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Home , Paruresis, Phobia

National Phobics Society (NPS) Registered Charity No: 1113403 Company Reg. No: 5551121 Tel: 0870 122 2325 www.phobics-society.org.uk

1975 Golden Rail Award breaking the silence 1989 National Whitbread Community Care Award 2002 BT/THA Helpline Worker of the Year Award The Queen’s Award for Voluntary Service 2006

unsung heros The Queen’s Award for Voluntary Service 2006 what is toilet ?

Toilet Phobia is rarely just one condition. It is a term used to describe a number of overlapping conditions (see diagram below):

social what is toilet phobia? 3 phobia

who can be affected? 4 toilet phobia what causes toilet phobia? 5 panic parcopresis

does everyone have the same experience? 5 ocd

forms of toilet phobia 6-7

real life experiences 8-12 These conditions have one thing in Due to the nature of this common - everyone affected has problem, people are often difficulties around using the toilet. reluctant to admit to the & : understanding the effects 13-14 These difficulties vary but with the condition or to seek help. right support, the problems can Those who do seek help can usually be alleviated, reduced or usually overcome or improve what types of help are available? 15-19 managed. their ability to cope with the problem, even after many The around the toilet include: years of difficulty. Seeking help real life experiences 20 • not being able to is the first step to finding real urinate/defecate improvements. success stories 21 • fear of being too far from a toilet • fear of using public toilets • fear that others may be watching your next step 22 or scrutinising/listening

glossary 23

2 3 who can be affected? what causes toilet phobia?

Almost anyone - Toilet Phobia is Toilet Phobia and overlapping/ not as rare as you may think. inter-related conditions are often caused by: Exact statistics are not known as more population based research is • Anxiety required. However, the British • Fear Psychological Society (BPS), the representative body for • Specific experience/trauma and in • Learnt behaviour from the UK report that: someone close

Nearly four million people in the UK are unable to urinate in public toilets because of a social phobia commonly does everyone have called 'shy pee', which can affect relationships, dent the same experience confidence and even lead to suicidal feelings of toilet phobia?

Everyone is different, but many of the people with Toilet Phobia share Some people are affected common characteristics: significantly, others moderately and a large number of people are • Fear of not being able to affected mildly as shown in this urinate/defecate pyramid: • Fear about the cleanliness of public toilets (this is a form of OCD) • Fear that others may be watching/able to see you whilst using the toilet • Fear that others may hear you whilst using the toilet. No one is exactly the same, so it is important to establish what form of Toilet Phobia affects you, so that you can get the right kind of help.

4 5 forms of toilet phobia Fear of urinating in Fear of defecating in Fear of being unable Fear of using public public places public places to use a toilet in public toilets/contamination places issues This fear which is often This fear is known as 'psychogenic accompanied by difficulties in faecal retention', 'shy bowel This fear is common in women This fear is usually associated with urinating is sometimes called syndrome', bashful bowel (but not exclusively), especially worries and concerns about 'avoidant paruresis', 'psychogenic syndrome' and 'parcopresis'. It is those who have a history of cleanliness and the subsequent ', or 'shy bladder recognised as a form of and/or panic attacks. possibility of catching germs from syndrome'. It is recognised as a phobia. It can affect men, women Sufferers fear having a panic toilet seats etc. It is classified as a form of social anxiety which can and children. Sufferers of this attack whilst outdoors and being form of Obsessive Compulsive develop at any age and can affect problem experience increased unable to reach a toilet during an Disorder (OCD). Whilst public men, women and children. This anxiety when others are nearby. episode of panic/peak anxiety. The toilets are rarely very clean, most type of Toilet Phobia is more This increased anxiety causes an sufferer can gradually withdraw people can use them if need be. prevalent amongst men probably increase in muscular tension which from society, preferring to stay Sufferers of this form of Toilet because of the design of public in turn, decreases the likelihood of indoors, or may keep to places Phobia however go out of their toilets and the openness of urinals. passing a bowel movement. Like where he/she knows there is an way to avoid using public toilets avoidant paruresis, those affected accessible public toilet. even if this means ultimately Sufferers often think/feel that often develop 'safe' places such Alternatively, the sufferer may soiling/wetting themselves. This is someone may see or hear them as their homes, and are only able become obsessed with finding out in contrast to other sufferers who urinating in public or that their to pass a motion in these places. the locations of public toilets and view soiling/wetting themselves a motives for being at a urinal may They therefore feel the need to be develop a form of obsessional shameful act. Sufferers will often be questioned if they can't urinate. close to their 'safe' toilet, which is anxiety. Sufferers may adapt their go to great lengths to avoid In the main there is not usually a usually at home. Sufferers may diet and movements/lifestyle to touching things around toilets, for problem at home. change their diet to try to control prevent the risk of needing to have example, they will only turn off the Public toilet facilities anywhere can bowel movements. to use a public toilet. This can taps or pull the door open with a be a problem at school/college on occur regardless of whether the paper towel or tissue. This trains or ships, at work, in pubs or use of the toilet is to pass a problem can affect men, women restaurants, on holidays, even motion or to urinate. The problem and children and again people friends' homes. Problems usually is entirely associated with the often change their diet to try to disappear at home but visitors in location and immediate control their use of toilets. Most the house can cause problems for accessibility of toilets. sufferers feel more in control at some. The difficulty largely home because they are sure of disappears if sufferers are certain their home's cleanliness. there is no-one else around and they are confident of their surroundings. Sufferers can rarely urinate on demand so giving urine samples for testing is usually not possible. Those affected may change their drink/food habits to try to control when they need to urinate.

