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Abstract

Objective Paruresis refers to the inability to initiate or sustain urination where individuals are present due to the fear of perceived scrutiny from others. The aim of this systematic review was to evaluate four key questions: (1) What is the prevalence of paruresis and its associated demographic features; (2) What is the prevalence of psychopathology in paruresis cohorts, how does it compare to other chronic-health conditions, and what percentage of paruresis patients also have social anxiety disorder? (3) How does quality of life, and levels of anxiety and depression compare between those with and without paruresis; and (4) do psychological interventions for paruresis patients reduce paruresis symptoms, or, anxiety, or depression, or improve quality of life? Method A review was conducted using PRISMA protocol for search strategy, selection criteria, and data extraction. Searched databases included PubMed, CINAHL, and PsychINFO. Over the 1418 studies screened, ten were found relating to at least one review question. Results The prevalence of paruresis ranged between 2.8 and 16.4%, and around 5.1–22.2% of individuals with paruresis also had Social Anxiety Disorder. Paruresis symptoms were shown to reduce in one intervention study. Paruresis was also associated with poorer quality of life. A key limitation of the research to date has been the notable methodological problems and lack of standardisation relating to the measurement of paruresis. Conclusion Little is known about the prevalence of paruresis and more rigorous studies of paruresis are required. Recommendations in terms of clinical implications, diagnostic criteria and future research relating to paruresis are discussed.

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... Paruresis is a condition where individuals are unable to initiate or sustain micturition (urination) in the presence of others (e.g., public restroom) due to the overwhelming fear of being scrutinised (Boschen 2008;Kuoch et al. 2017). A closely related condition is parcopresis, which similarly involves the inability to defecate in public restrooms due to fear of perceived scrutiny (Maia Barros 2011). ...
... A closely related condition is parcopresis, which similarly involves the inability to defecate in public restrooms due to fear of perceived scrutiny (Maia Barros 2011). The prevalence of paruresis has been noted to range between 2.8-16.4% (Kuoch et al. 2017), however prevalence of parcopresis has yet to be identified given paucity of research on this condition. These two conditions have been reported to result in considerable psychological distress, interpersonal, occupational, and social impairment and reduction in quality of life (Boschen 2008;Vythilingum et al. 2002), for review see Kuoch et al. (2017). ...
... The prevalence of paruresis has been noted to range between 2.8-16.4% (Kuoch et al. 2017), however prevalence of parcopresis has yet to be identified given paucity of research on this condition. These two conditions have been reported to result in considerable psychological distress, interpersonal, occupational, and social impairment and reduction in quality of life (Boschen 2008;Vythilingum et al. 2002), for review see Kuoch et al. (2017). Little empirical research has been published on paruresis and parcopresis, with most of the extant literature consisting of case studies (e.g., Hambrook et al. 2017;Maia Barros 2011). ...
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To date, research exploring the socio-cognitive processes associated with paruresis and parcopresis symptomology is lacking. The current study aimed to investigate how the socio-cognitive processes dysfunctional attitudes (DAs) and fear of negative and positive evaluation (FNE and FPE respectively) relate to paruresis and parcopresis symptomology. In total, 254 undergraduate students (74.0% female; mean age = 31.67 years) completed a cross-sectional online study. A structural equation model indicated the data fit reasonably well (χ2p value = .209, CMIN/df = 1.514, CFI = .995, TLI = .983, RMSEA = .045, SRMR = .0272), with FPE mediating the relationship between DAs and paruresis symptom severity (p = .001) along with parcopresis symptom severity (p = .001). However, secondary analyses identified that FPE and FNE act as mediators between DAs and paruresis and parcopresis symptom severity when placed in separate models. This is the first study to provide evidence that the psychosocial-cognitive processes DAs and fear of evaluation play an important role in paruresis and parcopresis symptomology. Although this research should be replicated, the current study provides evidence that DAs, and FPE are important contributory factors in paruresis and parcopresis symptoms.
... 1 Paruresis reportedly affects between 2.8% and 16.4% of the population. 2 Paruresis tends to be more prevalent in males (75-92%) than females (8.1-44.6%), which may be due to anatomical differences between male and female genitourinary systems. 2 A closely related condition is parcopresis, which refers to the difficulty or inability to defecate in public restrooms because of overwhelming fear of perceived scrutiny. ...
... which may be due to anatomical differences between male and female genitourinary systems. 2 A closely related condition is parcopresis, which refers to the difficulty or inability to defecate in public restrooms because of overwhelming fear of perceived scrutiny. 3 Little is known about parcopresis and prevalence of this condition has yet to be confirmed. ...
... 3 Little is known about parcopresis and prevalence of this condition has yet to be confirmed. 2 In the one case study that has been published on this condition, parcopresis has been noted to share similar characteristics with paruresis whereby there is overlap in symptomology. 3 Key clinical features that paruresis and parcopresis patients may present with include the complaint of significant difficulty or inability to urinate or defecate in public facilities. 1 Consistent with anxiety, patients may also report avoidance behaviours and psychosomatic symptoms such as diaphoresis, tachypnea, heart palpitations, muscle tension, blushing, nausea and trembling, which occur during moments of heightened arousal (eg being inside a busy restroom). ...
Article
Background: Paruresis and parcopresis are psychogenic conditions that involve a difficulty or inability to void or defecate, respectively, in a public setting (eg public restroom). Both conditions are associated with significant psychological distress. As a result of shame, embarrassment and stigma, individuals with these conditions may not actively identify behaviours or symptoms or seek treatment in general practitioner (GP) consultations. Objective: The objective of this article is to provide a summary of the associated psychopathology and comorbidity, and diagnostic challenges associated with paruresis and parcopresis. Treatment recommendations relating to paruresis and parcopresis are also provided. Discussion: Paruresis and parcopresis can have a significant impact on an individual's psychological health and overall quality of life. GPs play a part in identifying these conditions, defusing feelings of shame and embarrassment, and enabling access to psychological interventions, which are likely to provide significant benefits to individuals living with paruresis and/or parcopresis.
... Elimination of bodily waste is considered one of twelve basic activities of daily living (Tierney 1998). For most individuals, elimination through micturition (urination) and defecation is a routine daily activity that occurs without hindrance or concern, however for some, it is a significant source of physical and psychological distress (Kuoch et al. 2017;Maia Barros 2011;Seres et al. 2008;Soifer et al. 2010;Soifer et al. 2001). Two psychosomatic bladder and bowel anxiety conditions concerned with elimination include, paruresis and parcopresis (Kuoch et al. 2019a;Maia Barros 2011;Soifer et al. 2001). ...
... Affecting around 2.8-16.4% of the population (Kuoch et al. 2017), paruresis refers to a difficulty or inability to initiate or sustain micturition when others are present (e.g., in a public restroom) due to a fear of perceived scrutiny (Boschen 2008;Knowles and Skues 2016;Soifer 2012;Soifer et al. 2001). Similarly, parcopresis refers to the difficulty or inability to defecate due to fear of perceived scrutiny from others (Maia Barros 2011). ...
