L ast December, Tom Smith was fired from his job at Caterpillar, Inc., because he was unable to urinate for a drug test. Smith suffers from shy bladder syndrome (paruresis), a condition characterized by trouble using a bathroom away from home. Now he's fighting back. He passed an "independent hair" drug test that he paid for himself (which is more accurate than the urine drug test), and is suing Caterpillar, contending that it violated the Americans with Disabilities Act.

THE SECRET PHOBIA

I was surprised to learn that 7% of the American population -- 17 million men, women and children -- have paruresis, which is recognized as a social phobia by the American Psychiatric Association. These individuals suffer mostly in silence, hiding their disorder from friends and family members.

People with shy bladder syndrome find it difficult or even impossible to urinate in the presence of others. Visiting a public restroom at a movie theater or baseball game can be a nightmare. Some even experience difficulties at the private homes of friends or in their own home when guests visit.

The good news is that those with paruresis need not suffer in silence. According to Steven Soifer, PhD, MSW, associate professor of social work at the University of Maryland in College Park, president of the International Paruresis Association and author of Shy Bladder Syndrome: Your Step-by-Step Guide to Overcoming Paruresis (New Harbinger), paruresis is nothing to be ashamed of and there are steps you can take to overcome this condition.

THE ROOT OF SHY BLADDER SYNDROME

When you look at the social pressures surrounding using a public restroom, the impact of paruresis becomes very clear...

• For men: There is virtually no privacy in public restrooms. Urinals create anxiety in some men, says Dr. Soifer.
• For women: The cultural pattern of women going to the bathroom in groups can cause problems for females with paruresis. Dr. Soifer says that some women become agoraphobic or housebound because they are so fearful about being pressured to use a public restroom in the company of colleagues or friends.
• For children: Children can develop shy bladder syndrome in public schools, where cleanliness is an issue, stalls often lack doors or locks and there may be bullying or intimidation.

COPING WITH PARURESIS

How do people cope with shy bladder syndrome? They urinate as much as possible before leaving home... drink few fluids when out... and avoid lengthy social or business commitments. Not surprisingly, this can be very disruptive to one's family, social and professional life.

The first step is to see your health-care provider to rule out underlying medical conditions. For example, older men often have prostate problems and consequent difficulties with urination. Generally speaking, if you have no problem going to the bathroom at home alone but have difficulty using public restrooms, chances are you have shy bladder syndrome. Dr. Soifer says that researchers are only beginning to explore possible physical underpinnings -- but he would not be surprised to discover a physical reason for shy bladder syndrome, since most people with this problem suffer from no other psychological disorder.

Treatment can take place on an individual basis or in workshops. Dr. Soifer recommends either a weekend workshop or eight to 12 sessions of therapy. You also can tackle the problem on your own, in which case it is best to enlist the help of a buddy.

BEHAVIORAL EXPOSURE THERAPY

With behavioral exposure therapy, Dr. Soifer notes that there is an 80% to 90% success rate in conquering paruresis. In a series of gradual exposure exercises, a person slowly learns to urinate in increasingly challenging locations.

Note: It helps to jumpstart this process by drinking plenty of fluids, so the urge to urinate will be strong.

Many participants find workshops to be a phenomenally liberating experience, observes Dr. Soifer. He says that just attending one often is half the battle. He has seen grown men cry with relief when they realize that other people also suffer from this condition and that there is something they can do about it.

Of course, not everyone is helped by behavioral exposure therapy. Dr. Soifer notes that some people have co-existing conditions, such as depression or other phobias, and often must get control of these problems in order to overcome shy bladder syndrome. In a South African study, 25% of those with shy bladder syndrome also had a generalized social phobia -- but 75% had no other problems.

The bottom line? Don't suffer in silence. If you have shy bladder syndrome, help is available. To learn more about therapists, workshops, support groups and self-treatment, call 800-247-3864 or visit www.paruresis.org.

Source

• Steven Soifer, PhD, MSW, associate professor of social work, University of Maryland, College Park, president, International Paruresis Association and author of The Shy Bladder Syndrome: Your Step-By-Step Guide to Overcoming Paruresis (New Harbinger). To learn more about paruresis, visit www.paruresis.org