The Fear of Using Public Toilets (Paruresis) - By Russell Gibbs
The Fear of Using Public Toilets – Paruresis (Public Toilet Anxiety – PTA)
By Russell Gibbs – Psychologist, Port Macquarie, NSW, Australia
This story is one of hope - not only for sufferers of Paruresis, but other performance-based types of social anxiety. Paruresis, or Shy Bladder Syndrome, Bashful Bladder Syndrome, and what I prefer to term Public Toilet Anxiety (PTA), was first described by psychologists Williams and Degenhardt in their 1954 research paper as ‘the difficulty or impossibility of urinating in the presence of others, leading to avoidance of public restrooms’. What is now regarded as a psychosomatic or psychophysiological condition, the inability to successfully void in public facilities was first identified in the medical literature of the early 1900s, as psychogenic urinary retention, predominately or exclusively referring to case studies in women.
The following is a real life story of a former patient, whom we will call Steve to protect his privacy. Steve recalls an incident at school when he was about 13 years of age. He was pushed and shoved into the urinal trough when attempting to urinate, and generally teased by some senior students. This terrifying experience quickly developed into a fear of using the school toilets, and Steve could only go when there was a cubicle (stall) vacant. Most of the time he did not urinate at all while at school.
Thus began the avoidance behaviour that accompanied Steve’s life for the next 30 years – the fear of using public toilets. This pattern of behaviour where one traumatic experience is followed by phobic behaviour is common, although not exclusive. Women too have reported school bullying as a trigger, which appears to usually correlate with the onset of Paruresis.
Paruresis is a secret condition that is slowly being recognised by the general public and the health professions (very slowly!). And yet it appears to be common (research indicates at least 7% of the population), estimated to affect 1.6 million Australians, with impairment ranging from low (inconvenience) to severe (absolute despair and lifestyle restriction). For chronic sufferers typical behaviour includes avoiding most social situations, limiting job choices and restricting personal relationships. Fortunately, over the years Steve was able to manage a reasonably productive and fulfilling lifestyle through developing coping methods for most challenges, but the fear and anguish of anticipating difficult public situations was always there. Steve never told anyone about his problem.
Stephen’s recovery began when he realised two things; firstly the irrationality of his fear of being judged as strange because he could not void normally, and secondly its correlation with his obvious low self-confidence. He began using relaxation techniques learnt in therapy. Steve also approached the problem with a new positive attitude, and over time he could accept failure at the urinal without too much anxiety and self-blame. With professional help he eventually realised that the shyness he experienced from childhood, culminating in a lack of confidence in social situations, contributed to his Public Toilet Anxiety (PTA). Over recent years our anonymous friend made major life decisions involving change and risk that he would once have not taken. Meeting new challenges for people with social anxiety is a difficult road to travel, but when tackled they find that fear can be gradually overcome by developing a positive outlook and continually confronting the threat.
As some people with Paruresis have discovered, the transformation from a life of fear to one of self-contentment with new opportunities, is a lifestyle that could previously be only imagined. Each small step helps in the long journey to recovery. Courage and determination to persist, despite set backs, is necessary; it is hard work, but I would recommend giving it a try if at all possible.
It is now a few years since Steven discovered the condition known as Paruresis and the international networks of web-based support services, including the Paruresis Association of Australia, now found at www.paruresis.org.au . Until then, Steve thought that he was the only one with this weird condition – certainly a lonely, isolated and secret place to be. Like most disorders, owning up and accepting our limitations is a major step on the trail to a better life, and in the case of Paruresis - being able to cope with the normal impulse to relieve oneself.
As a Practitioner in private practice, I studied Paruresis extensively and became inspired in 2004 to conduct the first Australian-based university study on urinary hesitancy. This extensive Internet-based survey was also the first worldwide study and remains the largest and most comprehensive ever undertaken. This research will hopefully provide some new answers as to why people 'freeze up' and cannot 'go', and although it is limited to men (the predominant group), implications for helping women are certain. The results are yet to be officially published, but a summary can be found on this website under http://www.adavic.org/education/articles/paruresis_survey_results.htm or at the International Paruresis Association (IPA) based in the USA, http://www.paruresis.org/research_results_main.htm
I extend my gratitude to Anna and the team for supporting anxiety-based conditions and for posting my web survey details on the 'Research' section of the ADAVIC site in the interests of public information. One of my aims in my professional role as a Registered Psychologist is to promote public knowledge of social anxiety, and in particular Paruresis, and to offer services to assist people on their road to recovery.
To this end I have assisted in conducting three 3-day International Workshops for the Paruresis Association of Australia; the first at Melbourne in 2005 as co-facilitator with Professor Steven Soifer of Maryland University USA; Professor Soifer is the founder and President of the IPA and is recognised as the world leader in the promotion of awareness into Paruresis and travels the world in this task; he handed over the responsibility for running future PAA Workshops to me. The second Workshop took place in 2006 at Sydney and was attended by participants from around Australia and New Zealand; the third was again booked out and took place in Melbourne early in 2007. The next scheduled PAA Workshop will be held in Sydney at the Sydney International Airport Inn February 1-3 2008. PAA President Mr John Reimer will again assist me in the presentation and coordination of the 3-day event. The success rate is always close to 100% in terms of significant individual improvement relative to personal goals. I have just been informed that the 2008 Workshop is fully booked.
Russell Gibbs (Bachelor of Psychology – Honours) December 2007.
Registered Psychologist
Email: gibbs.psychology@bigpond.com
Phone 02 65856311