... The current prevalence of parcopresis in the population is unknown. Paruresis and parcopresis are associated with considerable psychological distress, social, occupational, and interpersonal impairment along with reduced quality of life (Boschen 2008;Kuoch et al. 2017;Maia Barros 2011;Vythilingum et al. 2002). ...
Article
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Paruresis has been recognized as a subtype of Social Anxiety Disorder (SAD). A well-established model of SAD is the extended bivalent fear of evaluation model (extended BFOE) which include socio-cognitive processes such as fear of negative and positive evaluation (FNE and FPE), concerns of social reprisal (CSR), and disqualification of positive social outcomes (DPSO). In addition to the extended BFOE, dysfunctional attitudes (DAs) have also been recognized to contribute towards social anxiety symptoms and distress. The aim of this study was to examine whether an extended BFOE model for SAD could be used to explain paruresis and parcopresis symptoms. Three-hundred-and-sixteen undergraduate students (76.6% female; mean age = 31.25 years) completed a cross-sectional online study. A structural equation model (SEM) indicated the data supported the proposed model very well (χ²p value = .345, CMIN/df = 1.064, CFI = 1.00, TLI = .999, RMSEA = .014, SRMR = .0107) with significant direct relationships being found between DAs and FNE (p = .002), DAs and FPE (p = .002), FNE and CSR (p = .001), FPE and CSR (p = .001), CSR and paruresis score (p = .045), CSR and DAs (p = .006), FPE and paruresis score (p = .001), FPE and parcopresis score (p = .004), FNE and paruresis score (p = .004), and FNE and parcopresis score (p = .002). Although this research should be replicated, the current study provides evidence that DAs, FNE, FPE and CSR are important contributory factors in paruresis and parcopresis symptoms.
... In studies investigating patients who visit urology clinics because of their LUTS (i.e., severe enough symptoms to bring the patients to the clinic), bladder SSD (previously also called psychogenic LUTS) has been well documented and includes symptoms of OAB and voiding difficulty/ retention (also called paruresis (Kuoch et al., 2017), bashful bladder Upper panel, female; lower pane, male; dark hatched, severe (always, > once a day; daytime frequency >10 times; nighttime frequency >3 times); light hatched, mild (sometimes, > once a week; daytime frequency >8 times; nighttime frequency > twice). Cited from ref. (Fowler and Griffiths, 2010). ...
... The sex ratio was female dominant (6 men to 10 women). These demographic features were consistent with those of previous findings (Kuoch et al., 2017;Rosario et al., 2000;Hambrook et al., 2017). ...
Article
We here described the frequency and nature of voiding and storage bladder symptoms in depression/anxiety, for which we propose the name “bladder somatic symptom disorder (SSD)” because such symptoms most probably have brain mechanisms. SSD was formerly called as various terms including “somatoform disorder”, “medically unexplained physical symptoms”, “functional somatic syndrome” and “hysterical neurosis/hysteria”. Bladder SSD has the following specific features that are distinguishable from “true” neurologic/organic bladder dysfunction: 1) situation-dependence (close association with life event in some), 2) urodynamically increased bladder sensation/hypersensitivity and 3) absence of neurologic/organic diseases, in addition to 4) other stress symptoms (insomnia, etc.), are key clues to the possibility of bladder SSD. Urodynamics in these patients showed, to a lesser extent, underactive bladder without post-void residual. These findings might reflect the biological changes of the depressive brain; e.g., decreases in serotonin and GABA, and possible increases in CRH. Treatment of bladder SSD can follow that of general depression/anxiety, with the potential addition of anticholinergic or selective beta3 bladder drugs.
... The process of removing waste from the body through urination and defecation is a basic activity of the human condition (Tierney, 1998), however for some the experience of using restrooms is associated with significant distress (Kuoch et al., 2017;Maia Barros, 2011;Seres et al., 2008;Soifer et al., 2001Soifer et al., , 2010. Two related anxiety-based conditions that are associated with distress while using restrooms are parcopresis (also referred to as shy bowel) and paruresis (also referred to as shy bladder). ...
... Individuals with parcopresis and/or paruresis identify difficulty defecating or urinating respectively, due to the perceived scrutiny of others (Maia Barros, 2011;Kuoch et al., 2019c;Boschen, 2008;Knowles & Skues, 2016;Soifer et al., 2001Soifer et al., , 2012. While the prevalence of parcopresis is not known, a recent study reported around 22.8% of university students identified experiencing parcopresis and/or paruresis (Kuoch et al., 2019c), which was slightly higher than the 2.8-16.4% prevalence range for paruresis reported in a recent systematic review (Kuoch et al., 2017). Understandably, living with these conditions is associated with significant impairment across multiple domains of life (e.g., occupational, social) and poorer quality of life (Boschen, 2008;Maia Barros, 2011;Vythilingum et al., 2002;Kuoch et al., 2019c). ...
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Parcopresis is a condition where individuals have trouble (or inability) defecating in restrooms due to the perceived scrutiny of others. The aim of the current research was to identify the prevalence of public toilet avoidance and explore if an extended socio-cognitive model of parcopresis predicts toilet avoidance. Seven-hundred and fourteen university students (73.2% female; mean age = 28.79 years) met criteria to participate and completed a series of questionnaires and ten restroom vignettes. On average 80.00% (gender adjusted 82.54%) of the participants chose to use an available toilet, while 16.78% (gender adjusted 14.44%) avoided a toilet for non-contamination fears. A further 3.22% (gender adjusted 3.01%) participants on average avoided using a toilet due to fears of contamination. Males were significantly more likely to use and not avoid toilets than females across all vignettes. A structural equation model (SEM) indicated the data supported the proposed model well (χ²p value = .185, CMIN/df = 1.359, CFI = .998, TLI = .995, RMSEA = .023, SRMR = .0207) with significant direct relationships being found between: dysfunctional attitudes influencing fear of positive and negative evaluation and fear of social reprisal, and fear of positive and negative evaluation influencing fear of social reprisal and social anxiety symptoms. Social anxiety symptoms had a direct significant influence on parcopresis symptoms, while in turn parcopresis symptoms had a direct significant influence on toilet avoidance. The current study provides evidence that toilet avoidance is underpinned by social anxiety processes and affects at least 14.44% of university students.
... Paruresis (also termed shy bladder) refers to difficulty or inability to initiate or sustain micturition when others are present (e.g., in a public restroom) due to overwhelming fear of perceived scrutiny (Boschen 2008;Knowles and Skues 2016;Soifer 2012;Soifer et al. 2001), and is noted to affect around 2.8-16.4% of the population (Kuoch et al. 2017). Conversely, parcopresis (also termed shy bowel) refers to the difficulty or inability to defecate due to fear of perceived scrutiny from others (Maia Barros 2011). ...
... The current prevalence of parcopresis in the population has yet to be identified. Paruresis and parcopresis are both associated with significant psychological distress, reduced QoL, and interpersonal, social, and occupational impairment (Boschen 2008;Kuoch et al. 2017;Maia Barros 2011;Vythilingum et al. 2002). Currently, paruresis is recognized a subtype of Social Anxiety Disorder (SAD; American Psychiatric Association 2013) as it includes overwhelming and unrealistic fear of evaluation, and avoidance behaviours (Hammelstein and Soifer 2006;Maia Barros 2011;Malouff and Lanyon 1985;Soifer et al. 2010;Soifer et al. 2001;Vythilingum et al. 2002). ...