6 7 real life experiences

Toilet Phobia is quite common, led a very full life. He has to turn sympathetic towards people every day, increasing the dose if but those who suffer from it often down work as he can't travel. His suffering from this condition. she is particularly anxious and feel isolated. Below are some real work always gave him great Murray may well find Cognitive takes it whilst her mother is at life experiences from Toilet Phobia satisfaction but he feels this has Behaviour Therapy (CBT) helpful work just in case there is an sufferers which you may identify been taken away from him. as it would help him to manage emergency and she is called out with. his anxiety and enable him to to her. Another safety technique If Murray has a hospital work out a programme, allowing Emma uses is the clothes she appointment he will stop drinking him to take small steps towards wears. She prefers winter as she hours before it. He says he knows murray - rarely goes out achieving his overall goal (i.e. can wear clothes which hide he is ruining his kidneys but this and has turned down work being able to urinate in a public everything and also wears only does not stop his avoidant toilet). CBT would explicitly help dark-coloured clothing. Emma has Murray has suffered from shy behaviour although it does add to Murray to challenge and change lost contact with most people but bladder syndrome and his anxiety. the unhelpful thoughts and always avoided telling people agoraphobia for 50 years. His behaviours that he experiences, about her problem in case she problem has affected his life Professor Karina Lovell says: thereby gradually overcoming his was considered 'weird'. She is dramatically. He refers to his Murray has had Toilet Phobia for difficulties. happier to let people know she problem as 'life-inhibiting'. His a number of years. Many, but not suffers from anxiety and panic mother used to suffer in a similar all start in childhood and rather than admit to her Toilet way. If anyone was near when she go unabated for years without emma - affected since Phobia. was about to use the toilet she effective treatment. The shame childhood would just flush it and go away. that people feel with Toilet Phobia Professor Karina Lovell says: is acute which is demonstrated Emma has had issues around Murray rarely goes out because of Emma has a severe Toilet Phobia by Murray who has only recently toilets for as long as she can shy bladder syndrome. If he does which manifested itself in been able to tell his sons. His remember. She was bullied at go out, he finds it extremely childhood following a traumatic phobia has affected many school and there was a particularly stressful. He has to make sure incident. Her phobia has now aspects of his life including unpleasant incident in a toilet after that he knows where the toilets extended to all areas of her life, avoiding going out if at all which she developed Toilet are and that he is away from impacting on everything that she possible. The safety behaviours Phobia. people. He would rather not go does to the extent that she is that Murray uses when he goes out than deal with the . He Emma's problem is around soiling unable to go out. She also out show the extent to which gets invitations from people but herself, even though she has engages in a range of safety phobias affect people's lives. turns them down. He does not never done so. She has developed behaviours such as taking Murray, although aware of the want to reveal his problem as he avoidance techniques around Imodium and restricting her diet. dangers, restricts his fluid intake feels this would make him appear eating and does not go out. She Emma's case history clearly before going out to try to ensure weak. He considers himself very avoids a lot of foods in case it brings out the element of shame he does not have the urge to sociable but now avoids being with causes her to have problems with that people feel when they have urinate when away from home. people. He has only recently told her bowels and says she would any phobia (but particularly Toilet his sons about his problem. He completely avoid eating, however What can be done? Phobia). wouldn't visit them and they she needs to eat because the thought he was being unsociable. Raising awareness of Toilet that she is on makes What can be done? Phobia will help health care her sick if she has an empty Murray can't do anything and this Raising awareness of this professionals to be more stomach. She takes Imodium frustrates him as he has always problem will help other people to

