Paruresis (Psychogenic Inhibition of Micturition): cognitive behavioral formulation and treatment

Abstract

Paruresis is a condition characterized by difficulty or inability to urinate in situations where others are present, or may soon be present. Despite knowledge that paruresis can significantly impact on occupational functioning, social functioning, and quality of life, there exists a paucity of research into effective treatments. Although cognitive conceptualizations have been advanced for other anxiety disorders, there has not been a comprehensive cognitive behavioral model of paruresis. This article presents a revised cognitive and behavioral conceptualization of paruresis, drawing on empirical evidence from other anxiety disorders. Using this conceptualization, a cognitive-behavioral intervention strategy is outlined, with clear targets for cognitive and behavioral strategies.

Changing the clinical narratives patients live by: A cognitive behavioral approach of a clinical case of paruresis

“…Presence of many people and in close proximity to each other in a physical space of toilets seem to be important factors that inhibit people urinating (Boschen, 2008;Malouff & Lanyon, 1985;Soifer, Zgourides, Himle, & Pickering, 2001). Men, in particular, may perceive that their privacy is not respected, since they often have to use urinals without suitable partitions, exposing them to others (Soifer et al, 2010).…”

“…Diverse approaches have been used in treatment of paruresis, including pharmacologic approaches (e.g., alpha blockers, benzodiazepines, and selective serotonin reuptake inhibitors), with little or no results (Hatterer et al, 1990;Zgourides, 1987); or/and adjuvant cognitive and behavioral approaches with more promising results (Boschen, 2008;Jaspers, 1998;McCracken & Larkin, 1991;Zgourides, Warren, & Englert, 1990).…”

“…People suffering from paruresis may frequently feel that they are not able to urinate, under potential scrutiny of others (Boschen, 2008;Soifer et al, 2010). In addition, they might present significant stress and impairment in daily activities (Soifer et al, 2001).…”

Kognitive Therapie der Paruresis

“…Zwar gibt es in der Literatur vielfältige Überlegungen zur Erklärung der Paruresis, empirisch fundierte Modelle, aus denen sich die Interventionen ableiten lassen, existieren jedoch nicht [Boschen, 2008]. Eine (geringe) Anzahl von Falldarstellungen mit berichteten Therapieerfolgen basieren vor allem auf behavioralen Methoden [Lamontagne und Marks, 1973;McCracken und Larkin, 1991], weniger auf kognitiven Interventionen [Jaspers, 1998].…”

“…Beispielsweise stellen Lamontagne und Marks [1973] Obwohl in der Psychopathologie und der Behandlung der sozialen Phobie kognitive Interventionen in den vergangenen Jahren stark an Bedeutung gewonnen haben [Clark und Wells, 1995], wurden diese Modelle bislang kaum auf die Paruresis angewandt [Jaspers, 1998]. Boschen [2008] schlägt eine Neuformulierung der Therapie zur Paruresis vor, bei der behaviorale Elemente mit kognitiven Interventionen kombiniert werden sollen. In seinem Modell weist er auf die Wichtigkeit hin, die dysfunktionalen Gedanken sowie Sicherheitsverhaltensweisen mittels Aufmerksamkeitslenkung, kognitiver Umstrukturierung und Verhaltensexperimenten zu hinterfragen und zu modifizieren.…”