Article
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The current study aimed to explore the validity of a single, self-report measure for bladder and bowel anxieties (Bladder and Bowel Anxiety Grouping Item; BABAGI), using two appropriate scales entitled the Shy Bladder and Bowel Scale (SBBS) and the Bladder and Bowel Incontinence Phobia Severity Scale (BBIPSS). This study also aimed to examine the similarities and differences in dysfunctional attitudes (DAs), fear of negative and positive evaluation (FNE and FPE), concerns of social reprisal (CSR), and disqualification of positive social outcomes (DPSO) across individuals who self-identify as having paruresis/parcopresis, incontinence anxiety, or neither condition according to the BABAGI measure. Three-hundred-and-six undergraduate students (77.1% female; mean age = 31.18 years) completed a cross-sectional, online study. The results supported the hypothesis that by using the BABAGI, self-reported paruresis/parcopresis could be reliably identified by SBBS scores of above 6.75 and that self-reported incontinence anxiety could be reliably identified by BBIPSS scores above 15.21. The results also supported the hypothesis that individuals who self-identified as having paruresis/parcopresis or incontinence anxiety would score higher in socio-cognitive processes (DAs, FNE, FPE, CSR, DPSO) compared to individuals who self-identified as having neither condition. Given that the paruresis/parcopresis and incontinence anxiety groups do not significantly differ from each other with respect to socio-cognitive processes, this suggests that both sets of conditions share similar underlying psychosocial processes.
... Conversely, parcopresis comprises of the inability to initiate defecation in the presence of others due to fear of scrutiny (Maia Barros, 2011). Like bladder and bowel incontinence phobia, little is known about the prevalence of paruresis and parcopresis within the general population (Kuoch, Meyer, Austin, & Knowles, 2017). It is clear that further research is required to elucidate the relationship between these potentially related conditions. ...
... The abovementioned conditions share a common feature in that they are all anxiety conditions related to bladder and bowel function. While bladder and bowel incontinence phobia is concerned with the overwhelming fear of losing control of ones bladder or bowel in a public setting (Pajak & Kamboj, 2014), paruresis and parcopresis involve the inability to initiate micturition or a bowel motion due to fear of perceived scrutiny ( Kuoch et al., 2017). Given the significant associations identified, it is possible that bladder and bowel incontinence phobia, paruresis, and parcopresis represent a cluster of conditions. ...
Article
The current research investigates the development and validation of the Bladder and Bowel Incontinence Phobia Severity Scale (BBIPSS). Over two studies, two independent samples consisting of university students and respondents from the general public were used to validate the scale (study 1 n = 226; study 2 n = 377). A 15-item, two-factor model was confirmed in study 2 where strong construct (convergent and divergent) validity was demonstrated. The BBIPSS did not display significant correlations with openness and gender (divergent validity) and displayed significant correlations with depression, anxiety, and stress scores (DASS), alongside paruresis and parcopresis scores (Shy Bladder and Bowel Scale [SBBS]; convergent validity) and the Bowel and Bladder-Control Anxiety Scale [BoBCAtS]. The BBIPSS also demonstrated strong test–retest reliability (bladder r = 0.89; bowel r = 0.86) in a small sample of adults ( n = 13). Overall, this scale provides researchers and clinicians with a reliable and psychometrically valid assessment tool to measure bladder and bowel incontinence phobia severity.
... Two bladder and bowel anxieties that are related to BBIA include paruresis (difficulty or inability to initiate or sustain micturition when others are present due to a fear of perceived scrutiny; Boschen 2008;Kuoch et al. 2017;Soifer et al. 2001) and parcopresis (difficulty or inability to defecate due to fear of perceived scrutiny from others; Maia Barros 2011). While paruresis and parcopresis are distinct from BBIA, these conditions are similar in that they all deal with anxieties associated with bladder and bowel function and each are noted to contain elements of SAD (Hammelstein and Soifer 2006;Kamboj et al. 2015;Maia Barros 2011;Malouff and Lanyon 1985;Pajak and Kamboj 2014;Pajak et al. 2013). ...
Article
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The aim of this study was to examine whether the extended bivalent fear of evaluation model (extended BFOE) of Social Anxiety Disorder (SAD) could be used to explain bladder and bowel incontinence anxiety (BBIA). It was hypothesised that the relationship between dysfunctional attitudes (DAs) and BBIA would be mediated by fear of negative evaluation (FNE), fear of positive evaluation (FPE), concerns of social reprisal (CSR), and disqualification of positive social outcomes (DPSO). Three-hundred-and-seventeen undergraduate students (76.7% female; mean age = 31.07 years) completed a cross-sectional online study. A structural equation model (SEM) supported the proposed model (χ²p value = .131, CMIN/df = 1.560, CFI = .996, TLI = .990, RMSEA = .042, SRMR = .0245) with significant relationships found between DAs and FNE (p < .001), DAs and FPE (p = .002), DAs and CSR (p = .007), FNE and CSR (p < .001), FNE and DPSO (p < .001), FPE and CSR (p < .001), FPE and DPSO (p < .001), CSR and DPSO (p < .001), BBIPSS bladder and bowel with incontinence anxiety (p < .001). These results suggest that DAs, FNE, and DPSO are important contributory factors in BBIA. Given that FNE was the strongest mediator in the model, clinicians may find it advantageous to target FNE in treatment of incontinence-anxiety.
... "Paruresis refers to the inability to initiate or sustain urination where individuals are present due to the fear of perceived scrutiny from others" [31]. Few therapies exist for this type of anxiety also called the "shy bladder syndrome" [32]. ...
Article
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In urology technologies and surgical practices are constantly evolving and virtual reality (VR) simulation has become a significant supplement to existing urology methods in the training curricula of urologists. However, new developments in urology also require training and simulation for a wider application. In order to achieve this VR and simulation could play a central role. The purpose of this article is a review of the principal applications for VR and simulation in the field of urology education and to demonstrate the potential for the propagation of new progressive treatments. Two different cases are presented as examples: Exposure therapy for paruresis and virtual cystoscopy for diagnosis and surgery of bladder cancer. The article uses research and publications listed in openly accessible directories and is organized into 3 sections: The first section covers features of VR and simulation technologies. The second one presents confirmed applications of current technologies in urology education and showcases example future applications in the domain of bladder treatment and surgery. The final section discusses the potential of the technology to improve health care quality.
... Unfortunately, public bathrooms have yet to achieve this sense of well-being and may even trigger feelings of aversion [4,5,8]. In extreme cases, these psychological reactions could become pathological [13,14]. However, there is very little scientific literature about the relationship of people with public bathrooms from a psychological perspective based on their appraisals. ...
