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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

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 1n= 226; study 2n= 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 (bladderr= 0.89; bowelr= 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.

In clinical practice, urologist often has to treat women who have various forms of dysuria that do not have a pathomorphological substrate and manifest by various types of urinary disturbances and pathological sensations in the urinary tract. The relevance of this topic can be explained by the increasing prevalence of dysuria, its recurrent nature and insufficient efficiency of routine urotherapy, including the use of an extensive armamentarium of drugs and interventions, as well as by pronounced discomfort and a significant decrease in the quality of life and working capacity in the socially active adult patients. Despite a steady growing of interest in this problem, most researchers use a variety of questionnaires and evaluation methods and receive extremely unreliable data that do not contribute to an understanding of the serious psychourological problem of a particular patient with dysuria. In this article, such cases are discussed from the perspective of an interdisciplinary approach using the qualification apparatus of modern psychosomatic medicine and relying on the clinical experience of leading specialists in the field of urology and psychosomatics. The introduction of a comprehensive multidisciplinary approach into clinical practice will contribute to adequate referring, timely provision of specialized care, a reduction of medical costs and an increase in the quality of life in a large group of patients with dysuria.

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 (χ2 p 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.

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.

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 (χ2 p 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.

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.

This is a psychological clinical case study of a young male, who suffered from paruresis. His problematic narrative is about the fear of not being able to urinate in public toilets or in situations where others may be present or entered in the facility. This problem prevents him from living a normal life and affects his self-confidence. We present a comprehensive cognitive behavioral conceptualization of the problematic narrative and also we reflected on the therapeutic intervention process, its challenges and cognitive strategies. To date, he has progressively adopted more constructive alternative explanations around the problem and is changing the narrative he lives by. Additionally, he has felt more confident, partly due to the fact he can urinate outside the home more often and in different places, yet not all.

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.

Urine doping controls have become a regular part of athletes’ lives, and approximately one half of all athletes suffer at least once from urination difficulties during these tests. Previous studies could not satisfactorily explain why athletes are affected. This paper examines the relation between urination difficulties during doping controls and psychological reactance. It is assumed that psychological reactance is positively correlated to urination difficulties. The results are based on a study involving 187 German-speaking athletes participating in elite sports at the national team level. In addition to demographic data and information about doping controls, the Psychogenic Urine Retention during Doping Controls Scale (PURDS) and Therapeutic Reactance Scale (TRS) were used. The results do not confirm our hypothesis and indicate that reactance correlates negatively rather than positively to urination difficulties during doping controls. The results are surprising as they suggest that athletes who show low oppositional potential toward doping rules are most strongly affected. Suggestions for interventions are given.

Urine doping controls have become a part of the daily lives of elite athletes. However, little knowledge is available on how athletes perceive these controls. In order to investigate this question, four hundred elite athletes completed an online survey in which they replied to open and closed questions about their experiences. The results showed that athletes approve of doping testing and that the majority of them are careful to report all substances they have consumed. Fear of a false positive test result despite not having taken forbidden substances is of concern for about half of the athletes, and significantly more for female and younger athletes. Furthermore, a third of the athletes report about experiencing stress caused by urination difficulty during the control, and a smaller group (approximately one out of seven) feel their personal integrity is violated because someone is watching them urinate. In addition, a quarter of the athletes feel that urine doping controls performed at their home are an ...

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.

Background: Paruresis, or “shy bladder syndrome”, is a relatively common anxiety disorder, yet little is known about the causes of, and effective treatments for this disabling condition. Aim: This report describes a case study in which a man (Peter) presenting with paruresis was treated using formulation-driven CBT, which aimed to address the idiosyncratic processes that were maintaining his anxiety and avoidance of urinating in public. Method: Peter attended 12 sessions of CBT including one follow-up session a month after treatment had ended. Treatment involved collaboratively developing an idiosyncratic case conceptualization (identifying longitudinal and cross-sectional factors involved in the development and maintenance of his difficulties), followed by a number of standard cognitive and behavioural interventions commonly used in evidence-based CBT protocols for other anxiety disorders. Peter completed sessional outcome measures of paruresis symptomatology, anxiety, depression, social anxiety and functional impairment. Results: Peter subjectively found the intervention helpful and his scores on all of the outcome measures reduced over the course of his therapy, and were maintained at one month follow-up. Conclusions: This report adds to the scarce literature regarding effective treatments for individuals suffering with paruresis. Limitations of the design are acknowledged and ideas for further research in this area are discussed.

Psychogenic urine retention during doping controls (PURD) refers to an athlete's inability to urinate during a doping control. This paper reports PURD to occur quite frequently in elite athletes, investigates the relationship to the clinical disorder of paruresis (PAR), and investigates its relation to recovery, performance, and self-perception of professionalism and athletic excellence. Furthermore, a scale developed especially for the close description and measurement of PURD is presented. A questionnaire was used for measuring paruresis. The results are based on two online and one paper and pencil study involving 222 German-speaking athletes from various sports. The results indicate that 60% of these athletes have experienced psychogenic urine retention during doping controls, with only 39% of them showing symptoms of paruresis. PURD impacts athlete recovery and self-perception of professionalism and athletic excellence. Suggestions for psychological interventions and recommendations for improving the doping control system are given.

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.

The term functional urologic disorders covers a wide range of conditions related broadly to altered function rather than structure of the lower urinary tract, mainly of impaired urine voiding or storage. Confusingly, for a neurologic readership, these disorders of function may often be due to a urologic, gynecologic, or neurologic cause. However, there is a subset of functional urologic disorders where the cause remains uncertain and, in this chapter, we describe the clinical features of these disorders in turn: psychogenic urinary retention; Fowler's syndrome; paruresis (shy-bladder syndrome); dysfunctional voiding; idiopathic overactive bladder, and interstitial cystitis/bladder pain syndrome. Some of these overlap in terms of symptoms, but have become historically separated. Psychogenic urinary retention in particular has now largely been abandoned as a concept, in part because of the finding of specific urethral electromyogram findings in patients with this symptom now described as having Fowler's syndrome, and their successful treatment with sacral neurostimulation. In this chapter we review the poorly researched interface between these "idiopathic" functional urologic disorders and other functional disorders (e.g., irritable-bowel syndrome, fibromyalgia) as well as specifically functional neurologic disorders. We conclude that there may be a relationship and overlap between them and that this requires further research, especially in those idiopathic functional urologic disorders which involve disorders of the urethral sphincter (i.e., voluntary muscle).

Este trabajo revisa los aspectos clásicos de la Paruresis o Síndrome de la Vejiga Tímida, afección que se define como la imposibilidad o dificultad de orinar en lugares públicos; analizamos la definición, grados, diferencias, naturaleza, etiología, terapias tradicionales, mitos del origen, etcétera; pero las aportaciones más novedosas de esta investigación transdisciplinar son dos: primera, la descripción de la vida cotidiana del parurético, cuyo eje principal es el encubrimiento de la paruresis; y segunda: ofrecemos una alternativa a la comunidad parurética que es beneficiosa para otros colectivos estigmatizados, La Salida del armario, proceso que se inicia en los grupos de autoayuda.

This article outlines the challenges and negative experiences athletes encounter during urine doping controls and how they can be dealt with. Negative experiences can be caused by physiological (e.g., inability to urinate) and psychological (e.g., feelings of embarrassment) factors relating to the control as well as to the way in which the doping control officer (DCO) conducts the procedure. Negative experiences can lead to short- and long-term effects on athletes' well-being and potentially also performance. The article outlines a number of strategies that can be applied to minimize negative experiences of urine doping controls. Furthermore, recommendations for how policy regarding urine doping tests could be changed are given.

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.

Zusammenfassung. Theoretischer Hintergrund: Die Störung der Paruresis besteht in dem Unvermögen, auf öffentlichen Toiletten zu urinieren. Sie ist bislang in der Sozialen Phobie-Forschung nur wenig beachtet worden, was nicht zuletzt an dem Mangel an Messinstrumenten liegen könnte. Fragestellung: Entwicklung und Überprüfung der Paruresis-Skala (PARS). Methode: An einer Stichprobe von N = 180 über das Internet rekrutierten Probanden, die vier Gruppen zugeordnet wurden (Paruresis, Nichtgeneralisierte Soziale Phobie, Generalisierte Soziale Phobie, Kontrollgruppe), wurde eine Item- und Faktorenanalyse durchgeführt sowie konvergente und diskriminante Validität bestimmt. Ergebnisse: Die PARS weist sehr gute Kennwerte der Reliabilität auf, korreliert mit urologisch bedingten Miktionsbeschwerden nur schwach und kann zwischen den an Paruresis und den an reiner sozialer Phobie leidenden Probanden trennen. Schlussfolgerung: Die PARS ist als Messinstrument im Forschungskontext geeignet.

Paruresis, the inhibition of micturition in public rest rooms, has been treated successfully by cognitive-behavioral therapy (CBT) with an exposure component. There are no reports of treatment for paruresis in the context of an organically based urinary dysfunction. This study examined the effectiveness of CBT for a 53-year-old male with chronic paruresis and benign prostatic hyperplasia (BPH). Coping skills training and in vivo exposure were applied in 21 sessions over a 12-week period. Pre- and posttreatment subjective units of distress (SUDS) ratings upon entering various public rest room situations were obtained. Data collected during exposure trials included latency of micturition, ratings of urinary volume, and SUDS ratings. Increased ability to urinate in public rest rooms and reduced anxiety and urinary delays in the presence of others were achieved. Implications for the conceptualization of paruresis and the effect of BPH on its treatment are discussed.

The development of the power therapies, behavioral medicine, and short term interventions have reported such success even with trauma cases that it is relevant to question the justification for lengthy psychotherapy. Yet some patients with complex mind/body conditions impervious to medical treatment/hypnosis may require extended, multi-modal, integrative therapy. This paper details a single complex case of paruresis as a prototype for illustrating a holographic treatment model for recalcitrant conditions: Component features of the proposed model presented include: 1) the sequential utilization of hypnobehavioral and analytic approaches; 2) uncovering work providing access to the somatic ego state associated with the illness condition; 3) the extended treatment time frame required for deep psycho-physiological change; and 4) the stages of counter-transference expectably evoked by such patients (e.g. urgency, exuberant optimism, frustration, discouragement), and the transformation of such reactions to achieve maximum therapeutic efficacy.

Paruresis: Remarks on its Etiology and Behavioral Therapy The paruretic disorder, a special subtype of social phobia, is presented. It has been almost completely neglected by Germ

Paruresis, the difficulty or inability to urinate in the presence of others, is a highly prevalent (7-32%) social anxiety subtype that is both chronic and pervasive. Paruresis negatively impacts quality of life. Treatment strategies have focused on psychological interventions. To date, standard social anxiety pharmacotherapies utilized in the treatment of paruresis have shown minimal efficacy. A PUBMED search revealed no references to paruresis treatment with selective serotonin reuptake inhibitors or gabapentin. This case report presents the first instance of successful monotherapy treatment of paruresis with gabapentin. The patient's relative medicine noncompliance resulted in an on-off-on treatment design with a dose-dependent response. Efficacy persisted throughout a 7-month treatment course. Gabapentin should be studied further for its potential use in the treatment of paruresis.

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.

In vivo desensitization was employed with a patient exhibiting chronic paruresis. Measures of urination delay, and subjective units of distress were obtained at pre-training, during training, at a generalization trial, and at a follow-up assessment. Urine volume was also measured at pre- and post-training. There was shorter delay in urination, greater urine output, and less subjective anxiety following treatment. These effects were also demonstrated during a generalization post-test in which the patient was exposed to an unknown observer. A follow-up trial involving exposure to a second unknown observer indicated that treatment effects were maintained at 7.5 months following treatment.

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.

Paruresis is a special type of non-generalized social phobia that involves fear and avoidance of urination in public restrooms. We administered eight 60-minute sessions of desensitization of triggers and urge reduction (DeTUR), an addiction protocol of eye movement desensitization and reprocessing (EMDR) therapy, to a 29-year old man with paruresis of 10 year duration. Because phobic avoidance is the hallmark of any anxiety disorder, we applied DeTUR targeting the urge to avoid each anxiety-provoking situation in succession. After treatment, the participant no longer met the requirements for a diagnosis of social anxiety disorder, and the self-reported symptoms of social anxiety had decreased to non-clinical levels; furthermore, these treatment gains were maintained at the one-year follow-up. Further clinical studies are needed to generalize this finding.

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.

Background: 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). Method: 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. Results: 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.

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.

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.

Propranolol, a nonselective beta-blocker, was administered to a client with paruresis (psychogenic urinary retention) following a novel in vivo exposure treatment. The client did not report a significant increase in his ability to urinate in public facilities during subsequent exposures. Rationale for including propranolol as an adjunct to exposure therapy of paruresis is discussed.

This article reviews directive interventions for paruresis, the inability to urinate in the proximity of others. As in treatments for other anxiety disorders, historical interventions have included the use of paradoxical intention and several different forms of exposure. The results of pharmacological treatment have not proven promising. Although a multidimensional treatment model has been recommended, little attention has been paid to treating cognitive components of the problem. In this paper, a single case is described in which cognitive components of the problem of paruresis were evident. A cognitive approach and exposure in vivo were applied. Measures of successful trials were obtained over 18 weeks. The combination of cognitive interventions and gradual exposure was effective in reducing paruresis. At follow-up 6 mo. later results had been maintained. The results of this case suggest more attention to the cognitive components is appropriate in the treatment of paruresis, as was stated previously for other specific social phobias.

Atenolol, a cardioselective beta blocker, was administered following unsuccessful treatment with propranolol to a male with a significant history of paruresis. During atenolol therapy, the client reported a decrease in ANS symptoms but no increase in ability to urinate in public restrooms. Rationale for use of atenolol is discussed.

To the Editor. — Klonoff and Jurow 1 reported a case of "Acute Water Intoxication as a Complication of Urine Drug Testing in the Workplace." Paruresis caused by a lack of privacy during micturition for urine testing was discussed, and impaired renal water excretion as a result of chronic psychiatric or neurological disorders was mentioned as a possible causal factor. The patient had been taking twice daily for 10 days a cold tablet containing phenlypropanolamine hydrochloride, chlorpheniramine maleate, dextromethorphan hydrobromide, and acetaminophen. Package labels on this over-the-counter preparation bear a warning that the purchaser is advised not to take the product if there is difficulty in urination due to enlargement of the prostate gland or bladder neck obstruction. This part of the warning is not intended for women, and a hesitancy in urination resulting from the medication may be easily overlooked by them. Anticholinergic effects of chlorpheniramine may precipitate or

Although most cases of psychogenic urinary retention can be ameliorated by a program composed of various behavioral techniques, there is a small percentage of cases which resists the behavioral treatment of choice. The present multiple case paper focused on the treatment of several resistant cases of functional urinary retention. Following a two week baseline period, each individual was exposed to eight weekly behavioral sessions. Whereas most cases of urinary retention have significantly improved by this time, the five individuals chosen for the present study were dissatisfied with their progress. Thus, following the eighth week, paradoxical intention was employed. Within six weeks treatment for the urinary problem was terminated as all clients were comfortable with this aspect of their daily behavior. It was hypothesized that cases of psychogenic urinary retention which resist behavioral techniques are possibly exacerbated by performance anxiety. Such anxiety can be efficiently handled by paradoxical intention.

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 Kegel exercises and the use of beta-adrenergic blocking drugs are specific methods for alleviating the maladaptive symptomatology.

(1954). Paruresis: A Survey of a Disorder of Micturition. The Journal of General Psychology: Vol. 51, No. 1, pp. 19-29.

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.

A major difficulty in treating paruresis (psychogenic urinary retention) by prolonged in vivo exposure therapy involves the individual's inability to initiate urination in response to anxiety-provoking stimuli easily and frequently enough to generalize the desired behavior to everyday situations. Administration of bethanechol chloride, a parasympathomimetic compound that facilitates urination by prompting contraction of the detrusor muscle of the bladder, prior to therapeutic sessions is suggested to enhance the efficiency and effectiveness of in vivo desensitization procedures in the treatment of paruresis.

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.

Five men complaining of an inability to urinate in a public facility were successfully treated in an in vivo desensitization program. Office visits were dedicated to arrangement of restroom facilities into hierarchies of increasing difficulty and strategies of increasing the likelihood of success for each desensitization step.