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how to practice exposure therapy for paruresis

A person with paruresis finds it difficult or impossible to urinate (wee) when other people are around. Paruresis is believed to be a common type of social phobia, ranking second only to the fear of public speaking. Paruresis is often first experienced at school.

The condition affects men and women of all races. In mild cases, paruresis is an occasional event, like a form of performance anxiety. For example, a man at a public urinal may find that he is unable to urinate when flanked by other men. In severe cases, a person with paruresis can only urinate when alone at home.

The condition is also known as ‘avoidant paruresis’, ‘shy bladder syndrome’, ‘psychogenic urinary retention’ and ‘pee-phobia’.

A person with paruresis typically has a sensitive, shy, conscientious personality and is fearful of being judged or criticised by others. Paruresis can be mild, moderate or severe. Signs and symptoms of severe paruresis can include:
The need for complete privacy when going to the toilet
Fear of other people hearing the urine hit the toilet water
Fear of other people smelling the urine
Negative self-talk while trying to urinate: for example: ‘I can’t do it. I’m never going to pee. I’m such an idiot.’
Inability to urinate in public toilets or at other people’s homes
Inability to urinate at home when guests are present
Inability to urinate at home if someone is waiting outside the toilet
Feeling anxious about needing to go to the toilet
Restricting drinks to reduce the need for urination
Avoiding travel and social events.