Article
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Public bathrooms are sensible locations in which individuals confront an intimate environment outside the comfort of their own home. The assessment of public bathrooms is especially problematic for people whose illnesses make them more prone to needing this service. Unfortunately, there is a lack in the evaluation of the elements that are relevant to the user's perspective. For that reason, we propose a new scale to assess these elements of evaluation of public bathrooms. We developed a scale of 14 items and three domains: privacy, ease of use and cleanliness. We tested the factor validity of this three-factor solution (n = 654) on a sample of healthy individuals and 155 respondents with a bowel illness or other affection that reported to be bathroom-dependent. We found that bathroom-dependent people value more privacy and cleanliness more than their healthy counterparts. We additionally found a gender effect on the scale: female participants scored higher in every domain. This study provides the first scale to assess value concerning public bathrooms and to highlight the relevance of different bathrooms' aspects to users.
... Postoperative care needs to include (1) an evaluation of input to clarify dehydration and hypovolemia, (2) a bladder sonography to confirm that urine is in the bladder rather than spilling into the abdomen, (3) an evaluation of pain that might suggest peritonitis from intra-abdominal urine or hemorrhage, (4) serial hematocrits for hypovolemia caused by an intra-abdominal hemorrhage, and (5) screening and instructions for paruresis [2,4,5]. ...
... Paruresis, a little researched condition which may affect up to 7% of the male population, occurs when a person is unable to urinate when others are present, such as in a public toilet. 31 Patients' social, work and romantic lives can be significantly affected. ...
Article
We present a practical overview of functional neurological disorder (FND), its epidemiology, assessment and diagnosis, diagnostic pitfalls, treatment, aetiology and mechanism. We present an update on functional limb weakness, tremor, dystonia and other abnormal movements, dissociative seizures, functional cognitive symptoms and urinary retention, and 'scan-negative' cauda equina syndrome. The diagnosis of FND should rest on clear positive evidence, typically from a combination of physical signs on examination or the nature of seizures. In treatment of FND, clear communication of the diagnosis and the involvement of the multidisciplinary team is beneficial. We recommend that patients with FND are referred to specialists with expertise in neurological diagnosis. FND is a common presentation in emergency and acute medical settings and there are many practical elements to making a positive diagnosis and communication which are useful for all physicians to be familiar with.
... Paruresis, also known as shy bladder syndrome, is a social anxiety condition that involves concern and avoidance of urinating in public settings [29]. According to the Kuoch et al. systematic review, the prevalence of paruresis ranged between 2.8 and 16.4 percent [30]. ...
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Safe water and sanitation, which give rise to appropriate hygiene, are fundamental determinants of individual and social health and well-being. Thereby, assessing and widening access to sustainable, durable water and sanitation infrastructure remains a global health issue. Rural areas are already at a disadvantage. Poor access to water, sanitation, and hygiene (WASH) can have a major negative effect on students in rural schools. Thus, the paper aims to assess the current condition and the challenge to access WASH in rural Kazakh schools. The study was conducted in three rural schools in Central Kazakhstan. Data were gathered through a survey among pupils, observations of the WASH infrastructure and maintenance, and a face-to-face interview with school administrators. The mean survey response rate was 65% across schools. Results indicated there was no alternative drinking-water source in schools, and 15% of students said they had access to water only occasionally. Half of the students reported that the water was unsafe to drink because of a poor odor, taste, or color. The toilet in school 3 was locked with a key, and a quarter of the students reported there was no access to a key. Moreover, not having gender-separated toilet facilities was a challenge because of the traditional gender norms. Despite the effective regulations and measures of handwashing taken during COVID-19, 27.7% of the students answered that soap was not offered daily in classrooms. Additionally, warm water was only provided in school 2. About 75% of students did not have access to drying materials continuously. The study shows that having the schools’ infrastructure is not enough when characteristics, such as availability, accessibility, maintenance, operation, quality of services, education, and practices, are ignored. Cooperation between local education authorities, school administration, and parents should be encouraged to the achievement of the sustainable development goals (SDGs) by 2030.
Article
This is the first manuscript relating to paruresis in the travel medicine literature. It describes a case of a 30-year-old man who is unable to urinate on board commercial air flights. The case is described and recommendations for management are advanced.
Article
Objective To describe clinical features relevant to diagnosis, mechanism and aetiology in patients with ‘scan-negative’ cauda equina syndrome (CES). Methods We carried out a prospective study of consecutive patients presenting with the clinical features of CES to a regional neurosurgery centre comprising semi-structured interview and questionnaires investigating presenting symptoms, neurological examination, psychiatric and functional disorder comorbidity, bladder/bowel/sexual function, distress and disability. Results 198 patients presented consecutively over 28 months. 47 were diagnosed with ‘scan-positive’ CES (mean age 48yrs, 43% female). 76 ‘mixed’ category patients had nerve root compression/displacement without CES compression, (mean age 46yrs, 71% female) and 61 patients had ‘scan-negative’ CES (mean age 40yrs, 77% female). An alternative neurological cause of CES emerged in 14/198 patients during admission and 4/151 patients with mean duration 25 months follow up. Patients with ‘scan-negative’ CES had more positive clinical signs of a functional neurological disorder (11%‘scan positive’ CES v. 34%mixed and 68%‘scan-negative’, p<0.0001), were more likely to describe their current back pain as ‘worst ever’ (41% vs. 46% and 70%, p=0.005) and have symptoms of a panic attack at onset (37% vs. 57% and 70%, p=0.001). Patients with ‘scan positive’ CES were more likely to have reduced/absent bilateral ankle jerks (78% ‘vs. 30% and 12%, p=<0.0001). There was no significant difference between groups in the frequency of reduced anal tone and urinary retention. Conclusions The first well phenotyped, prospective study of ‘scan-negative’ CES supports a model in which acute pain, medication, and mechanisms overlapping with functional neurological disorder may be relevant.
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Samimi, et al.’s article on discharging patients without voiding is an interesting statistical exercise. However, it does not cover when or why complications are missed, post-operative evaluation of potential complications, or at-home instructions needed to protect individual patients. Those concepts are more important than simply concluding that it is reasonable to send a patient home. If a patient is sent home without voiding because of a bladder perforation, the impact can be devastating. / By late July 2020, 99.96% of the US population had survived the COVID virus but more than 150,000 were known to have died. Statistically safe is not safe for all
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[Purpose] To assess lower urinary tract symptoms in different stages of menopause and the quality of life of females with incontinence. [Subjects and Methods] The sample consisted of 302 females, aged between 40 and 56 years, divided into three groups: PRE (n= 81), PERI (n= 108) and POST (n= 113). This was a cross-sectional, analytical, observational study. Data were collected by assessment chart and conducting the International Consultation on Incontinence Questionnaire-Short Form. [Results] Most of the women had less than 10 years of schooling and were married. In PERI and POST menopause, the most frequent lower urinary tract symptoms were urinary urgency and stress incontinence. The PRE group did not exhibit nocturia, urge incontinence or urinary urgency, and had the lowest symptoms frequency. In the three stages, stress incontinence was the most prevalent symptom. Of the three menopause stages, PERI had a greater impact on urinary incontinence according to the International Consultation on Incontinence Questionnaire. [Conclusion] The presence of lower urinary tract symptoms can vary across the different stages of menopause and the urinary incontinence was the most frequent complaint. Moreover, it was observed that quality of life was more affected in the perimenopause stage.
