Is "shy bladder syndrome" (paruresis) correctly classified as social phobia?

Name avoidance in social anxiety: Understanding alexinomia

Emerging evidence suggests that certain individuals are unable to address others by name, presumably owing to anxiety experienced in social situations. This fear of using personal names has been termed alexinomia and occurs in all forms of relationships and communication. The symptoms of alexinomia show large overlap with the symptoms typically associated with social anxiety, raising the question of whether social anxiety could be the main driving factor of this type of name avoidance. Here, we investigated the relationship between alexinomia and social anxiety by testing name avoidance behavior in a sample of 190 participants with varying degrees of social anxiety. Results showed a strong positive relationship between these two variables. High levels of social anxiety, as measured by two independent standardized psychological instruments (i.e., the Social Interaction Anxiety Scale and the Liebowitz Social Anxiety Scale), were associated with higher degrees of fear-based name avoidance. This was shown by regression analysis as well as analyses of group differences. The findings indicate that alexinomia could be a common symptom in socially anxious individuals that so far has not been discussed in the psychological literature on social anxiety.

Exploring paruresis ('shy bladder syndrome') and factors that may contribute to it: a cross-sectional UK survey study

OBJECTIVES

To assess the prevalence and severity of paruresis ('shy bladder syndrome') in a population of university staff and students and to determine if there was any relationship between demographics, self-esteem, presence of social anxiety disorders and negative toilet experiences and paruresis.

DESIGN

We undertook an anonymised cross-sectional online survey using Microsoft Forms. We invited participants aged 18 and over to complete the survey which included demographic information; any pre-existing medically or self-diagnosed anxiety-related conditions; Shy Bladder Scale (SBS); Rosenberg Self-Esteem Scale (RSES) and questions about using school toilets in their younger life. We defined 'mild' and 'severe' paruresis based on total SBS cut-off scores of greater than or equal to 31 and greater than or equal to 40. We calculated prevalence of paruresis, and explored differences in self-esteem, school toilet experience and social anxiety disorders between individuals with and without paruresis. Multivariable logistic regression was used to determine which variables had any influence on having a 'mild' and 'severe' paruresis diagnosis.

SETTING

We distributed the survey to all staff and students via their university email address as well as promoting the survey on university social media sites.

RESULTS

We received responses from 356 individuals. Most participants (237, 66.6%) were within the 18-30 year age category and most (277, 77.8%) were white. There were 221 (62.1%) females, 119 (33.4%) males and 16 (4.5%) other genders. The prevalence of 'mild' paruresis was 25.8% and of 'severe' paruresis 14.9% in this sample. 73.0% indicated that they had at least one medically or self-diagnosed anxiety disorder. There was a statistically significant difference in the total SBS score between individuals with and without an existing anxiety disorder (8 vs 19, <0.001). The adjusted odds of 'mild' paruresis were higher for men than women (OR 3.39; 95% CI 1.90 to 6.06), lower for those with a lower RSES score (OR 0.90; 95% CI 0.85 to 0.96), lower for those for a lower school toilet experience score (OR 0.88; 95% CI 0.78 to 0.99) and higher for those with at least one anxiety disorder (OR 3.164; 95% CI 1.52 to 6.59). The adjusted odds of 'severe' paruresis were higher for men than women (OR 2.60; 95% CI 1.32 to 5.12), lower for those with a lower RSES score (OR 0.90; CI 0.84 to 0.97) and higher for those with at least one anxiety disorder (OR 2.99 (1.18-7.56)).

CONCLUSION

Large organisations should consider measures to help manage anxiety and improve toilet experiences. These could include resources and signposting to manage anxiety disorders and single-occupancy toilets and toilets in quiet areas to limit anxiety associated with shy bladder syndrome.

Can we predict and manage persistent storage and voiding LUTS following bladder outflow resistance reduction surgery in men? ICI-RS 2023

AIMS

Lower urinary tract symptoms (LUTS) persist in up to 50% of patients after bladder outflow resistance reduction surgery (BORRS) in men. Our think tank aims to address the predictive factors for persistent LUTS after BORRS and to propose the recommendations for future research to enable improved better patient counseling and selection by more accurate prediction of treatment outcome.

METHODS

A think tank of ICI-RS gathered in 2023, Bristol, UK, to discuss the pre and postsurgical clinical and urodynamic evaluation of men undergoing BORRS and whether it is possible to predict which men will have persistent LUTS after BORRS.

