Paruresis or shy bladder: what the urologist should know, narrative review
DOI:
https://doi.org/10.48193/9xkekh05Keywords:
paruresis, shy bladder syndrome, situational inability to urinateAbstract
Description: Paruresis, also known as Shy Bladder Syndrome or situational inability to urinate, is defined as the inability to initiate or maintain urination in the presence of others due to fear of scrutiny. The varying degrees of severity and the fact that it is not a life-threatening condition lead to it being underdiagnosed and poorly studied, causing significant interpersonal, social deterioration and impacting the patient's quality of life.
Relevance: There is little research on this condition, as it presents a wide variability of symptoms. Given its likelihood of initial diagnosis in urological consultations, a narrative review was undertaken to characterize the current state of the art.
Conclusions: Paruresis is a complex medical disorder. The lack of awareness among various specialties contributes to poor treatment outcomes. Only education, research, and a multidisciplinary approach will allow progress in understanding this condition.
References
Kuoch KLJ, Meyer D, Austin DW, Knowles SR. A systematic review of paruresis: Clinical implications and future directions. Journal of Psychosomatic Research. 2017;98: 122–129. https://doi.org/10.1016/j.jpsychores.2017.05.015.
Loriente Zamora C. ¿Qué es la Paruresis o Síndrome de la Vejiga Tímida? Una investigación transdisciplinar. Actas Urológicas Españolas. 2007;31(4): 328–337. https://doi.org/10.1016/S0210-4806(07)73645-8.
Malouff JM, Lanyon RI. Avoidant Paruresis: An Exploratory Study. Behavior Modification. 1985;9(2): 225–234. https://doi.org/10.1177/01454455850092006.
Boschen MJ. Paruresis (psychogenic inhibition of micturition): cognitive behavioral formulation and treatment. Depression and Anxiety. 2008;25(11): 903–912. https://doi.org/10.1002/da.20367
Vythilingum, B., Stein, D. J., & Soifer, S. (2002). Is "shy bladder syndrome" a subtype of social anxiety disorder? A survey of people with paruresis. Depression and anxiety, 16(2), 84–87. https://doi.org/10.1002/da.10061
Labbate LA. Paruresis and urine drug testing. Depression and Anxiety. 1996;4(5): 249–252. https://doi.org/10.1002/(SICI)1520-6394(1996)4:5<249::AID-DA9>3.0.CO;2-8.
Pollard CA, Henderson JG. Four types of social phobia in a community sample. The Journal of Nervous and Mental Disease. 1988;176(7): 440–445. https://doi.org/10.1097/00005053-198807000-00006.
Hammelstein P, Soifer S. Is “shy bladder syndrome” (paruresis) correctly classified as social phobia? Journal of Anxiety Disorders. 2006;20(3): 296–311. https://doi.org/10.1016/j.janxdis.2005.02.008.
Hatterer JA, Gorman JM, Fyer AJ, Campeas RB, Schneier FR, Hollander E, et al. Pharmacotherapy of four men with paruresis. The American Journal of Psychiatry. 1990;147(1): 109–111. https://doi.org/10.1176/ajp.147.1.109.
Zgourides G. Atenolol treatment of paruresis. Psychological reports. 1991;68(3 Pt 1): 766. https://doi.org/10.2466/pr0.1991.68.3.766.
Tesar GE, Rosenbaum JF, Pollack MH, Otto MW, Sachs GS, Herman JB, et al. Double-blind, placebo-controlled comparison of clonazepam and alprazolam for panic disorder. The Journal of Clinical Psychiatry. 1991;52(2): 69–76.
Taylor L. H. (1997). Fluoxetine efficacy in social phobia. The Journal of clinical psychiatry, 58(3), 124–125. https://doi.org/10.4088/jcp.v58n0307c
Baethge C, Goldbeck-Wood S, Mertens S. SANRA—a scale for the quality assessment of narrative review articles. Research Integrity and Peer Review. 2019;4(1): 5. https://doi.org/10.1186/s41073-019-0064-8.
Kuoch KL, Austin DW, Knowles SR. Latest thinking on paruresis and parcopresis: A new distinct diagnostic entity? Australian Journal of General Practice. 2019;48(4): 212–215. https://doi.org/10.31128/AJGP-09-18-4700.
Deacon BJ, Lickel JJ, Abramowitz JS, McGrath PB. Development and Validation of the Shy Bladder Scale. Cognitive Behaviour Therapy. 2012;41(3): 251–260. https://doi.org/10.1080/16506073.2012.658852.
Jaspers K. Psicopatología general. Fondo de Cultura Económica; 1993.
Stahl SM. Stahl’s Essential Psychopharmacology: Neuroscientific Basis and Practical Applications. Cambridge University Press; 2021.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision. Washington, DC: American Psychiatric Association Publishing; 2022.
Zgourides GD, Ph. D. Himle J, Pickerling NL. The Shy Bladder Syndrome: Your Step-By-Step Guide to Overcoming Paruresis.. 1st ed. Oakland, Calif: New Harbinger Pubns Inc; 2001.
Soifer S, Himle J, Walsh K. Paruresis (shy bladder syndrome): a cognitive-behavioral treatment approach. Social Work in Health Care. 2010;49(5): 494–507. https://doi.org/10.1080/00981381003684898.
Knowles SR, Skues J. Development and validation of the Shy Bladder and Bowel Scale (SBBS). Cognitive Behaviour Therapy. 2016;45(4): 324–338. https://doi.org/10.1080/16506073.2016.1178800.
McGraw MS, Rothbaum GL, Sterner WR. Paruresis: What Counselors Need to Know about Assessment and Treatment of Shy Bladder Syndrome. Journal of Mental Health Counseling. 2014;36(3): 228–242. https://doi.org/10.17744/mehc.36.3.703453j7780t1384.
Zgourides GD. Paruresis: Overview and Implications for Treatment. Psychological Reports. 1987;60(3_part_2): 1171–1176. https://doi.org/10.1177/0033294187060003-233.1.
Liang S, Zhou Y, Yu C, Gao X, Ji F, Fang Q, et al. Chinese herbal medicine combined with cognitive-behavioural therapy for avoidant paruresis: a controlled trial. General Psychiatry. 2023;36(5): e101014. https://doi.org/10.1136/gpsych-2023-101014.
Rosier PFWM, Valdevenito JP, Smith P, Sinha S, Speich J, Gammie A, et al. ICS-SUFU standard: Theory, terms, and recommendations for pressure-flow studies performance, analysis, and reporting. Part 1: Background theory and practice. Neurourology and Urodynamics. 2023;42(8): 1590–1602. https://doi.org/10.1002/nau.25192.
Middlemist RD, Knowles ES, Matter CF. Personal space invasions in the lavatory: Suggestive evidence for arousal. Journal of Personality and Social Psychology. 1976;33(5): 541–546. https://doi.org/10.1037/0022-3514.33.5.541.