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A psychotropic drug is defined as a drug “capable of affecting the mind, emotions, and behavior; denoting drugs used in the treatment of mental illnesses” (Medical Dictionary for the Health Professions and Nursing 2012). Use of these drugs can lead to urinary dysfunction, but it is often difficult to delineate whether urinary dysfunction is a direct/indirect result of drug use or secondary to an unrelated concurrent condition. This situation can therefore result in diagnostic or management dilemmas for urologists, psychiatrists, and primary care physicians. This article reviews the literature published in the last 3 years, and provides an update on the desirable and undesirable effects of psychotropic drugs on lower urinary function. Duloxetine is an antidepressant with efficacy in the treatment of stress urinary incontinence. In addition, duloxetine and desipramine have been proposed in the treatment of overactive bladder. Laboratory research into potential therapies which target the role of neurotrophins in lower urinary tract function is in progress. Narcotic analgesia, several antipsychotics, antidepressant, anticonvulsant, and stimulant medications are associated with urinary retention. Several antidepressants have been associated with nocturnal enuresis. Furthermore, ketamine is known to induce storage symptoms, with reduction in bladder capacity. Lower urinary tract symptom (LUTS)-causing drugs are associated with polypharmacy, and elderly patients are particularly susceptible to adverse events due to pharmacotherapy. Awareness of psychotropic drug side effects and rationalization of their use is important to avoid undesirable outcomes. When patients with bothersome LUTS who are on psychotropic drugs fail to benefit from simple first-line treatments for LUTS, clinicians should be mindful that the psychotropic drug may indeed be the cause of LUTS and seek to liaise with the patient’s psychiatrist or primary care physician to discuss reasonable alternatives.
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Currently research exploring paruresis and parcopresis, anxiety relating to urinating and having bowel motions in public respectively is limited. While there are several validated measures of paruresis, no valid measure assessing parcopresis is currently available. The present study investigates the development and validation of the Shy Bladder and Bowel Scale (SBBS) which assesses both paruresis and parcopresis. Two participant groups were utilised to validate this scale, a student psychology cohort (n = 387) and a public cohort (n = 334). An eight-item two-factor model was identified in the psychology cohort and confirmed in the public cohort. The two-factor SBBS was found to be a valid and reliable measure of paruresis and parcopresis. Paruresis and parcopresis-related concerns were associated with social anxiety in both cohorts. Subscales for both paruresis and parcopresis (i.e. difficulty, interference and distress) were positively correlated, suggesting individuals are likely to report similar levels of concerns across both conditions. Further, individuals self-identifying with either paruresis or parcopresis reported significantly higher scores on the respective SBBS subscales than non-identifying paruresis and parcopresis individuals. The SBBS also demonstrated strong test–retest reliability in a small sample of adults (n = 13). Overall, the developed scale provides clinicians and researchers with a valuable tool to evaluate both paruresis and parcopresis.
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Depression and anxiety are common mental illnesses. It is recognized that depression/anxiety causes physical changes, including insomnia, anorexia, and bladder dysfunction. We aimed to delineate bladder dysfunction in patients with depression/anxiety by reviewing the literature. We performed a systematic review of the literature to identify the frequency, lower urinary tract symptoms (LUTS), urodynamic findings, putative underlying pathology, and management of bladder dysfunction in patients with depression/anxiety. From a recent survey of a depression cohort (at a psychiatry clinic), the frequency of bladder dysfunction in depression is lower (up to 25.9%) than that in Parkinson's disease (up to 75%) and stroke (up to 55%), whereas it is significantly higher than that in age-matched controls (around 10%). In both the depression cohort and the psychogenic bladder dysfunction cohort (at a urology clinic), the most common LUTS was overactive bladder (OAB), followed by difficult urination and infrequent voiding. Compared with severe LUTS, urodynamic findings were dissociated; i.e. urodynamic findings were normal except for increased bladder sensation without detrusor overactivity for OAB (50% of all patients), followed by underactive detrusor without post-void residual for difficult urination. The effectiveness of serotonergic or anti-cholinergic medication for ameliorating OAB in the patients awaits further study. In conclusion, although the frequency of LUTS among the depression cohort is not elevated, depression/anxiety is obviously a risk factor for OAB. This finding presumably reflects that the bladder is under emotional control. Amelioration of bladder dysfunction is an important target in treating patients with depression/anxiety.
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Paruresis, characterized by the difficulty or inability to urinate in a variety of social contexts, is a scientifically under-studied phenomenon. One reason for this state of affairs is the paucity of reliable and valid measures for assessing this problem. The present article attempted to address this limitation by investigating the psychometric properties and validity of a new measure of paruresis: the Shy Bladder Scale (SBS). In two undergraduate samples, the SBS demonstrated excellent internal consistency and a stable factor structure assessing difficulty urinating in public, impairment and distress, and paruresis-related fear of negative evaluation. Undergraduate students evidenced very low levels of paruresis-related concerns. In contrast, SBS scores were markedly elevated among individuals recruited from an online support network who appeared to meet diagnostic criteria for paruresis-specific social phobia. Our findings highlight the SBS's potential utility as a measure of paruresis in clinical and research contexts.
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Paruresis is a social anxiety disorder characterized by a fear of being unable to urinate in the presence of others. This condition has not been covered in the social work literature, yet is a perfect example of a person-in-environment problem. This article explores the use of graduated exposure therapy during weekend-long workshops for the treatment of paruresis. One hundred one participants participated in workshops and were administered pretreatment, posttreatment, and 1-year follow-up treatment scales. Repeated measures analysis of variance indicated significant improvement in shy bladder symptoms. Significant improvement in global severity of shy bladder was observed posttreatment and at the 1-year follow-up point. Findings suggest that graduated exposure therapy improves self-reported global severity of shy bladder symptoms and that these gains were maintained at 1-year follow up.
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To date, shy bladder syndrome, or "paruresis," chiefly has been seen as a psychological problem; consequently, little attention has been focused on this debilitating condition. The best estimate is that 7% of the general population, or approximately 17 million people in the United States, suffer from paruresis. While much has been written about urologic topics, such as incontinence and the neurogenic bladder, urologic literature does not contain any articles that specifically refer to paruresis. Little is known about the underlying causes of paruresis, but research indicates that the condition may have a physiological basis in addition to the more obvious psychological factors. Paruresis is a complex medical condition of unknown origin. The lack of awareness among the medical, nursing, and therapeutic communities contributes to the significant unmet needs of patients suffering from paruresis and its related symptoms. Only with education and research, in addition to clarification and agreement of the terminology for this phenomenon, can progress be made in understanding and effectively treating paruresis.
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The hypothesis that personal space invasions produce arousal was investigated in a field experiment. A men's lavatory provided a setting where norms for privacy were salient, where personal space invasions could occur in the case of men urinating, where the opportunity for compensatory responses to invasion were minimal, and where proximity-induced arousal could be measured. Research on micturation indicates that social stressors inhibit relaxation of the external urethral sphincter, which would delay the onset of micturation, and that they increase intravesical pressure, which would shorten the duration of micturation once begun. Sixty lavatory users were randomly assigned to one of three levels of interpersonal distance and their micturation times were recorded. In a three-urinal lavatory, a confederate stood immediately adjacent to a subject, one urinal removed, or was absent. Paralleling the results of a correlational pilot study, close interpersonal distances increased the delay of onset and decreased the persistence of micturation. These findings provide objective evidence that personal space invasions produce physiological changes associated with arousal.
