Having been a sufferer from paruresis (shy bladder syndrome) in the past, and having seen a number of messages from people who are at the same stage now as I was a few years ago, I just wanted to share my experience of coping with the condition.
I started suffering from paruresis whilst I was at secondary school, around the age of 13. The problem started shortly after someone said to me I was "getting fat" whilst getting changed at the end of a PE lesson. I know now that I wasn't fat, but the comment had a lasting effect on me, and left me feeling very self-conscious about my body. I didn't really notice the problem at first, there were just a couple of occasions where I found it difficult to use the urinals at school when other people were around. However, I gradually realised it was becoming more of a problem and that I was very uncomfortable using any form of public toilet. I can best describe it as feeling very anxious or 'on edge' when trying to use public toilets, and feeling very pre-occupied with what was going on around me; exactly what you don't need when you're trying to relax. It felt like everyone else had their focus fixed upon me.
At this time, I found the issue to be a little frustrating, but it didn't significantly impact my life; this came later when I started university, around the age of 18. I would often need to use public toilets when attending lectures on campus or going on nights out with friends. I found this a real problem; I didn't just struggle to use urinals but also found I often couldn't go in the stalls. When I would drive down to university at the beginning of term - a 4 hour drive - there was even a specific petrol station at which I would always stop, because it was the only place that had a toilet where I felt comfortable going. What made my condition worse was that I felt really embarrassed about it and I didn't feel I could tell anyone about the problem; so if I was ever out with friends and couldn't go, I'd be making excuses to try and slip away back to the toilets to try again. I found bars and nightclubs to be a particular problem, because the toilets tended to be a very busy, loud environment, which I found very distracting. On occasions I even left the nightclub with a smoker's pass just to try and find somewhere else where I could go.
I was sitting in my room one day contemplating the problem when I decided to google my symptoms, to see if I could find anyone else suffering from the same condition. After looking at the UK Paruresis Trust website, along with a few others, I found a diagnosis that accurately described my condition - paruresis or shy bladder syndrome.
I found the prospect of telling someone else about my condition altogether daunting, but in fact this was my first major step on the road to recovery. I told my Mum about the problem and she was really supportive; she listened to everything I had to say and even told me she knew someone else who suffered from the same condition (which I later found out was my Uncle). I would strongly recommend anyone suffering from paruresis to tell someone else about their condition - I found just sharing the burden with another person really helped negate some of my feelings of isolation.
My next step, a few weeks later, was to go and see my GP to explain my symptoms. The first doctor I saw I found fairly unhelpful; he didn't seem to understand how much of an impact on my life the condition was having and he didn't offer any further treatment. His view was that "everyone gets nervous sometimes" and it was just something I would have to learn to deal with. Not satisfied with his assessment, I returned a month later to see a different doctor, this time taking my Mum with me for moral support. The second doctor was much more supportive; he agreed I was suffering from some kind of anxiety disorder and recommended I go for further treatment to help me manage my condition.
I started by attending some sessions with a councillor at the Student Health Centre at my university. I attended a 1 hour session once a week for something like 6 weeks. The councillor was very supportive and he helped me understand how my paruresis had become a bit of a self-fulfilling prophesy; when I was walking into a public toilet, I was telling myself that I wouldn't be able to go, which was just making me feel more anxious, which by definition made me less able to go. He also taught me some techniques to try and keep myself calm in order to control my anxiety. Whilst I did see a small improvement in my condition, I continued to find public toilets a problem; but just the fact I was receiving some help made me feel better about the whole thing. I also tried to tell some of my friends about my condition, although I found I got a fairly mixed response. Some people would be supportive but others just didn't understand.
Shortly after I graduated from university, age 21, I went back to see my GP as my paruresis continued to be a problem. This time he referred me to see a psychiatrist. My psychiatrist, called Gary, was familiar with paruresis and recommended I see someone for Cognitive Behavioural Therapy (CBT) - a type of talking treatment that focuses on how your thoughts, beliefs and attitudes affect your feelings and behaviour, and teaches you skills for dealing with different problems. I paid to go privately to avoid the long waiting list on the NHS (my private medical cover did not cover the condition). Gary was also able to recommend some books on coping with the condition, which I have found to be massively beneficial: (1) Shy Bladder Syndrome: Your Step-By-Step Guide To Overcoming Paruresis by Steven Soifer (2) Overcoming Anxiety by Helen Kennerley and (3) Cognitive Behavioural Therapy For Dummies by Rhena Branch and Rob Willson.
Receiving CBT was where I had my real breakthrough with beating paruresis. I saw my CBT therapist, Claudia, for about a year in total (starting with once a week and later moving to once every few weeks). I remember from the very start that Claudia was entirely confident that I would be able to conquer my phobia, even when I wasn't. She started by trying to understand where my phobia of using public toilets could have come from and I learned that my self-consciousness was primarily due to body consciousness. Then, using experiences from my life as examples, we then started to analyse how my reactions to certain events were unreasonable, due to my misinterpreting the situation, and I learnt how I was automatically turning things people said to me into negative thoughts. I also found greater confidence in other areas of my life, such as anxiety at work, through my sessions with Claudia. In addition, one of the most important aspects that Claudia encouraged me to do was 'exposure therapy'. This I practised with my Mum at home. It basically involved trying to urinate when someone was close by. At the start, I really struggled to go even with the bathroom door closed and my Mum standing over 10 feet away. However, through continued practice I gradually began to feel more comfortable and eventually got to the stage where I could go even if the door was open and my Mum was standing just a few feet away. Whilst it might seem like this sort of practice would only be relevant to going in front of one person (i.e. my Mum), in fact I found that the whole experience made me feel more confident in using public toilets and I soon noticed much improved results.
By the end of my sessions with Claudia, my paruresis had dramatically improved and I had a much greater success rate using public toilets. What was more, this only improved in the coming months and years as I continued to practice (using public toilets became a bit of a challenge rather than something terrible to be avoided)! I even discovered that on the increasingly rarer occasions that I couldn't go, if I stood over the toilet facing the door then I actually felt more comfortable and could nearly always go. I also found my own confidence grew over time through my work and by getting into shape at the gym. When I met my girlfriend, Chloe, she continued to support me and would help me practice my exposure therapy.
In total, paruresis seriously impacted my life for in excess of 10 years, but I am hugely proud to have overcome this obstacle. I don't think I will ever be someone who is completely 'anxiety-free' when it comes to using public toilets, but I am at a stage now where it is no longer negatively impacting my life and it is a rarely a hindrance. I work in a busy office building in London and on a daily basis I use a urinal with a number of other people in the toilets without a problem. My advice to anyone suffering from this condition would be to address the problem as soon as they can and not to waste their lives suffering from this horrible condition.
As I said at the beginning, I really wanted to do this just to share my experience and hopefully inspire some people who are suffering from the condition to seek help. I am always happy to talk to anyone who needs support.
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