RESULTS

Our think tank agrees that due to the multifactorial, and still not fully understood, etiology of male LUTS it is not possible to precisely predict in many men who will have persistent LUTS after BORRS. However, severe storage symptoms (overactive bladder, OAB) in association with low volume and high amplitude detrusor overactivity and low bladder capacity in preoperative urodynamics, increase the likelihood of persistent OAB/storage symptoms after BORRS. Furthermore, patients who are clearly obstructed and have good bladder contractility on preoperative pressure flow studies do better postoperatively compared to their counterparts. However, the benefit of pressure flow studies is decreased in patients who do not acceptably void during the study. Poor voiding after BORRS may occur due to persistent obstruction or detrusor underactivity.

CONCLUSION

Future research is needed to increase our understanding of why male LUTS persist after surgery, and to enable better patient selection and more precise patient counseling before BORRS.

Yoga practices in Social Anxiety Disorder (SAnD): A case report WSR to paruresis

Social anxiety disorder has characteristic features of the overwhelming anxiety and apprehensions especially in public gatherings. There is always a false perception in mind that someone is continuously watching, noticing or judging their activities. Many of times the situation is associated with some unusual behavioral problem like shy bladder syndrome, in which the person even cannot urinate in public restrooms. In the present case report, a patient was suffering from paruresis-specific social phobia. After administration of Yogasana, Pranayam, Omkar chanting and meditation practices by him under the supervision of yoga experts, significant improvement was noticed in multiple parameters. Subjective assessment on different scales was done before and after yogabhyasa. By regular yoga practices Liebowitz Social Anxiety Scale (LSAS) score was reduced 60.97%, Social Phobia Inventory (SPIN) score was reduced 56.25%, Shy Bladder Scale (SBS) score was reduced up to 59.42% and WHO Quality of life questionnaire- WHO QoL- BREF score was improved 56.81% in physical domain (D1), 34% in psychological domain (D2), 10.34% in social relationship domain and 27.91% in environment domain (D4). Hence, it can be concluded that yoga and meditation practices may play a good role in Social anxiety cases.

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Paruresis-specific social phobia is rare clinical entity. Here, we managed such a case fighting with this specific problem.

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We administered a specific tailored yoga and meditation module for six months.

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We found improvement in Liebowitz Social Anxiety Scale (LSAS) score, Social Phobia Inventory (SPIN) score, Shy Bladder Scale (SBS) score and WHO QoL- BREF score.

When should the driver with a history of substance misuse be allowed to return to the wheel? A review of the substance misuse section of the Australian national guidelines

Assessing fitness to drive in applicants with a historical or current substance use disorder presents a specific clinical challenge. The Australian guidelines require evidence of remission and absence of cognitive change when considering applications for re-licensing driver or individuals applying to reengage in safety-sensitive work. This paper reviews some of the clinical and biochemical indicators that determine whether a particular person is in 'remission' and meets the criteria for return to driving or other safety-sensitive occupation. It provides an overview of the challenges in establishing an evidence-based approach to determining fitness for safety critical activities. There is no internationally accepted definition of 'remission'. Review of the literature and examination of assessment protocols from other national jurisdictions are available for alcohol and the more important drugs of interest in road safety. Assessing fitness to drive when there is a history of substance misuse and/or substance use disorders is a complex issue that requires assessment of biomarkers, clinical findings and clinical assessment before the person returns to driving. We propose that hair testing provides a reliable and reproducible way to demonstrate remission and provide cost-effective monitoring. Standardised psychological tests could provide a reproducible assessment of the cognitive effects of drug use and suitability to resume driving. We recommend that AustRoads amend the national guidelines to reflect an evidence-based approach to assessing fitness to drive after conviction for offences related to alcohol and drug use.

Development and validation of the Shy Bladder and Bowel Scale (SBBS)

Currently research exploring paruresis and parcopresis, anxiety relating to urinating and having bowel motions in public respectively is limited. While there are several validated measures of paruresis, no valid measure assessing parcopresis is currently available. The present study investigates the development and validation of the Shy Bladder and Bowel Scale (SBBS) which assesses both paruresis and parcopresis. Two participant groups were utilised to validate this scale, a student psychology cohort (n = 387) and a public cohort (n = 334). An eight-item two-factor model was identified in the psychology cohort and confirmed in the public cohort. The two-factor SBBS was found to be a valid and reliable measure of paruresis and parcopresis. Paruresis and parcopresis-related concerns were associated with social anxiety in both cohorts. Subscales for both paruresis and parcopresis (i.e. difficulty, interference and distress) were positively correlated, suggesting individuals are likely to report similar levels of concerns across both conditions. Further, individuals self-identifying with either paruresis or parcopresis reported significantly higher scores on the respective SBBS subscales than non-identifying paruresis and parcopresis individuals. The SBBS also demonstrated strong test–retest reliability in a small sample of adults (n = 13). Overall, the developed scale provides clinicians and researchers with a valuable tool to evaluate both paruresis and parcopresis.