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Paruresis is characterized by the fear of not being able to urinate in public bathrooms and has been classified by some to be a sub-type of social anxiety disorder (social phobia). Despite the existence of a consumer advocacy organization, the "Intentional Paruresis Association (www.paruresis.org)," there is sparse literature on this condition. A survey of people affiliated with the "International Paruresis Association" was undertaken using a self-report questionnaire with items that addressed demographic variables, the phenomenology of paruresis, comorbid disorders, and the impact of symptoms on quality of life. Sixty-three patients (59 M, 4 F) completed the questionnaire. The mean age of the subjects was 38.1+/-12 years, with the mean duration of symptoms being 24.5+/-13 years. Paruresis impacts significantly on sufferers' lives, with approximately one third limiting or avoiding parties, sports events, or dating and just over half of the sample limiting the job they choose to do. Social anxiety disorder (SAD) and depression are the most common comorbid disorders and the most common disorders in family members. Analysis of Liebowitz Social Anxiety Scale (LSAS) scores showed higher performance than social interaction subscale scores across the whole sample (whether suffering from SAD or not.) However, compared to subjects without co-morbid SAD, those with comorbidity had higher total, performance, and social interaction scores. Thus, paruresis can be a chronic and disabling symptom, and there seems to be an association between paruresis and other performance anxieties. Further research to characterize paruresis and to determine effective treatments is needed.
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Although research interest in social phobias has expanded during the last decade, a special subtype of social phobia known as paruresis, which manifests in the inability to urinate in public rest rooms, is rarely mentioned. The aim of the present study was to achieve for the first time an estimation of point prevalence in a representative male sample (n = 1,105). Due to the lack of well-established screening instruments for paruresis, the Paruresis Checklist (PCL) must be tested for reliability and validity. An empirically based cutoff score must be determined by using the subjective interference with everyday life as an external criterion. Reliability of the PCL seemed to be sufficient, and adequate evidence for validity was found. Using the empirically based cutoff score of the PCL, 2.8% of the sample was diagnosed as suffering from paruresis. In contrast to other forms of social phobia, paruresis is not associated with a lower educational or occupational level.
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AimTo investigate the prevalence and impact of symptoms of pelvic floor dysfunction in identified workforce groups. Background Productivity of workforce groups is a concern for ageing societies. Symptoms of pelvic floor dysfunction are associated with ageing and negatively influence psychosocial health. In the general population, lower urinary tract symptoms negatively influence work productivity. DesignA systematic review of observational studies. Data sourcesElectronic searches of four academic databases. Reference lists were scanned for relevant articles. The search was limited to English language publications 1990-2014. Review methodsThe Centre for Reviews and Dissemination procedure guided the review method. Data extraction and synthesis was conducted on studies where the workforce group was identified and the type of pelvic floor dysfunction defined according to accepted terminology. Quality appraisal of studies was performed using a Joanna Briggs Institute critical appraisal tool. ResultsTwelve studies were identified of variable quality, all on female workers. Nurses were the most frequently investigated workforce group and urinary incontinence was the most common subtype of pelvic floor dysfunction examined. Lower urinary tract symptoms were more prevalent in the studied nurses than related general populations. No included study investigated pelvic organ prolapse, anorectal or male symptoms or the influence of symptoms on work productivity. Conclusion Lower urinary tract symptoms are a significant issue among the female nursing workforce. Knowledge of the influence of symptoms on work productivity remains unknown. Further studies are warranted on the impact of pelvic floor dysfunction subtypes in workforce groups.
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Paruresis, considered a category of social phobia, is the fear of being unable to initiate or sustain urination in the presence of others or in situations where others may become present. Many clients who struggle with paruresis present with symptoms commonly associated with other types of social phobia, which makes assessment, diagnosis, and treatment difficult. Although paruresis is relatively common, many counselors know little about it. This article focuses on the prevalence, etiology, course, assessment, diagnosis, and treatment of paruresis. Case scenarios are presented to guide counselors in assessing and diagnosing paruresis. Implications for counselors are discussed.
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Research has demonstrated that individuals with generalized anxiety disorder (GAD) hold unhelpful beliefs about worry, uncertainty, and the problem-solving process. Extant writings (e.g., treatment manuals) also suggest that other types of maladaptive beliefs may characterize those with GAD. However, these other beliefs have received limited empirical attention and are not an explicit component of cognitive theories of GAD. The present study examined the extent to which dysfunctional attitudes, early maladaptive schemas, and broad self-focused and other-focused beliefs explain significant variance in GAD symptoms, over and above negative and positive beliefs about worry, negative beliefs about uncertainty, and negative beliefs about problems. N = 138 participants classified into Probable GAD and Non-GAD groups completed self-report measures. After controlling for trait anxiety and depressive symptoms, only beliefs about worry, negative beliefs about uncertainty, and schemas reflecting unrelenting standards (e.g., "I must meet all my responsibilities all the time"), the need to self-sacrifice (e.g., "I'm the one who takes care of others"), and lesspositive views of other people and their intentions (e.g., lower endorsement of views such as "other people are fair"), were unique correlates of Probable GAD versus Non-GAD or GAD severity. Theoretical and clinical implications are discussed.
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ContextThe cultivation of mindfulness and acceptance has been theoretically and empirically associated with psychological ancillary well-being and has demonstrated efficacy in the treatment of various disorders. Hence, mindfulness and acceptance-based treatments (MABTs) have recently been explored for the treatment of social anxiety disorder (SAD). This review aims to evaluate the benefits of MABTs for SAD.Methods Systematic review of studies investigating an MABT for individuals with SAD, using PsycInfo, Medline, PubMed, and Cochrane Central Register of Controlled Trials.ResultsNine studies were identified. Significant improvements in symptomatology were demonstrated following the MABT, but benefits were equivalent or less than yielded by cognitive-behavioral therapy (CBT).LimitationsThe few treatment studies available were compromised by significant methodological weaknesses and high risk of bias across domains. Studies were largely uncontrolled with small sample sizes. The hybrid nature of these interventions creates ambiguity regarding the specific utility of treatment components or combinations.ConclusionsMABTs demonstrate significant benefits for reducing SAD symptomatology; however, outcomes should be interpreted with caution until appropriate further research is conducted. Furthermore, the benefit of MABTs above and beyond CBT must be considered tentative at best; thus, CBT remains best practice for first-line treatment of SAD.