8 9 realise that people should not fears picking up a bug which will becoming ill or being sick (which pete - worries about the feel ashamed and that these make her sick or affect her she is fearful of), or it affecting cleanliness of toilets phobias are common. Emma bowels. Her first marriage ended her bowels (which she also would also benefit from because of her difficulties and her fears). Caroline's response to this Pete suffers from Obsessive psychological help and CBT is toilet-related problems became has been to avoid more and Compulsive Disorder and likely to be helpful. Although there extreme after her second more things and this is making constantly worries about dirt, are many interventions used in marriage. Caroline finds it her life very difficult. From the germs and contamination issues. CBT, I would suggest exposure distressing using the toilet when case study, it would seem that He thinks he has felt this way therapy where Emma would be her husband is around. She Caroline's phobia has extended since he was six years of age. asked to write down all her dreads holidays and gets upset out (we use the word Pete lived in Jamaica until he was feared situations and put them with her husband for using the generalisation) because of the eleven and thinks his earliest from 'highest fear' to 'lowest toilet even though they have stressful life events that she has experience of contamination fear'. Following this we would ask separate toilets. She has even experienced. issues was connected with a Emma to decide which fear she phoned him at work because she cousin who used to pull out his What can be done? would be most prepared to has been so distressed by the milk teeth for him. He remembers tackle from the list and then thought that he had used the toilet Caroline would benefit from a full becoming very anxious about dirt encourage her (at her own pace) there. They do not have people to psychological assessment to gain and germs one time she did this to gradually and repeatedly face the house. There was a brief visit a better understanding of her after combing a woman's hair. the fear until her anxiety reduced from family at Christmas but this difficulties. It is difficult to Toilets are a particular problem for and she was no longer fearful. was very difficult and has not been ascertain from the case study Pete. He always makes sure he We would continue to work with repeated. She manages a trip to whether Caroline has OCD, uses the toilet at home before he the hierarchy of fears until the her in-laws about once a month. agoraphobia, , goes out in order to minimise any fears that impacted on her life social phobia or a combination There are also aspects of need he might have to use a toilet had decreased. of these problems. As with the Obsessive Compulsive Disorder in away from home. He will never sit other case studies, the best Caroline's story and she finds a on the seat of a toilet or allow his evidence we have for helping change in routine very disturbing. If children to. After he has used the caroline - couldn't even these types of difficulties is CBT. her husband is on holiday or she toilet he will only touch taps and visit her sons In Caroline's case I would want to sees or hears her neighbours, she door handles if he uses paper know more about her difficulties Caroline is 34 and has suffered gets very agitated. She also gets towels. If there are no towels and how they fit together before from (vomit phobia) upset if she hears her neighbours available he will use his elbows or I recommended a specific since she was 8 years old. Her using the toilet. even his feet. Toilet Phobia is more recent. She treatment plan. However all such Caroline only eats food that will not was brought up by her plans would be based on working If Pete has to use a public toilet make her sick or affect her bowels grandparents and remembers her in a collaboratively way - doing whilst out this will result in him - mostly carbohydrates. grandmother always talking about things together. being unable to eat afterwards. He won't use a public toilet at all if he being constipated. Professor Karina Lovell says: feels it is too dirty. Caroline feels she has developed Caroline has a severe phobia. In food shops and take-aways he agoraphobia because of her other Her main fear appears to be often finds himself thinking about two phobias. She will go out but centred around 'picking up a bug' what the assistants may have with great difficulty. She always which could either result in her been doing before serving the

