Paruresis and Drug Testing: Know Your Rights

Paruresis, also known as “bashful bladder syndrome,” is the fear of having to urinate in a public restroom. Unlike medical conditions (like prostatitis) which cause physical problems in the urinary system, paruresis is a psychological condition (phobia), which is triggered by the fear of performing in public or in front of other people – in this case, going to the restroom in a public place. Paruresis is a highly common form of phobia, affecting nearly 17 million people worldwide.

Bashful bladder syndrome (BBS) is typically characterized by three common traits. First, the person who suffers from BBS usually has trouble urinating around strangers, which makes going to the restroom in a public facility difficult. Secondly, the person suffering from BBS may feel that the partitions in a public restroom don’t afford enough privacy, and without privacy, the person cannot relieve himself. Thirdly, a person who suffers from BBS may experience feelings of anxiety, fear, or even anger about going to the restroom in a public place.  For example, a person may feel anxious because she needs to “hurry up and go” because other people are waiting. This additional pressure can make it difficult – if not impossible – for a person with BBS to relax enough to urinate.

What causes paruresis? Usually it is triggered when an individual has an experience where he or she needs to use the bathroom on command – such as for a medical test – and cannot do so. This sets off a kind of performance anxiety, which then triggers the sympathetic nervous system to go into overdrive. This combination of performance anxiety and sympathetic nervous system activity can make it almost impossible for someone suffering from BBS to be able to use the restroom in public. For many, the only way to use the restroom is to do so in the privacy and comfort of home.

When BBS Can Cost You Your Job

According to a recent article published on CNN.com, a 30-year captain of the Coast Guard was fired for his inability to submit a drug test. Capt. Kinneary received a letter in the mail that he needed to renew his Coast Guard license, but needed to submit a urine test to do so. Kinneary, who had battled the drug urination test since its first appearance a decade ago, was unable to produce a sample for the test. As a result, his license was not renewed and he was fired.

The article quoted Dr. Stephan Soifer, the executive director of the International Paruresis Association, as saying this situation is not at all uncommon. “Many people have suffered, lost jobs, or have been demoted because of this disorder – not to mention the millions of people who have been battling with it their whole lives. I receive daily calls from people who have lost their jobs or have been discriminated against because of this.” The International Paruresis Association lobbies on behalf of people who have been discriminated against because of BBS. In addition, the IPA works to educate the general public about this phobia.

This phobia can pose a real risk to people who must submit urine samples for drug tests in order to keep their jobs. Soifer admitted that he received a phone call from a truck driver who had nearly committed suicide due to his suffering from BBS. The truck driver had lost his job because he could not submit a urine sample for drug testing. But if you suffer from BBS, before you despair or lose hope, know that you do have rights as an employee and that there are steps you can take to resolve your struggles with paruresis.

Hope on the Horizon

If your company has instituted a policy of drug testing, then you should discuss your struggle with BBS frankly with your supervisor. In some cases, you may qualify for protection under the Americans with Disabilities Act (ADA). Otherwise, you are going to have to approach your supervisor and explain your phobia with him. According to the International Paruresis Association, you can tell your employer that you suffer from an anxiety disorder called paruresis,  ”which is a bona fide social anxiety disorder listed in the Diagnostic Statistical Manual of Mental Disorders (DSM) IV with code 300.23, and that under the ADA, you should be given reasonable accommodation in terms of drug testing.” Therefore, you should be willing to submit a different type of drug test, such as a hair, saliva, or blood sample test rather than a urine test. Submit any kind of documentation you can to support your diagnosis, either from a medical doctor or psychologist. If you are a union member, you should inform your union of your diagnosis so that you will receive their support in case of any disciplinary action.

You may want to pay for an independent drug test to protect your rights in case of disciplinary action. You should also be aware that drug testing using hair samples can detect drug activity that happened months before you submit your sample. So if you do indulge in recreational drug use, you will want to curb this activity during the drug testing period. In this way, hair samples are much more accurate than urine samples in detecting drug use.

Most employers, however, will be willing to work with you to make sure you can submit a sample and keep your job. Just be honest and upfront and offer to work around your phobia in a way that still gives your employer what he or she needs. You can also find self-help programs that will help you resolve your struggles with BBS so you no longer have to work around your anxiety.

Using a variety of methods such as exposure therapy, visualization, laughter therapy, and other techniques, a self-help program can help you unlearn the negative thought process that can lead to paralyzing BBS. In time, you can rewire your thought patterns so you no longer have to struggle with paruresis and can use the bathroom in public or as needed for medical or drug testing with no struggle.

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