It is considered a social phobia by mental health professionals because the person who has it knows it's irrational. Some people have been known to have held their bladder for 12, 16, 20 hours because they could not find a “safe” bathroom. People with this condition get anxious and fear that others may be watching or listening and the internal sphincter shuts off and urination is impossible. For many, the only “safe” place is in the privacy of their own home.
While some trace their problem to emotional, physical, or sexual abuse, or some to a particularly anxiety-provoking toilet training experience, most blame a specific, traumatic event in early adolescence. Some psychiatrists claim that for males at least, is it a manifestation of castration or penis size anxiety, especially when standing shoulder to shoulder with a stranger.
A common early adolescence event was being teased, harassed or hurried by classmates at a sensitive age, usually around puberty, while trying to pee. Subsequently, to avoid anxiety the person avoids public bathrooms and the behavior ultimately becomes ingrained and eventually it's no longer a choice; the person is physically unable to urinate in public.
There are actually support groups for people with paruresis who often feel isolated and ashamed. Once a person seeks treatment from a therapist or urologist they can usually be helped. The most common treatment is for the person to attempt to urinate while a friend waits at a comfortable distance. Each time, the friend moves a bit closer, until the patient is able to relax and let go with someone in the next room, then with someone standing right outside the door, and eventually, in a public facility. It often takes 8-10 weeks.
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