10 11 anxiety and fear: food, and in particular he worries What can be done? understanding the effects about their standards of hygiene. There is clear evidence in the By Professor Karina Lovell Professor Karina Lovell says: NICE (National Institute for Health and Clinical Excellence) As described earlier, Toilet Phobia individual experiences of Toilet It is clear from Pete's story that guidelines that the most effective he has Obsessive Compulsive can occur in many different forms. Phobia outline many of the treatment for OCD is CBT. The It is clear from the experiences of behaviours that people exhibit Disorder (OCD) and experiences treatment that may help Pete thoughts (e.g. I will become sufferers that Toilet Phobia affects when feeling anxious. For example, would be and people in a range of ways. The Murray avoids invites from his contaminated from dirt and response prevention - germs from toilets) and exhibits common factor experienced by all friends, Caroline avoids using the i.e. gradually and in collaboration Toilet Phobia sufferers is however, toilet if her husband is at home, ritualistic behaviour (e.g. avoids with Pete, exposing him to his using public toilets, not sitting on anxiety. To understand how to Emma avoids eating certain foods fear of toilets and asking him to overcome Toilet Phobia we and Pete avoids public toilets. any toilets or allowing his children refrain from ritualising until his to, avoids touching bathroom therefore first need to understand Murray, Caroline and Emma all avoid anxiety reduces. Pete's what anxiety is. going out as much as possible. taps and doors with his hands). treatment would also (indirectly Anxiety (or any other emotion for or directly) involve his family, Things we think: that matter) can be seen to particularly his children so that When anxious or panicky we often consist of three separate but inter- they too are ‘allowed’ to sit on have a lot of unhelpful thoughts. related parts: a toilet. For example Pete's thoughts are • Things we feel physically focused on becoming contaminated, and Emma's • Things we do or stop doing thoughts are focused on her (behaviours) loosing control of her bowels. • Things we think (cognitions)

Things we feel physically: All these 3 aspects of anxiety are When anxious or panicky we separate but inter-related. For experience a number of physical example, Pete fears that he will be symptoms including a racing heart, contaminated from dirt and germs butterflies in the stomach, associated with toilets. Each time sweating, shaking (either visibly or this is triggered, he becomes feeling as though we are shaking) anxious - experiencing physical and jelly legs. feelings and unhelpful thoughts which leads to him avoiding certain Things we do: situations. Avoidance leads Pete to This usually includes avoiding, or feel less anxious but this relief in escaping from situations in which anxiety is only temporary until the we feel panicky. For example next time it is triggered. This people with Toilet Phobia will often process is called the vicious circle avoid using public toilets. The of anxiety.

12 13 the vicious circle of anxiety what types of help are available? trigger dirt or germs More research is needed on Cognitive restructuring is a way of this condition. By improving changing our unhelpful and understanding, we would hope anxious thoughts by looking at to see improvements in the them and challenging them. When management of this condition. we are anxious or panicky we Currently it is generally accepted have many unhelpful thoughts that CBT (Cognitive Behaviour such as "I am going to soil relieves anxiety Therapy) is the most effective myself", "I might pick up a bug and anxiety/panic form of management for Toilet become ill", "I won't be able to temporarily until the next time Phobia and its associated urinate in a public toilet". These a trigger occurs conditions. However as everyone unhelpful thoughts often stop us is different, people may find other doing things that we want to. The methods work for them and so more unhelpful thoughts that we we have included information on have, the stronger they become other available treatments. and then we have even more unhelpful thoughts. It is yet behaviours Generally recommended another vicious circle. treatment: avoids all public toilets The features of unhelpful where possible • Cognitive Behaviour Therapy thoughts are: avoids sitting on toilet (CBT) uses towels to turn on taps • They are automatic - we don't Other treatments which think them on purpose, they just may be of use: appear in our heads The vicious circle • Graded Exposure • They seem believable and real at To make this clear I will use as limiting the amount he will drink • Clinical the time they appear another case study to explain the before going to specific places - • Diet hence avoiding the need to use • They are the kind of thoughts vicious circle of anxiety. Murray • Relaxation has shy bladder syndrome. His the toilet. Such avoidance results that would upset anybody • Exercise fearful situation is using the toilet in a reduction in anxiety. However There are 3 main stages to particularly when other people are this reduction is only temporary • Medication cognitive restructuring. These are: around. In this situation or even and reoccurs the next time a • Identifying exactly what the when thinking about it, Murray similar situation arises. What is Cognitive content of your unhelpful becomes anxious and panicky. To Behaviour Therapy thoughts are relieve this anxiety, Murray avoids (CBT)? going out whenever possible and CBT is based on the vicious circle • Doing something to help you avoids travel. Murray also uses a of anxiety, as described earlier. examine the thought more number of safety behaviours such It helps people overcome their objectively. Sometimes this anxiety by working with people's includes collecting 'evidence' as to thoughts and behaviours. how accurate the thought really is

