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Bashful bladder not so shy after brief CBT. (Afflicts About 7% of Population).

PHILADELPHIA -- Bashful bladder is no laughing matter.

Some 7% of the population is afflicted with avoidant paruresis, a form of social phobia that involves difficulty urinating in public places, Steven Soifer, Ph.D., said in a poster presentation at the annual meeting of the American Psychiatric Association.

Patients with bashful bladder typically are unable to void anywhere but at home and in private, which can adversely affect occupational options and can limit many aspects of life. "These patients never date or travel," Dr. Soifer told this newspaper.

But the good news is that a brief program of cognitive-behavioral therapy (CBT) using graduated exposures can set these patients on a road to psychological relief and some degree of symptom alleviation, he commented.

In a study of 101 patients with the condition, severity self-ratings averaged 7 out of 10 before the workshop. After the program and at 1-year follow-up, the average score was six, which was a statistically significant difference.

The program involves a weekend concentrated group workshop in which patients undergo repetitive exposure to progressively more challenging restroom situations. Initially patients share their stories. "There is an enormous sense of relief being with other people who have the problem and to be able to talk about it, often for the first time," said Dr. Soifer of the School of Social Work, University of Maryland, Baltimore.

The practice sessions begin with patients attempting to urinate in their hotel bathrooms with another person present in the hotel room. They then attempt to use the public restrooms in the hotel, which are usually quiet. At this point, many patients are able to try using restrooms in malls, restaurants, and airports.

While the actual severity scores may not appear to have decreased in a clinically meaningful way, most patients reported that they felt they had been helped either "some" or "a lot," he said. This reflects patients' sense of relief and realization that they will be able to get over this, rather than actual symptom relief "There's often a fairly significant cognitive shift in terms of how people feel about themselves during the treatment sessions."

Like many other anxiety disorders, bashful bladder appears to be genetically linked. It usually first appears around puberty, and may involve hormonal factors. "Patients with avoidant paruresis seem to have a more sensitive bladder neck."

"It's sheer hell for the kids and can be misdiagnosed as school phobia," he said. "It's really important for parents to notice strange or different bathroom behavior in youngsters of this age."

Dr. Soifer plans to do a controlled study of the program, also evaluating the possible use of selective serotonin uptake inhibitors in conjunction with CBT.

Information about paruresis is available at
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Article Details
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Title Annotation:cognitive-behavioral therapy
Author:Walsh, Nancy
Publication:Clinical Psychiatry News
Article Type:Brief Article
Geographic Code:1USA
Date:Jul 1, 2002
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Next Article:Emotional avoidance a hurdle in CBT therapy. (Identify Assumptions Behind Avoidance).

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