Urinating in public can be a source of anxiety for some people, especially among men. In more severe cases, it can take a pathological form. Termed “shy bladder syndrome” (also called paruresis), this pathological form is characterized by a fear of not being able to urinate in public bathrooms or in situations in which others are aware that the person is urinating.
Paruresis is more common among men, and it is strongly associated with the presence of other psychopathologies (i.e., comorbidity), such as social anxiety, obsessive compulsive disorder (OCD) and major depressive disorder (MDD). More interestingly, it has been proposed that paruresis could actually be a subtype of social anxiety.
PARURESIS AND SOCIAL ANXIETY
Indeed, it appears that there are similarities between paruresis and social anxiety in terms of symptoms and triggers. For example, individuals with this syndrome find it most difficult to urinate in public bathrooms when there is a line and in busy public restrooms. In these situations, they experience symptoms of panic attack such as trembling, sweating, shortness of breath, blushing and even nausea.
In addition, these symptoms are not related to concerns with cleanliness or hygiene, which exclude the possibility that it could indicate an obsessive-compulsive disorder.
Furthermore, paruresis appears to have implications for well-being and functioning. Notably, sufferers report negative emotions such as shame and embarrassment, as well as difficulties at work. For example, there are complaints of having to select specific jobs, or even turning down job opportunities due to the condition.
Thus, paruresis is arguably a chronic and disabling condition that share similarities with performance anxiety disorder as performance is the most determining factor in the condition than social interactions. Therefore, paruresis fits the criteria for a subtype of social anxiety disorder.
Reference:
Vythilingum B, Stein DJ, Soifer S. Is “shy bladder syndrome” a subtype of social anxiety disorder? A survey of people with paruresis. Depress Anxiety. 2002;16(2):84-7. doi: 10.1002/da.10061. PMID: 12219340.