14 15 • Finally, reconsidering the thought Accessing CBT: What is Graded did this every day for a week or in light of the evidence you have You may have to wait some time Exposure? so, it would be likely that her collected. You can then test the anxiety would have reduced to the for CBT if you want to access it Graded Exposure means gradually thought by doing a brief extent that she would feel through the NHS as waiting lists facing your fear until anxiety falls. experiment (like exposure) to confident that she was not going are often long. Your GP however From the vicious circle of anxiety see whether it is true or not. to have a problem with her bowels may be able to refer you to your we know that avoidance, escape and could then move onto the For example, using Emma's story, local primary care and undertaking other safety next fear. one of her thoughts is probably service which usually offers brief behaviours reduce anxiety but only centred on the belief that she therapeutic interventions which are on a short term basis. We know would loose control of her bowels underpinned by CBT. that confronting anxiety will lead to What is Clinical if she did not take the Imodium You can also access CBT through it decreasing on its own (usually Hypnotherapy? when her mother was at work. the NPS. We have a team of within 40 - 60 minutes). However, In cognitive behaviour therapy we volunteer trained therapists who exposure is not about confronting Some people find this form of would look at this thought in detail, offer their time to NPS members at your biggest fear in one go, it is therapy helpful as it focuses on for example, by asking Emma to special reduced rates. We are also about starting with your smallest bringing about deep levels of rate how much she believed it and able to offer CBT over the phone. fear and progressing to greater relaxation and therefore helps fears; facing them systematically reduce levels of stress and what emotions the thought CBT can also be accessed and gradually- hence the term anxiety. Clinical Hypnotherapy is evoked. Emma would then be privately. For more information on ‘Graded Exposure’. not the same as Stage encouraged to challenge the this and to find out about and should be practised by an thought. The simplest way of doing accredited CBT practitioners If you want to use Graded experienced Clinical this would be to ask Emma to contact: Exposure it is helpful to list all the identify the evidence for and situations you avoid from the least Hypnotherapist. against the thought. Having difficult to the most difficult. The Accessing Clinical generated a list of evidence we The British Association for most important thing about Hypnotherapy: would ask her to rate the thought Cognitive and Behavioural Graded Exposure is that it should again; usually the intensity of the be practiced regularly (every day if If you are a member of NPS you thought reduces following this (BABCP) possible). It is also helpful to have can access our in-house therapy exercise. We would then try to The Globe Centre support from friends/family service for Hypnotherapy and the devise an experiment to test PO Box 9 members. other related therapies, such as whether the thought was a fact. Accrington In Emma's experience, her lowest the Fast Phobia Technique, For example, we might suggest BB5 0XB fear might be to resist taking Neuro-Linguistic Programming that she does not take the Imodium when her mother is at (NLP), Eye Movement Imodium when her mother is at Tel: 01254 875277 work and her largest fear might be Desensitisation and Reprocessing work and see if her prediction that www.babcp.org.uk going out and eating a meal. If (EMDR), she would loose control of her Emma resisted taking the Imodium (TFT), Emotional Freedom bowels is true. We would then whilst her mother was at work and Techniques (EFT) and a range of challenge other thoughts in a tolerated the subsequent anxiety, other holistic therapies such as similar manner. it would reduce gradually. If she aromatherapy, reflexology etc.

