Do you have toilet phobia?
What is toilet phobia?
Toilet phobia is simply 'an unreasonable fear of using the toilet'. Despite being a basic human need that each and everyone of us has to attend to various times a day, excreting bodily waste for some is extremely embarrassing.
This fear about using the toilet may include one or more of the following: general fear of using public toilets, fear of being too far away from a toilet, fear of scrutiny from others when using a toilet, not being physically able to urinate or defecate.
Who is affected by toilet phobia?
Due to the nature of the phobia, anyone suffering from it is likely to experience extreme embarrassment. Due to this, numbers of actual sufferers are far higher than would be imagined as people will attempt to hide or deal with their 'little secret' alone.
Although exact statistics are unknown regarding numbers of toilet phobics, there is estimated to be approximately 7-10% of men who suffer from one aspect of toilet phobia known as paruresis or shy bladder syndrome. Despite men being more commonly affected (possibly due to the lack of privacy afforded by the majority of men's public toilets), women find themselves affected also. Paruresis is an inability to urinate in the presence or perceived presence of others.
Other types of phobia
As briefly mentioned above, one aspect of toilet phobia is known as paruresis (or shy bladder syndrome, bashful bladder, pee shyness, bashful kidneys, urophobia). This inability to urinate in front of others is tremendously debilitating for the sufferer. It mainly affects men as male public toilet design means they are stood in the open at a urinal. This leaves them open to the visual scrutiny of other users. The longer the user is stood at the urinal, the more they often feel scruitinized by others, which causes greater anxiety and further decreases any likelikhood of being able to relax enough to pee.
Another phobia is parcopresis (or shy bowel syndrome, psychogenic faecal retention). This can affect men, women and children equally and is the inability to pass a bowel movement due to increases in anxiety if others are near. The increase in anxiety causes increases in muscular tension and can make a bowel movement impossible. Although difficult to deal with, parcopresis will not have the impact on the individual's day to day life as paruresis does due to the frequency of excretion involved.
Fear of being unable to locate a public toilet is another form of toilet phobia. This tends to be common in individuals who have had a history of anxiety or panic attacks. They may become obsessed with needing to find out the exact location of all public facilities nearby. This phobia can ultimately, like other forms, lead to withdrawal from society.
Fear of public toilets and contamination issues is classified as a form of obsessive compulsive disorder (OCD), whereby the individual obsessively worries about toilet cleanliness and the possibility of catching germs. Sufferers become so fearful that they will ultimately soil or wet themselves rather than subject themselves to using a public toilet.
What is anxiety?
All the previously mentioned toilet phobias have the common thread of provocating and eliciting fear and anxiety in the individual.
Anxiety is a common emotion in all of us at certain times and involves separate but interlinked parts:
- what we feel or experience (feelings)
- what we do/don't do (behaviour)
- what we think (cognition)
Feelings we experience when anxious can include: hot flushes/flashes, blushing, butterflies in the stomach and sweating.
Behaviour is then affected and in the case of toilet phobics, they will often avoid social engagements, day trips and nights out to the detriment of their social life and their significant others.
Anxiety affects our cognition often by causing us to focus on unhelpful thoughts. In the case of someone with shy bladder for example, they may find themselves focusing on thoughts such as: "Everyone is looking at me", "Everyone must think I'm weird". These, often unfounded, thoughts merely serve to consolidate the problem.
Vicious circle of anxiety
Anxiety consists of the three separate but interlinking areas of: what we feel, what we do/don't do and what we think. These three areas often serve to set the individual up in a vicious circle leading to a self-perpetuating situation.
Let's take an example:
John suffers from paruresis or shy bladder syndrome. When needing to use a public toilet he begins to experience some of the symptoms of anxiety (sweating, jittery legs, butterflies etc) and unhelpful thoughts ("everyone will think I'm weird"), causing him to avoid using a public toilet to urinate or even to avoid going out at all. This avoidance relieves John's unpleasant thoughts and feelings but is only temporary. The next time John gets an invite to a bar with friends or to the game he will experience the thoughts and feelings all over again. This usually determines his subsequent behaviour - AVOIDANCE. On and on it goes!
Treatment for phobias
The treatment for phobias is numerous, ranging from: hypnosis to exposure therapy to NLP (neuro linguistic programming). However, to date for this type of phobia, the most successful form of treatment recommended by clinicians and psychologists is cognitive behavioural therapy (CBT).
CBT in its simplest form helps people to overcome theirs fears and anxieties by aiding them to work on their thoughts and their subsequent behaviours. One method of CBT involves changing thought processes. It is a common fact that the more we concentrate on something (positive or negative), the more impact it has on our lives. Therefore, someone with a phobia who is constantly dwelling on unhelpful thoughts, such as: "I'll catch thousands of germs and become ill if I use this toilet", or "I can't go, someone will hear me and think badly of me", will become constantly more absorbed by these thoughts. As there is often no objective evidence that "I will catch germs..." or "....someone will think badly of me" then the job of this type of therapy is to get the individual to face up to these facts. Objectify the situation, as opposed to merely thinking about them subjectively. As CBT is such an extensive subject, it is too complex to discuss in this article. Please see my other article on CBT.
In addition to CBT, other treatments include: diet, relaxation, exercise, medication.
While diet, relaxation and exercise are common recommendations for a healthy lifestyle, their implementation, whilst aiding with general health will have no significant effect on tackling the type of phobia head on. Medication can be a source of help in overcoming severe anxiety in the short term. However, it is merely a crutch to aid the individual to cope short term and can only ever be recommended via consultation with a medical professional.