Anxiety Social Anxiety Disorder Symptoms and Diagnosis What Is Paruresis? By Arlin Cuncic, MA Arlin Cuncic, MA Arlin Cuncic, MA, is the author of "Therapy in Focus: What to Expect from CBT for Social Anxiety Disorder" and "7 Weeks to Reduce Anxiety." She has a Master's degree in psychology. Learn about our editorial process Updated on February 18, 2022 Learn more." data-inline-tooltip="true"> Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Akeem Marsh, MD Medically reviewed by Akeem Marsh, MD Akeem Marsh, MD, is a board-certified child, adolescent, and adult psychiatrist who has dedicated his career to working with medically underserved communities. Learn about our Medical Review Board Print Sebastian Kopp/EyeEm/Getty Table of Contents View All Table of Contents What Is Paruresis? Causes Effects on Daily Life Severity Treatment A Word From Verywell What Is Paruresis? Paruresis is the fear of public toilets without any medical cause. Paruresis is also known as urophobia, shy kidney, shy bladder, or bashful bladder syndrome (BBS). Paruresis is experienced by women and men of all ages and when severe and untreated can lead to medical complications. Paruresis is considered to be a social phobia. In general, if you live with paruresis, you fear negative evaluation by others related to using public toilets. If this fear is severe and limits your life, it may be diagnosed as social anxiety disorder (SAD). If you live with a medical condition that prevents you from being able to urinate, you would not be diagnosed as having paruresis. Social Anxiety Disorder and Public Restrooms Causes of Paruresis Just as with social anxiety disorder, it is unlikely that there is one cause underlying paruresis. At the same time, there are some experiences that seem to be present for some people with the condition: You may have experienced childhood bullying or had parents who were overly critical.You may have experienced a traumatic episode in which you were not able to urinate when you were supposed to—for example, your doctor or some other professional might have asked you to provide a urine sample. It's also common for paruresis to co-occur with the following mental health conditions: DepressionObsessive compulsive disorderSocial anxiety Common Triggers If you live with paruresis, there are probably some triggers that make it more difficult for you to use a public toilet, including:The restroom you need to use is very busy.The toilet stall lacks proper partitions for privacy.You are feeling particularly anxious, fearful, or pressed for time when trying to use the toilet.Someone is waiting for you while you use the toilet.You have the perception that others are listening while you use the toilet. Effects on Daily Life Paruresis can cause difficulty with travel, social obligations, and professional commitments. If you are constantly concerned about using public toilets, it can leave you feeling out of control and needing to develop strategies to cope. For example, you may find yourself carefully structuring your day so as to avoid using public toilets. You might drink little so that you don't have as much need to urinate. You might also urinate frequently while at home so that you don't have to once you leave the house. Some people also run the tap or flush so that other people cannot hear when they use the toilet. While it may feel helpful to have these coping strategies, in the long term they serve to reinforce the idea that you should fear using the toilet or that your anxiety is warranted. Living With Social Anxiety Disorder Severity of Paruresis For some people, the fear involved in paruresis extends beyond public toilets to using those of friends or family, or even the one in your own home if there are visitors. The impact of paruresis can also range from mild to severe. If you have a mild problem, you are probably unable to urinate in certain circumstances but capable in others. If you have a more severe problem, you might only be able to use the toilet in your own home and when nobody else is visiting. Paruresis is generally a progressive problem, with fear increasing and generalizing over time to more locations. Unless you do something to manage your fear, it will get worse instead of better, placing ever more limits on your life. Treatment of Paruresis The most common form of treatment for paruresis is graduated exposure therapy. Other treatments include cognitive therapy and anti-anxiety medications. Although exposure therapy can be very effective, it is most useful if paruresis is a stand-alone problem and not part of a larger issue with social anxiety. How to Practice Exposure Therapy for Paruresis If you live with a number of social fears, treatment should address problems with self-esteem, self-confidence, and beliefs about your abilities. In addition, before you begin any psychological treatment for paruresis, physical causes should be ruled out by a medical professional. A Word From Verywell Although paruresis can be an embarrassing problem to deal with, through treatment, it is possible to learn to manage your anxiety so that it does not interfere with life on a daily basis. If you or someone you know is living with a fear of using public toilets, speak to your doctor about a referral to a mental health professional. 4 Sources Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Knowles SR, Skues J. Development and validation of the shy bladder and bowel scale (SBBS). Cogn Behav Ther. 2016;45(4):324–338. doi:10.1080/16506073.2016.1178800 Kuoch KLJ, Meyer D, Austin DW, Knowles SR. A systematic review of paruresis: Clinical implications and future directions. J Psychosom Res. 2017;98:122-129. doi:10.1016/j.jpsychores.2017.05.015 Kuoch KL, Austin DW, Knowles SR. Latest thinking on paruresis and parcopresis: A new distinct diagnostic entity?. Aust J Gen Pract. 2019;48(4):212-215. doi:10.31128/AJGP-09-18-4700 Park H, Kim D, Jang EY, Bae H. Desensitization of triggers and urge reduction for paruresis: a case report. Psychiatry Investig. 2016;13(1):161–163. doi:10.4306/pi.2016.13.1.161 Additional Reading Hambrook D, Taylor T, Bream V. Cognitive Behavioural Therapy for Paruresis or “Shy Bladder Syndrome”: A Case Study. Behav Cogn Psychother. 2017 Jan;45(1):79–84. International Paruresis Association (IPA). About Avoidant Paruresis. Soifer S, Himle J, Walsh K. Paruresis (shy bladder syndrome): a cognitive-behavioral treatment approach. Soc Work Health Care. 2010;49(5):494–507. By Arlin Cuncic, MA Arlin Cuncic, MA, is the author of "Therapy in Focus: What to Expect from CBT for Social Anxiety Disorder" and "7 Weeks to Reduce Anxiety." She has a Master's degree in psychology. See Our Editorial Process Meet Our Review Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit