Q: How do you pronounce “paruresis?”

A: It’s pronounced: “par-YOU-ree-sis.” The origin of the word is from the Latin language, and means abnormal urination. It is the technical medical term for the condition.

Q: Is this condition mental, physical, or something else?

A: For diagnostic purposes, paruresis is classified as a social phobia in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV 300.23). However, this classification does not mean the cause of paruresis is purely mental, or that a person with paruresis is “mentally ill.” We don’t understand enough about paruresis at this point to state that it only has one origin. The description given in the DSM currently classifies it as a Social Anxiety Disorder with contributing genetic, physiological, and environmental factors. Indeed, there is growing evidence that anxiety has a genetic and physiological origin, not a mental one.[i]

Until we know more, it can be helpful to think about paruresis as a disease that can be treated with a variety of approaches, including psychotherapy, medication, and support group work. Having paruresis does not mean you are crazy, suffer serious psychological problems, or that you might end up in a mental hospital. It simply means you experience anxiety that affects your ability to urinate. When a person learns proven techniques to manage the anxiety, recovery becomes possible. Many people are recovering successfully from this disease.  You might also wish to think of paruresis in terms of having a skill (peeing in public) that needs some improvement work in order to live the life you want.  Thinking you are inferior or blaming yourself has been shown to make recovery more difficult, so start off on the right foot by realizing you are not responsible for your paruresis (just like you aren't responsible for getting a cold.)  What you are responsible for is your recovery. 

Anxiety is a very powerful feeling. When a person experiences anxiety, their mind will try to figure out a solution to reduce it.  Often, people adopt a strategy of avoiding the situation where they felt the anxiety. Unfortunately, avoiding the situation has a strange effect, and the anxiety can increase in intensity after a period of staying away from the fear-inducing situation.

Confronting the anxiety can also be dangerous, as a person can develop a panic response to the situation. Once a panic response develops, even the thought of visiting a restroom can trigger intense anxiety and desire to avoid.  These are logical consequences to the brain’s instinctive reaction to reduce unpleasant feelings. They don’t mean a person is necessarily mentally ill. What they do mean is that a person needs to learn other ways to manage the anxiety that don’t have these unhealthy consequences. Learning these techniques is part of the treatment and recovery process.

Defeating avoidance is in many ways a form of jujitsu. It is using a weak position to defeat a stronger enemy through learning the vulnerabilities of the enemy and using gentle, carefully applied force in the right places and at the right times.