vejigaIn 1954, psychologists W. Griffith Williams and Elizabeth T. Degenhardt from Rutgers University in New Jersey (USA) conducted a study with 1400 students, in which they first identified paruresis or ‘shy bladder syndrome’.

This syndrome is characterized by the inability to urinate in the presence of others. It was documented since the Middle Ages, when it was believed that a spell could make an enemy impotent and unable to expel urine.

In modern times, this condition has also been mentioned in the psychiatric literature; not as a syndrome, but as a symptom of another disease, either psychological or at the urinary system.

The study published in the Journal of General Psychology in 1954, found that 14% of the subjects had trouble urinating in front of others. In later years, other work released proportions of between 2.8% and 25%.

In 1975, researchers Bill Rees and Debbie Leach described in a study, published in the Journal of the American College Health Association, three types of discomfort to the public toilets: visual, auditory or olfactory. Women were more affected by noise, while men by what they saw. Each type was classified depending on the severity: from mild, in which paruresis cause a delay in the flow of urine; to severe, when urination was not possible.

Two years after the publication of this study, psychologist Gerald Koocher (former president of the American Psychological Association) questioned the work ethic of Rees and Leach in an article entitled Behavior in the bathroom and human dignity, published in the Journal of Personality and Social Psychology. His arguments caused for many years that studying this peculiar syndrome became irrelevant and none a priority.

Dr. Antonio Prunas, researcher at the Università degli Studi di Milano-Bicocca, Milan, Italy and author of several studies on the syndrome, conducted a thorough search on the internet, finding an internet forum formed by a large community of people with the condition. This forum shows these people’s great discomfort due to feeling abandoned and misunderstood by mental health professionals.

As with most psychiatric disorders, the causes of shy bladder syndrome are still unknown. Prunas explains that there are different biological, psychological and social risks factors interacting in the etiology of the disorder. Therefore, he said, it is possible to assume that people who develop paruresis probably has some biological vulnerability that interacts with other causes, both psychological and social.

However, for a minority there was other explanation. “One in three people suffering from paruresis identified a specific traumatic event in childhood related to toilets use that they consider the onset of their disorder,” mentioned Prunas.

About the best treatment or therapy for shy bladder, Prunas explains that there is not “solid scientific evidence. However, some studies [usually single cases and with results without control groups] show that cognitive behavioral therapy can be effective.”

Dr. Steven Soifer, a professor at the University of Memphis, director of the International Paruresis Association and considered a guru in cognitive-behavioral therapy (CBT) for this syndrome, said: “There is enough literature dating back until the 30s, as I document in my book The Shy Bladder Syndrome: Your Step-By-Step Guide to Overcoming Paruresis, in 2001”. The Psychologist and PhD in Social Work recognizes that he suffered from this condition in adolescence, and there was not an effective method to help him solve it. Therefore, Soifer developed a CBT for this condition. These techniques, he says, work in 80-90% of cases, according to practice-based evidence.

Soifer explains that his experience in workshops indicates that some form of bullying is the most common cause of this social anxiety disorder. The average age of onset is puberty, at about twelve or thirteen years.

Through: El Servicio de Información y Noticias Científicas (SINC) — Information and Scientific News Service.