Avoidant paruresis (also known as 'bashful bladder' syndrome or psychogenic urinary retention) is a social anxiety disorder that involves the inability to pass urine in the presence of others. Avoidant paruresis can start at any age and affects mainly boys or men, although girls and women can also suffer from it.

The frequency of the condition is difficult to estimate, but surveys suggest that up to 7 per cent of the population may have paruresis, and this figure could be an underestimate.

Being afraid or unable to urinate when others are nearby.

Sufferers worry that someone might knock on the toilet door, or see or hear them urinating, or be waiting patiently outside.

Feelings of anxiety, anger, and body shyness in provoking situations. These emotions lead to contraction of the internal and external urethral sphincters (circular muscles that voluntarily and involuntarily restrict the flow of urine), both of which must be relaxed for urination.

Avoidant paruresis usually occurs when using public toilet facilities, including those on trains, buses, boats and planes.

Producing a specimen for a medical examination can be especially troublesome.

The condition can also occur at home when there are other people in the house, irrespective of whether or not they are in the bathroom.

The difficulty disappears if sufferers are certain that no one is around or likely to arrive.

More women than men develop avoidant, borderline, dependent and paranoid personality disorders. Men are much more likely than women to have antisocial personality disorder and obsessive-compulsive personality disorder.

Other risk factors for personality disorders include:
A history of childhood verbal, physical or sexual abuse
A family history of schizophrenia
A family history of personality disorders
A childhood head injury
Being American Indian or black
Being a young adult
Being divorced, separated, widowed or never married
Having low socioeconomic status.


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