin's paruresis is depicted as a major problem in
his social life. The 2009 sequel, Still Waiting..., shows how once the problem
is overcome, Calvin's life changes completely.
In the comic series The Big
Bang Theory, season 4, episode 22, Penny is shown experiencing bladder shyness,
while Amy attempts to indulge in toilet conversation. Amy begins to talk about
the subject of bladder shyness but Penny stops her, asking her to be quiet. She
eventually gives up, planning on "trying again later".
In episode 14 of the
first season of Friends, Chandler pesters Joey, while the latter tries to
urinate. Joey begs Chandler to cease the disturbance, claiming that he needs to
concentrate in order to urinate.
In a 2006 comic strip Dilbert, the namesake
of the strip is required to give a urine sample at work and he says that he is
unable due to "shy bladder
have to use the cubicles?
cant go if you hear even the slightest noise?
Have to try to think of something else to keep your mind off?
been really bursting but had to walk out of toilet because you couldn't go?
had to wait for the cubical even know the urinal was totally free?
feel Anxious?
Paruresis (pron.: /ˌpɑrəˈriːsɪs/ PAR-ə-REE-sis) is a type of phobia in which the
sufferer is unable to urinate in the (real or imaginary) presence of others,
such as in a public restroom. The analogous condition that affects bowel
movement is called parcopresis.
Impact
Some people
have brief, isolated episodes of urinary difficulty in situations where other
people are in close proximity. Paruresis, however, goes beyond simple shyness,
embarrassment, fear of exposure, or fear of being judged for not being able to
urinate. Other people may find that they are unable to urinate while in moving
vehicles, or are fixated on the sounds of their urination in quiet restrooms or
residential settings. In severe cases, a person with paruresis can urinate only
when alone at home or through the process of
catheterization.
Although
most sufferers report that they developed the condition in their teenage years,
it can strike at any age. Also, because of the differing levels of severity from
one person to another, some people's first experience of the problem is when,
for the first time, they "lock up" attempting to produce a sample for a drug
test. Many women are unaware that they, too, are subject to paruresis; articles
about women and urination emphasize other female urinary dysfunctions, such as
urinary incontinence or frequent urination.
Some people
cope by deliberately holding in their urine, by refraining from drinking
liquids, or locating unoccupied or single-occupancy public
bathrooms.
Severe cases
of this disorder can have highly restricting effects on a person's life. In
moderate to severe cases, overcoming paruresis can be extremely difficult
without the help of a psychologist, therapist or support groups. Severe
sufferers may not be willing to travel far from their home or be able to form
intimate relationships. Others cannot urinate even in their own home if someone
else can be heard to be there.
Origin of
the term
The term
paruresis was coined by Williams and Degenhart (1954) in their paper "Paruresis:
a survey of a disorder of micturition" in the Journal of General Psychology
51:19-29. They surveyed 1,419 college students and found 14.4% had experienced
paruresis, either incidentally or continuously.
Other
names
Paruresis is
also known by many colloquial terms, including bashful bladder,"wandering
bladder", bashful kidneys, mental cloggery, stage fright, pee fright, urophobia,
pee-shyness, the slow dribbles, creeping pee-pee, public piss syndrome, shy
bladder syndrome.
General
recognition
There is
growing recognition of the condition by the UK's National Health Service (NHS)
and government. The condition is catered for in the rules for mandatory urine
testing for drugs in UK prisons, and UK Incapacity Benefit tribunals also
recognise it. It is listed in the NHS on-line encyclopaedia of conditions and
disorders. It is now reported to have been accepted as a valid reason for jury
service excusal.[3] From 1 August 2005, the guidance on the rules relating to
the testing of those on probation in the UK explicitly cites paruresis as a
valid reason for inability to produce a sample which is not to be construed as a
refusal.
The
condition is recognised by the American Urological Association, who include it
in their on-line directory of conditions.
It has, from
time to time been the topic of advice columns such as Ann Landers, to which
sufferers have written in and been counselled on their
problem.
In the US
Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), it is
classified as a form of social phobia also known as being a type of chronic
social anxiety, but that is disputed by some
clinicians.
Context and
urine samples
Observed urine tests can be problematic
for those with paruresis.
There can be serious difficulties with workplace
drug testing where observed urine samples are insisted upon, if the testing
regime does not recognise and cater for the condition. In the UK, employees have
a general right not to be unfairly dismissed, and so have an arguable defence if
this arises, but this is not the case everywhere.
There is
growing evidence to suggest that some drug testing authorities find paruresis a
nuisance, and some implement "shy bladder procedures" which pay no more than lip
service to the condition, and where there is no evidence that they have
conducted any real research into the matter. In the U.S. Bureau of Prisons, the
Code of Federal Regulations provides that "An inmate is presumed to be unwilling
if the inmate fails to provide a urine sample within the allotted time period.
