You might never have heard of them, but public restroom phobias, or toilet phobias, are more common than you think. What makes them so different from the more well-known phobias such as acrophobia and arachnophobia is that they can be debilitating for sufferers, resulting in shame, humiliation and social anxiety--in some cases, to the point of guilt or complete self-isolation. In addition to being probably the second most common social phobia, there is virtually no public awareness of this social anxiety disorder, and very little recognition by the medical and mental health communities.
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Toilet phobia is the umbrella term for a variety of problems related to using--or, rather, the avoidance of--public restrooms. Classified as an anxiety disorder, it's commonly seen by clinicians as a form of social phobia with characteristics that mirror agoraphobia and obsessive-compulsive disorder (OCD).
Agoraphobia is defined as a fear of being trapped in places or situations in which there is no way to easily escape in the event of anxiety or a panic attack, or assumed danger. This can cause sufferers to avoid leaving their homes or doing things and going to places they fear could lead to a problem or embarrassment. OCD involves obsessive, intrusive thoughts that often compel sufferers to repeatedly perform ritualistic behaviors and routines in order to ease their anxiety.
A phobia of public restrooms might include a fear of contamination from using "dirty" toilets, worrying that people are aware of you using or able to hear you using the toilet, fear of leaving the house and being unable to find a "safe" toilet, being afraid of soiling yourself if leaving a safe locality, fear of being unable to do your business in a public place, or a specific fear of toilets or a toilet-related situation due to a traumatic experience.
Due to the vast number of possible contributors, some of them being disorders such as agoraphobia and OCD that are more clearly diagnosable, a toilet phobia can be classified as either of the former, a social phobia or anxiety, or more specifically parcopresis or paruresis.
Parcopresis is the clinical name for "bashful bowel syndrome," the inability to defecate in public toilets. This type of phobia is most prevalent among the public restroom phobias due to the need for sitting down, and being confined in a tight, "germ-filled" bathroom stall. And for many sufferers, this fear can extend to avoiding using friends' bathrooms, and anxiety after visitors have used their own.
The inability to urinate in others' presence or in public places is called paruresis. Other terms for this disorder and the afflicted are "shy bladder syndrome," "bashful bladder," "avoidant parures" and "pee-shy." Those affected by paruresis describe the feeling as a "freezing" or "locking up" of their bladder, and they're unable to urinate despite how uncomfortable they may be.
Among paruretics with fears of contamination and those who suffer from agoraphobia, urinating in public toilets can be more problematic for women than for men, who can avoid physical contact with toilets and aren't confined to stalls when urinating in public restrooms.
Most of the data on toilet phobias suggests that some four million people in the UK and at least 7 percent of the population of Canada and the United States are affected. However, due to the level of embarrassment associated with this phobia, it's assumed that these numbers are conservative. The average age of onset falls between 12 and 25 years, but toilet phobias can start at any age.
Potential Health Risks
Aside from the suffering and embarrassment of having a toilet phobia, a number of avoidance behaviors exist that can be damaging to your health and livelihood. For example, many people with public restroom phobias have quit jobs because of their disorder. Additionally, some might refrain from eating or consuming liquids to avoid needing to use the bathroom when away from home.
Avoidance behaviors can also be damaging to relationships. Children and family members of people with social anxiety disorders can suffer from having to accommodate their special needs. For sufferers dating and in romantic relationships, the embarrassment and guilt you go through can be devastating enough to avoid contact with a loved one, going on normal social outings, or in some cases, continuing the relationship at all.
Anxiety disorders, including phobias as well as OCD, are usually treated with cognitive-behavioral therapy, which has a high success rate when therapy is completed. Although many sufferers of anxiety fare well with anti-anxiety medication, the results of pharmacological treatment have not proven promising with parcopresis or paruresis.
If you or someone you know suffers from a toilet phobia, rest assured that you're not alone and that help is available. Common to all anxiety disorders, avoidance leads only to increased anxiety, guilt and embarrassment, so seeking out professional help is important. See your doctor or visit contact the International Paruresis Association for information on finding treatment.