A systematic review of paruresis: Clinical implications and future directions

OBJECTIVE

Paruresis refers to the inability to initiate or sustain urination where individuals are present due to the fear of perceived scrutiny from others. The aim of this systematic review was to evaluate four key questions: (1) What is the prevalence of paruresis and its associated demographic features; (2) What is the prevalence of psychopathology in paruresis cohorts, how does it compare to other chronic-health conditions, and what percentage of paruresis patients also have social anxiety disorder? (3) How does quality of life, and levels of anxiety and depression compare between those with and without paruresis; and (4) do psychological interventions for paruresis patients reduce paruresis symptoms, or, anxiety, or depression, or improve quality of life?

METHOD

A review was conducted using PRISMA protocol for search strategy, selection criteria, and data extraction. Searched databases included PubMed, CINAHL, and PsychINFO. Over the 1418 studies screened, ten were found relating to at least one review question.

RESULTS

The prevalence of paruresis ranged between 2.8 and 16.4%, and around 5.1-22.2% of individuals with paruresis also had Social Anxiety Disorder. Paruresis symptoms were shown to reduce in one intervention study. Paruresis was also associated with poorer quality of life. A key limitation of the research to date has been the notable methodological problems and lack of standardisation relating to the measurement of paruresis.

CONCLUSION

Little is known about the prevalence of paruresis and more rigorous studies of paruresis are required. Recommendations in terms of clinical implications, diagnostic criteria and future research relating to paruresis are discussed.

Cognitive Behavioural Therapy for Paruresis or “Shy Bladder Syndrome”: A Case Study

Background: Paruresis, or “shy bladder syndrome”, is a relatively common anxiety disorder, yet little is known about the causes of, and effective treatments for this disabling condition. Aim: This report describes a case study in which a man (Peter) presenting with paruresis was treated using formulation-driven CBT, which aimed to address the idiosyncratic processes that were maintaining his anxiety and avoidance of urinating in public. Method: Peter attended 12 sessions of CBT including one follow-up session a month after treatment had ended. Treatment involved collaboratively developing an idiosyncratic case conceptualization (identifying longitudinal and cross-sectional factors involved in the development and maintenance of his difficulties), followed by a number of standard cognitive and behavioural interventions commonly used in evidence-based CBT protocols for other anxiety disorders. Peter completed sessional outcome measures of paruresis symptomatology, anxiety, depression, social anxiety and functional impairment. Results: Peter subjectively found the intervention helpful and his scores on all of the outcome measures reduced over the course of his therapy, and were maintained at one month follow-up. Conclusions: This report adds to the scarce literature regarding effective treatments for individuals suffering with paruresis. Limitations of the design are acknowledged and ideas for further research in this area are discussed.

Social anxiety disorder: questions and answers for the DSM-V

BACKGROUND

This review evaluates the DSM-IV criteria of social anxiety disorder (SAD), with a focus on the generalized specifier and alternative specifiers, the considerable overlap between the DSM-IV diagnostic criteria for SAD and avoidant personality disorder, and developmental issues.

METHOD

A literature review was conducted, using the validators provided by the DSM-V Spectrum Study Group. This review presents a number of options and preliminary recommendations to be considered for DSM-V.

RESULTS/CONCLUSIONS

Little supporting evidence was found for the current specifier, generalized SAD. Rather, the symptoms of individuals with SAD appear to fall along a continuum of severity based on the number of fears. Available evidence suggested the utility of a specifier indicating a "predominantly performance" variety of SAD. A specifier based on "fear of showing anxiety symptoms" (e.g., blushing) was considered. However, a tendency to show anxiety symptoms is a core fear in SAD, similar to acting or appearing in a certain way. More research is needed before considering subtyping SAD based on core fears. SAD was found to be a valid diagnosis in children and adolescents. Selective mutism could be considered in part as a young child's avoidance response to social fears. Pervasive test anxiety may belong not only to SAD, but also to generalized anxiety disorder. The data are equivocal regarding whether to consider avoidant personality disorder simply a severe form of SAD. Secondary data analyses, field trials, and validity tests are needed to investigate the recommendations and options.