An inmate may rebut this presumption during the disciplinary process." Although
U.S. courts have ruled that failure to treat properly diagnosed paruresis might
violate prisoner's constitutional rights, the courts have also "routinely
rejected suspicious or unsubstantiated attempts to invoke it in defense of
failure to complete drug testing," particularly when there were no medical
record or physician testimony to back up the claim of paruresis.[8] The
International Paruresis Association stresses the importance of medical
documentation of one's condition since "the person who is unable to produce a
urine sample is presumed guilty in the absence of any evidence." Some prisons
have offered the use of a "dry cell" — i.e., a cell with no toilet facilities,
but only a container for the prisoner's waste — as an accommodation to inmates
who are hindered by paruresis from providing an observed urine
sample.
The codes
and procedures for drug testing in sports are set by the World Anti-Doping
Agency (WADA). Enquiries to WADA reveal that their doping codes do not cater for
the condition at all, and they say they have never had any reports of problems
with it.
Treatment
Monroe Weil,
Ph.D., a psychologist, has described a method he developed for treating
paruresis by the use of breath holding combined with in vivo desensitization.
The International Paruresis Association, an important resource for paruretics,
has information about this method on their website. Also, many videos have been
posted to YouTube by various individuals demonstrating their approaches to this
method. Medication is also an option, SSRI drugs like Prozac, Zoloft, Paxil,
etc. can be beneficial, and benzodiazepines such as Xanax, Valium, or Klonopin
can be used before the drug test or while in public to relax the muscles and
bring the anxiety level down enough to where you can produce a
sample.
In popular
culture
Video-x-generic.svg This film-related list is incomplete; you
can help by expanding it.
The
condition has been occasionally portrayed in popular culture, sometimes for
comedic effect or parody. Examples of this include:
Throughout the comedy
series Scrubs, the central character, Dr. John "J.D." Dorian, suffers paruresis
whenever he is in the presence of his mentor, Dr. Perry Cox.
A series 5
episode of the TV show Screenwipe presented by Charlie Brooker uses paruresis as
a subject in a parody of 'mission-documentaries' fronted by Konnie Huq. Although
the concept of mission-docs is being lampooned, it appears that information
about and interviews with sufferers of the condition are genuine.
In the
children's TV cartoon Chowder in the episode "The Vacation", the titular
character is shown to have severe paruresis when he becomes locked in a bathroom
with Mung Daal and Schnitzel while having to urinate, but can't do it because of
the lack of privacy. In a comedic scene, Chowder makes the other two turn
around, cover their eyes, and even sing out loud to drown out the noises of the
urination, but it doesn't work, causing Chowder to then inflate to a huge size
with urine. They then all fear that Chowder will "explode" and the other two
characters will drown in urine, and the rest of the episode focuses on this
fictional crisis.
In the 2011 comedy movie The Change-Up, the protagonists
Mitch and Dave, who have switched bodies paranormally after urinating in a
fountain and wishing they had each other's lives, have to urinate in the same
fountain again to revert to their original bodies. They find the fountain has
been moved to the inside of a shopping mall, where they have to expose
themselves and do this in full public view with security guards in pursuit.
Mitch in Dave's body has trouble urinating claiming to be completely "locked up"
because of all the horrified onlookers. Once the two characters resolve their
conflicts, Mitch in Dave's body is then released from the paruretic symptoms and
they complete the wish to change back. After this, the lights all go out, giving
them an escape. (It remains unclear whether the paruresis was associated with
Mitch's consciousness or Dave's body.)
In the 2008 comedy Sex Drive, the
main character Ian has to urinate into the radiator to fix the car they are
traveling in, but is unable to do so. His friend Lance refers to this as "stage
fright". Later in the movie when the two get arrested, Ian overcomes this and is
able to go freely in the holding cell. Lance praises him for overcoming the
phobia.
In the 2006 comedy Clerks 2, Jay is behind the restaurant where he
tries to urinate, referring to it as "public piss syndrome". He asks Silent Bob
for complete silence where Bob gives him an awkward look and Jay tells him to
look away and not look at his penis. Directly after, twice, he gets hit with the
door by both Dante and Randal and then again by Becky where it is revealed that
Becky is pregnant and Dante has told Randal.
In the 2003 comedy The In-Laws,
Jerrey is confronted in a public toilet and claims to have shy bladder.
In
the 2005 comedy Waiting..., Calvin's paruresis is depicted as a major problem in
his social life. The 2009 sequel, Still Waiting..., shows how once the problem
is overcome, Calvin's life changes completely.
In the comic series The Big
Bang Theory, season 4, episode 22, Penny is shown experiencing bladder shyness,
while Amy attempts to indulge in toilet conversation. Amy begins to talk about
the subject of bladder shyness but Penny stops her, asking her to be quiet. She
eventually gives up, planning on "trying again later".
In episode 14 of the
first season of Friends, Chandler pesters Joey, while the latter tries to
urinate. Joey begs Chandler to cease the disturbance, claiming that he needs to
concentrate in order to urinate.
In a 2006 comic strip Dilbert, the namesake
of the strip is required to give a urine sample at work and he says that he is
unable due to "shy bladder
