1 August 1998
Public Peeing Problems Put Right
Paruresis, or shy bladder syndrome, affects a surprisingly large number of people. It is thought to be second only to fear of public speaking in the heirarchy of social phobias. Its sufferers are mostly male but viewers of the Ally McBeal show will recognize that it affects females as well. It can compromise a person's social life, make travel difficult if not impossible, even limit job or professional options. Yet it's not a problem people tend to talk about.
Steven Soifer, MSW, PhD, is trying to change that. "Paruresis is where agoraphobia (fear of being in public places) was 20 years ago," Soifer says. "It is one of the most common and least talked-about anxiety disorders. Our goal is to break down the silence surrounding this topic and get people talking about it, so that some day it can be discussed openly like other formerly sensitive issues that deeply affect people's lives."
An associate professor at the University of Maryland School of Social Work and a longtime paruretic, Soifer conducts weekend workshops for people who have trouble peeing in public. His workshops are adaptations of longer-term graduated exposure therapy developed by Joseph Himle, PhD, an anxiety disorders therapist at the University of Michigan.
At Soifer's weekend workshops, participants begin by talking about their experiences, many for the first time. "I always thought I was the only one who had this problem," is a common admission. They learn about the mechanics of a sphincter muscle clenched shut, how forcible efforts actually reduce chances of success, and how subsequent avoidance behaviors, such as refusing social invitations, reinforce the phobia. Throughout the weekend they load up on water, tea and coffee to nurture the urge, and working with trained therapists as well as with "pee-buddies" from the group, they practice using a variety of public restrooms under increasingly stressful conditions. An optional "graduation" is held in the ominous public facilities at a ballpark during a game. Workshop graduates all report improvement, in some cases modest, in others, marked.
Soifer describes his and others' work in treating paruresis in the spring 1998 issue of the ADAA Reporter, the quarterly journal of the Anxiety Disorders Association of America. "This graduated exposure approach seems to be quite effective for the social phobia known as paruresis," he says. The results have yet to pass the test of controlled studies. Even so, says Soifer, "given the number of people potentially suffering from this anxiety disorder, having a relatively simple, effective and quick treatment approach is enormously useful."
Much more research is needed into the causes, prevalence and effective treatment approaches for paruresis, he says. In the meantime, Soifer has made it his mission to bring shy bladder syndrome out of its closet. Further information is available from the "Pee Shy and Bashful Bladder" web site.