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Bowel and bladder obsession [bowel/bladder-control anxiety (BBCA)] is a viscerally centered phobic syndrome involving a specific concern about losing control of bowel or bladder functioning in a public place. Like other anxiety disorders, BBCA is characterized by intrusive imagery. We have previously described the nature of intrusive mental imagery in BBCA and found imagery themes to be linked to actual experiences of loss of control or to “near misses.” A causal role for imagery in symptom maintenance can be inferred by examining the effects of imagery rescripting. Moreover, successful rescripting may point to a potentially efficacious avenue for treatment development. Three cases of imagery rescripting are described here with pre-, post-, and follow-up (1-week) data reported. After rescripting, two participants experienced pronounced reductions in imagery vividness, distress, shame, disgust, and belief conviction. Most importantly, all three participants experienced a reduction in fear-associated bladder and/or bowel sensations. The results support a causal role for mental imagery in bowel-bladder-control anxiety and suggest that rescripting of distressing intrusive memories linked to recurrent images may be a useful avenue for development of cognitive-behavioral treatments of bladder/bowel-control anxiety.
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Unlabelled: The objective of the study was to investigate variables, derived from both cognitive and emotion regulation conceptualizations of social anxiety disorder (SAD), as possible change processes in cognitive behaviour therapy (CBT) for SAD. Several proposed change processes were investigated: estimated probability, estimated cost, safety behaviours, acceptance of emotions, cognitive reappraisal and expressive suppression. Participants were 50 patients with SAD, receiving a standard manualized CBT program, conducted in groups or individually. All variables were measured pre-therapy, mid-therapy and post-therapy. Lower level mediation models revealed that while a change in most process measures significantly predicted clinical improvement, only changes in estimated probability and cost and acceptance of emotions showed significant indirect effects of CBT for SAD. The results are in accordance with previous studies supporting the mediating role of changes in cognitive distortions in CBT for SAD. In addition, acceptance of emotions may also be a critical component to clinical improvement in SAD during CBT, although more research is needed on which elements of acceptance are most helpful for individuals with SAD. The study's lack of a control condition limits any conclusion regarding the specificity of the findings to CBT. Key practitioner message: Change in estimated probability and cost, and acceptance of emotions showed an indirect effect of CBT for SAD. Cognitive distortions appear relevant to target with cognitive restructuring techniques. Finding acceptance to have an indirect effect could be interpreted as support for contemporary CBT approaches that include acceptance-based strategies.
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The Mini International Neuropsychiatric Interview (MINI) is a short diagnostic structured interview (DSI) developed in France and the United States to explore 17 disorders according to Diagnostic and Statistical Manual (DSM)-III-R diagnostic criteria. It is fully structured to allow administration by non-specialized interviewers. In order to keep it short it focuses on the existence of current disorders. For each disorder, one or two screening questions rule out the diagnosis when answered negatively. Probes for severity, disability or medically explained symptoms are not explored symptom-by-symptom. Two joint papers present the inter-rater and test-retest reliability of the Mini the validity versus the Composite International Diagnostic Interview (CIDI) (this paper) and the Structured Clinical Interview for DSM-IH-R patients (SCID) (joint paper). Three-hundred and forty-six patients (296 psychiatric and 50 non-psychiatric) were administered the MINI and the CIDI ‘gold standard’. Forty two were interviewed by two investigators and 42 interviewed subsequently within two days. Interviewers were trained to use both instruments. The mean duration of the interview was 21 min with the MINI and 92 for corresponding sections of the CIDI. Kappa coefficient, sensitivity and specificity were good or very good for all diagnoses with the exception of generalized anxietydisorder (GAD) (kappa = 0.36), agoraphobia (sensitivity = 0.59) and bulimia (kappa = 0.53). Inter-rater and test-retest reliability were good. The main reasons for discrepancies were identified. The MINI provided reliable DSM-HI-R diagnoses within a short time frame, The study permitted improvements in the formulations for GAD and agoraphobia in the current DSM-IV version of the MINI.
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Two patients with chronic psychogenic urinary retention were treated by prolonged exposure to the inhibiting situation of urinating in a lavatory outside the home. The principle was similar to that of flooding of a phobia. Both patients improved rapidly and maintained their gains to 9 months follow-up, despite residual difficulties.
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Information was gathered on the prevalence, correlates, and development of avoidant paruresis in males, the inability to urinate in the presence of others. Prevalence was found to be 6.8% based on a double screening starting with 381 college males. A reliable hierarchy of environmental cues related to avoidance was demonstrated. Avoiders differed from normals on self-reported interpersonal and performance anxiety, but not on sex-related items, introversion, or childhood family size. The most common age of onset was 12-15, and subjects viewed their problem as caused by anxiety and self-esteem factors. The findings thus suggest that this is a relatively common disorder, that it is anxiety based, and that specific treatment technologies relevant to anxiety should be explored.
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Examined the relationship between urinary hesitancy, body shyness, and scores from the California Psychological Inventory (CPI) of 90 male college students. Several CPI scales correlated with questionnaire measures of both hesitancy and body shyness. Results indicated that hesitancy was a common problem for these participants. (Author)
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Urinary retention may develop in the absence of significant organic disease. Patients with psychogenic retention range from those with episodic acute retention to those who have learned to inhibit urination and have retention with a large residual urine volume owing to myotonic detrusor degeneration. A combination of thorough medical, neurologic, psychiatric and urologic evaluation is indicated for all such patients. Management consists of the implementation of bladder training with or without intermittent catheterization, which generally may be accomplished on an outpatient basis.
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The case involved a thirteen-year-old girl with a history of different urological disorders who since the age of four showed several rituals associated with micturition as well as progressively intense urinary retention. Micturition occupied 2 to 12 hours a day. Treatment consists of systematic desensitization through imagery and in vivo together with progressive response prevention of ritualized behaviours. Cognitive therapy and parent counselling is also used. Normality is attained after 7 weeks treatment and maintained at 18 months follow-up. Psychiatric diagnosis is simple phobia to micturition.
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Four men with paruresis received trials of atenolol or phenelzine or both. Atenolol was effective in one patient. Three patients had a poor response to phenelzine, and they all experienced troublesome side effects.
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Paruresis or psychogenic urinary retention is a functional disorder of micturition characterized by psychosomatic symptomatology that includes an inability to void urine in public facilities. Through largely non-experimental studies and case reports, clinical investigators have identified characteristics, behaviors, and etiological factors associated with the disorder. Although few reports about paruresis appear in the literature, a review is presented to describe the disorder and compare treatments used. As adjuncts to a multifaceted approach to treatment, the 1948 Kegal exercises and the use of beta-adrenergic blocking drugs are specific methods for alleviating the mal-adaptive symptomatology.
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The literature on psychogenic urinary retention is reviewed. 2 cases treated by analytical psychotherapy are reported, in which significant demand for physical punishment was revealed and seen as linked to unacceptable, unconscious sadistic and aggressive feelings. Some psychodynamic aspects of what is considered to be "a disturbance of internal body space' are discussed. Psychogenic urinary retention has received little attention in the literature. It may represent the uneasy position this disorder of bodily function occupies in clinical practice, with clear physical symptoms and associated psychological factors. The condition is more frequent in females, usually young adults. Case histories regularly record the placid, passive presentation of these patients, childhood enuresis and disturbed backgrounds. The diagnosis, "hysteric', is frequent and most psychodynamic evaluations suggest the symptom represents a displacement of unacceptable sexual wishes and impulse. 2 patients treated by analytical psychotherapy are reported who, whilst fulfilling many of the criteria already noted, additionally revealed an intense desire for physical punishment. This punitive demand had less to do with unacceptable sexual wishes, than guilt at repressed aggressive drives of considerable magnitude. The role of aggression in the genesis of psychogenic urinary retention has so far been little studied.