Paruresis (shy bladder syndrome): a cognitive-behavioral treatment approach

Paruresis is a social anxiety disorder characterized by a fear of being unable to urinate in the presence of others. This condition has not been covered in the social work literature, yet is a perfect example of a person-in-environment problem. This article explores the use of graduated exposure therapy during weekend-long workshops for the treatment of paruresis. One hundred one participants participated in workshops and were administered pretreatment, posttreatment, and 1-year follow-up treatment scales. Repeated measures analysis of variance indicated significant improvement in shy bladder symptoms. Significant improvement in global severity of shy bladder was observed posttreatment and at the 1-year follow-up point. Findings suggest that graduated exposure therapy improves self-reported global severity of shy bladder symptoms and that these gains were maintained at 1-year follow up.

Entwicklung einer Skala zur Erfassung psychogenen Harnverhaltens bei Athletinnen und Athleten während der Dopingkontrollen

Zusammenfassung. In diesem Beitrag werden Ergebnisse einer Studie zur Entwicklung eines Fragebogens mit dem Ziel der Erfassung psychogenen Harnverhaltens bei Athletinnen und Athleten während der Dopingkontrollen im Sport berichtet. Hierzu wurde auf Basis von Interviews mit Dopingkontrolleurinnen und -kontrolleuren sowie Athletinnen und Athleten ein Fragebogen entwickelt, welcher Probleme in Dopingkontrollsituationen erfragt. Sowohl der neu entwickelte Fragebogen als auch die Paruresis-Skala ( Hammelstein & Pietrowsky, 2005 ) und das State-Trait-Angstinventar ( Laux, Glanzmann, Schaffner & Spielberger, 1970 ) wurden von 42 männlichen und 41 weiblichen Athleten online ausgefüllt. Nach Reduzierung der Items von 71 auf 47 zeigt eine forcierte exploratorische Faktorenanalyse bei 5 Faktoren eine Gesamtvarianzaufklärung von 59.95 %. Skalenreliabilitäten liegen zwischen α = .94 und α = .62. Weiterhin finden sich signifikant positive Korrelationen zur Paruresis-Skala und zum State-Trait-Angstinventar. Eine Partialkorrelation unter Kontrolle der Paruresis verhindert jedoch eine signifikante Korrelation zwischen psychogenem Harnverhalten bei Dopingkontrollen und Trait-Angst. Gruppenunterschiede zwischen Athletinnen bzw. Athleten mit und ohne Paruresis-Problematik zeigen signifikante Ergebnisse hinsichtlich des Ausmaßes des psychogenen Harnverhaltens während der Dopingkontrollen. Aufgrund der hohen Eigenwertsdifferenz zwischen dem ersten und dem zweiten Faktor ist über eine einfaktorielle Lösung nachzudenken. Jedoch deuten die Ergebnisse insgesamt auf ein vielschichtigeres Konstrukt hin als bislang angenommen.

Paruresis (psychogenic inhibition of micturition): cognitive behavioral formulation and treatment

Paruresis is a condition characterized by difficulty or inability to urinate in situations where others are present, or may soon be present. Despite knowledge that paruresis can significantly impact on occupational functioning, social functioning, and quality of life, there exists a paucity of research into effective treatments. Although cognitive conceptualizations have been advanced for other anxiety disorders, there has not been a comprehensive cognitive behavioral model of paruresis. This article presents a revised cognitive and behavioral conceptualization of paruresis, drawing on empirical evidence from other anxiety disorders. Using this conceptualization, a cognitive-behavioral intervention strategy is outlined, with clear targets for cognitive and behavioral strategies.

¿Qué es la Paruresis o Síndrome de la Vejiga Tímida? Una investigación transdisciplinar

This paper checks typical aspects of Paruresis or Shy Bladder Syndrome, disease defined as the impossibility or difficulty to urinate in public toilets. We analyze the definition, differences, degrees, nature, etiology, traditional treatments, myths about the origin, and so on; but two are the main contributions of this transdisciplinary research: first, the description of the paruretic's daily life, which main core is the concealment of paruresis; and second: we offer an alternative to paruretic community, that is beneficial to other stigmatized groups, Coming out of the closet, process that starts in self-help groups.