Physical
Paruresis: How Anxiety Makes Proper Elimination Difficult Physically
How we Define Anxiety
Anxiety is a combination of psychological and physiological condition accompanied by cognitive somatic, emotional and behavioral traits. While fear occurs in the presence of an observable stimulus, anxiety is triggered without a specific stimulus, and results from a perceived threat that is unmanageable or inevitable. A person can be anxious in situations because he perceives a threat even when there is none. His emotions are aroused because of his perception of the condition or situation that he feels traps him
Physical effects of anxiety involve rapid heartbeat, weakness and tension of the muscles, low energy, chest pains, vomiting, breathlessness, chest pain, headaches or stomachache, pallid skin, trembling, dilation of the pupils, cold sweat, and more. The body’s physiological reaction to the threat include increased heart rate and blood pressure, increased sweating and increased blood flow to the muscles, inhibition of the immune and digestive system (fight or flight response). There may also be a sense of panic although the fear is irrational and the perception of danger is not real.
Emotions associated with Anxiety consist of feelings of apprehension, lack of concentration, tensed or edgy feelings, feelings of anticipation, restlessness, irritability, scared, watching for signs of danger, blank mind, bad dreams, obsessions, déjà vu, and feelings of being trapped.
Some of the cognitive effects of anxiety are thoughts about suspected dangers such as fear of being watched, being heard, being judged or misjudged. Cognitive symptoms of anxiety include feelings of inadequacy, fear of making mistakes, fear about situations, worrying about things that may happen.
Anxiety and Paruresis
Paruresis or Bashful Bladder Syndrome (BBS) or Shy Bladder / Urination Shyness is a psychological disorder, specifically a social phobia, a performance anxiety, wherein the paruretic excessively fears being scrutinized or criticized when urinating in a public toilet. Physical manifestation of this type of fear is the inability to urinate in public restrooms, even in the house of friends or relatives, sometimes even at home when there are other people around.
Paruresis occurs mainly when a person sees or feels that there are other people around the toilet that he will use. It ranges in intensity from mild (can urinate in public toilets under certain circumstances) to severe (can only urinate when alone at home). The paruretic individual may suffer excessive hesitancy or total inability to urinate that would result in chronic and acute retention that necessitate medical intervention like the use of catheters.
Individuals with paruresis are excessively terrified of urinating in a shared toilet, which he thinks will cause him some embarrassment or that he will be judged negatively. Finding himself in such a situation will result in an immediate and intense level of anxiety, which often leads to a panic attack. Negative judgment is not the only obsessive fear of the paruretic – it is generally more of a particularly specific fear of being regarded as inadequate, awkward, clumsy, inept or incompetent.
Anxiety plays a major role in the life of a paruretic. Whenever he perceives that there are other people around the place where he is about to urinate – noise, odors, lack of visual privacy, other people talking, anxiety sets in and he is unable to urinate. This anxiety significantly affects activities like long travels, social engagements, and lengthy business meetings and prevents him from doing these activities.
Avoiding the anxiety may cause considerable emotional distress and may significantly interfere with interpersonal relationship and daily performance. Thus paruretics commonly avoid social situations which they feel will place them in a fearful negative situation.
What triggers the anxiety that makes proper elimination difficult physically as well as psychologically for paruretics? 1). Familiarity with the people present in the public toilet can trigger the anxiety. Strangers lead to greater anxiety and inhibition. The level of intimacy with people around him affects the degree of his anxiety and determines whether he can successfully urinate or not. 2). Physical and psychological proximity of the people while he tries to urinate influences the level of his anxiety. Psychological proximity involves the degree of privacy that is afforded while he tries to urinate. The need for privacy is a primary source of anxiety for paruretics. 3). Extreme emotional condition like anger and temporary psychological state of the paruretic like, fear of the sounds and smells they produce, or a feeling that they need to rush when urinating increases the level of anxiety. The anxious feeling to calm down adds more pressure and resistance to urinating.
Whenever the paruretic goes to a place where his irrational fear of using a shared toilet is perceived, his anxiety triggers the fight-or-flight mechanism. He either runs away from the situation or stay to fight. The pituitary gland excretes adrenalin to enable the body to fight or to flee from the fearful situation. The heart rate and breathing increases.
The paruretic is caught in a vicious circle created by the internal war within his system. With the increasing fear that runs in his mind, more adrenalin is released, which triggers more fear, that triggers still more adrenalin that further increase the fear.
The vicious circle activates the tensing up of the muscles as the anxiety leads to the overproduction of cortisol, which stimulates muscle tension. The muscles around the urinary tract are contracted and held without conscious effort on the part of the paruretic. As he tries hard to resist the anxiety, more adrenalin and cortisol are released into the system that prevents elimination.
Although a paruretic is aware of the situation, his physical condition influences the strength of his feelings. His anxiety does not come from the fear of urinating but from the irrational fear that he feels. He is anxious because he feels that he is in a situation that is beyond his capability to handle. His anxiety is conditioned by experience as an internalized response to something that may happen.
Anxiety affects individual paruretics in different ways. Some experience anxiety with psychological and emotional symptoms, while others experience a variety of physical effects. Anxiety poses a vicious circle, a self-perpetuating quality for the reason that the physical symptoms of anxiety can become extremely distressing that it can make the paruretic more anxious and more frightened.
If you or someone you love is struggling with paruresis or a shy bladder click below to read about what you can to help!