Article
The present study was an exploratory investigation of gender differences in a large sample of persons with social phobia. Potential differences in demographic characteristics, comorbidity, severity of fear, and situations feared were examined. No differences were found on history of social phobia, social phobia subtype, or comorbidity of additional anxiety disorders, mood disorders, or avoidant personality disorder. However, women exhibited more severe social fears as indexed by several assessment instruments. Some differences between men and women also emerged in their report of severity of fear in specific situations. Women reported significantly greater fear than men while talking to authority, acting/performing/giving a talk in front of an audience, working while being observed, entering a room when others are already seated, being the center of attention, speaking up at a meeting, expressing disagreement or disapproval to people they do not know very well, giving a report to a group, and giving a party. Men reported significantly more fear than women regarding urinating in public bathrooms and returning goods to a store. Additionally, there were some differences in the proportion of men and women reporting fear in different situations. Specifically, more women than men reported fear of going to a party, and more men than women reported fear of urinating in a public restroom. Gender differences among patients with social phobia are discussed in the context of traditional sex-role expectations.
Article
Survey research including multiple health indicators requires brief indices for use in cross-cultural studies, which have, however, rarely been tested in terms of their psychometric quality. Recently, the EUROHIS-QOL 8-item index was developed as an adaptation of the WHOQOL-100 and the WHOQOL-BREF. The aim of the current study was to test the psychometric properties of the EUROHIS-QOL 8-item index. In a survey on 4849 European adults, the EUROHIS-QOL 8-item index was assessed across 10 countries, with equal samples adjusted for selected sociodemographic data. Participants were also investigated with a chronic condition checklist, measures on general health perception, mental health, health-care utilization and social support. Findings indicated good internal consistencies across a range of countries, showing acceptable convergent validity with physical and mental health measures, and the measure discriminates well between individuals that report having a longstanding condition and healthy individuals across all countries. Differential item functioning was less frequently observed in those countries that were geographically and culturally closer to the UK, but acceptable across all countries. A universal one-factor structure with a good fit in structural equation modelling analyses (SEM) was identified with, however, limitations in model fit for specific countires. The short EUROHIS-QOL 8-item index showed good cross-cultural field study performance and a satisfactory convergent and discriminant validity, and can therefore be recommended for use in public health research. In future studies the measure should also be tested in multinational clinical studies, particularly in order to test its sensitivity.
Article
Paruresis manifests in an inability to urinate in public restrooms followed by a considerable avoidance behavior. According to DSM-IV TR this disorder is classified as social phobia. A sample of N = 226 subjects completed different questionnaires concerning paruresis, social phobic symptoms, lower urinary tract symptoms and depressive symptoms. These individuals were divided into four groups: no symptoms, suffering primarily from paruresis, non-generalized social phobia and generalized social phobia. The paruretic group differs significantly in all symptom variables from both the non-generalized and the generalized social phobia groups. Regression analysis separated by groups shows that the interference with everyday life can be mainly explained by paruretic symptoms (in the paruretic group) or by social anxiety and depressive symptoms, respectively (in the social phobic groups). These results question the classification of paruresis as simply being a form of social phobia.
Article
To test the hypothesis that improvements of lower urinary tract symptoms (IPSS) upon treatment with an alpha-blocker are due to reduction of bladder outlet obstruction (assessed as the bladder outlet obstruction index, BOOI); relationships of either with free flow Q(max) were also explored. The database of a large placebo-controlled, randomized, double-blind study with the alpha-blocker tamsulosin was analyzed retrospectively. Patients were stratified into lower and upper halves according to baseline IPSS, Q(max) or BOOI and treatment-associated alterations thereof. In these strata differences between values for the other two parameters were analyzed, for example, improvement of IPSS and Q(max) were compared in patients with below and above median improvement of BOOI. Patients with below and above median baseline for one parameter, for example, IPSS had rather similar values for the other two parameters, for example, Q(max) and BOOI. Likewise, patients based upon baseline strata for one parameter had rather similar improvements of the other two parameters. Most importantly, patients with below and above median treatment-associated improvements of one parameter, for example, BOOI exhibited only small if any difference for alterations of the other two parameters, for example, IPPS and Q(max). We conclude that IPSS, free flow Q(max) and BOOI are only loosely related at baseline. More importantly, treatment-induced improvements of these parameters are also only loosely related. These data do question the hypothesis that alpha-blockers largely improve lower urinary tract symptoms by reducing bladder outlet obstruction and suggest that they may also act independent of prostatic smooth muscle tone.
Article
Paruresis is a condition characterized by difficulty or inability to urinate in situations where others are present, or may soon be present. Despite knowledge that paruresis can significantly impact on occupational functioning, social functioning, and quality of life, there exists a paucity of research into effective treatments. Although cognitive conceptualizations have been advanced for other anxiety disorders, there has not been a comprehensive cognitive behavioral model of paruresis. This article presents a revised cognitive and behavioral conceptualization of paruresis, drawing on empirical evidence from other anxiety disorders. Using this conceptualization, a cognitive-behavioral intervention strategy is outlined, with clear targets for cognitive and behavioral strategies.
Article
The published data feature little information pertaining to the psychological status of patients with dysfunctional voiding. We conducted this study to evaluate the psychological profile of female patients afflicted with dysfunctional voiding. A total of 32 women with dysfunctional voiding completed an American Urological Association symptom index review, and a structured interview relating to depression (Hamilton Rating Scale for Depression), and anxiety symptoms (Hamilton Rating Scale for Anxiety). A group of 31 women who had no lower urinary tract symptoms served as controls. The anxiety and depression symptoms were compared between the dysfunctional voiding patients and asymptomatic controls. The mean patient age was 48.3 years. The mean total American Urological Association symptoms score was 20.3. The mean Hamilton Rating Scale for Depression score was 16.9, with 3.1%, 6.3%, and 50.0% patients revealing mild, mild to moderate, and moderate to severe depression symptoms, respectively. The mean Hamilton Rating Scale for Anxiety score was 21.2, with 21.9% and 34.4% patients having mild to moderate and moderate to severe symptoms of anxiety, respectively. For the controls, the mean Hamilton Rating Scale for Depression score was 4.3 and the mean Hamilton Rating Scale for Anxiety score was 4.8. Patients with dysfunctional voiding had a significantly greater degree of depression and anxiety than was the case for the controls. The results of this study have shown that women with dysfunctional voiding experience a greater degree of depression and anxiety compared with asymptomatic controls. Evaluation of the psychological profile is important for multidisciplinary management of the dysfunctional voiding in women.
The social inhibition of micturition (paruresis)
  • B Rees
  • D Leach
B. Rees, D. Leach, The social inhibition of micturition (paruresis), J. Am. Coll. Heal. 23 (203-205) (1975).