16 17 Some people find Reiki, Yoga and unhealthy this can lead to There are numerous exercise other complementary therapies weakness and tiredness which in books, DVDs etc. which can help useful. the long run can make anxiety you put together an exercise plan worse. which can then become part of For further information please call your daily life. the helpline on 0870 122 2325 or visit our website: www.phobics-society.org.uk How can relaxation help? You can also access How can medication Hypnotherapy privately through Relaxation training is a technique help? the British Society of Clinical that aims to reduce physical Like most anxiety disorders, Hypnosis (BSCH) tension in the body. It also helps to medication (usually Tel. 01262 403603 lower the heart rate, blood ), may be of help. www.bsch.org.uk pressure and slow down the rate You should discuss this possibility of breathing. People may with your GP. NPS has a experience a feeling of well-being Psychiatric Pharmacy Helpline and tranquillity. Relaxation Training Diet which offers information and for many is a very valuable and advice on any form of psychiatric Some people find that their diet is life-long skill to acquire. There are medication to its members. a particular problem due to the many teach-yourself videos, DVDs connection between eating and and tapes available to buy where needing the toilet. Many sufferers you can learn relaxation adapt their eating habits to techniques. Can I talk to others accommodate their fear of The NPS shop has a varied who will understand? needing to use a toilet. Some selection of such products - people may avoid eating at all if Gaining support from other people visit our website at: they can whilst others will only eat is often extremely useful in www.phobics-society.org.uk certain types of food they know beginning to manage an anxiety will not affect them. Some condition. Talking to other people sufferers will reduce their fluid who have had similar experiences intake or completely avoid fluids at How can exercise can be the first step to certain times. help? acknowledging and seeking help NPS operates a chat room and for a problem. Talking takes away It is important to try to eat a We all know that exercise keeps an online bulletin board for its the need to explain or justify your sensible, balanced diet and it is us not only physically healthy, but members, where you can meet anxiety and most importantly for recommended that sugar fixes mentally healthy as well. Any other anxiety sufferers and Toilet Phobia sufferers, it reduces and caffeine are avoided. Drinking exercise will release the body's share knowledge, experiences the experienced. water is beneficial but again this is natural endorphins creating a feel and coping mechanisms. You Many people benefit greatly from poses a problem for sufferers of good 'buzz' and raises self- can become an NPS member by support groups, as well as from Toilet Phobia. However, good esteem. Exercise also helps to visiting our website or by calling internet support and information nutrition and fluid intake underpin lower stress levels and therefore us on 0870 122 2325. There is websites. good health. If you are physically aids the management of anxiety. a small fee per annum to join.

18 19 real life experiences success stories

We are all different and “If we go in a pub/ restaurant “Toilet Phobia affects my life experience anxiety uniquely. “I have been receiving help now for the last 3 months from I always need to know where greatly. I am always planning Similarly people have a variety the loos are and I hate it if a . He is fantastic when it's going to be 'safe' to of experiences of treatment: there is a queue in the ladies go to the toilet and make sure and already I know he has as this adds to my anxiety. no-one knows where I'm helped me so much. I have Toilet Phobia affects our going. Holidays are a particular “I have been seeing a CBT gone from not being able to go plans for holidays or days problem as I find it impossible practitioner and have found out of the gate where I live, to out to places I'm not to 'go' when someone that I am more able to now being able to walk around familiar with.” else is in the room.” challenge my behaviours the block all on my own. Some and face my fears around days are better than others but Toilet Phobia” now I have the support from “I can afford to do lots of the right people, I believe that I “It's like being in a prison - things; I am qualified to do can this. I know I am at but an invisible one” lots of things; but I am “I have made contact with the beginning of a long journey unable to do anything.” another sufferer through NPS. to recovery but I now believe This has helped enormously as that there is light at the “I cannot go abroad as the support we give each other end of the tunnel” I am not sure what the toilet is invaluable. Talking to some- “I have had to inform my situation might be in any town one who understands has doctor because he was trying I visit. My wife would love to been a big step forward.” “I correspond with a pen-pal to get me to eat breakfast, go to Paris but I cannot I found through the internet, which makes me need to go bear the thought of it” which has been really helpful to the loo and inhibits “The thing that really and comforting. my travelling to work.” helped me was Clinical Although he doesn't suffer Hypnotherapy” from Toilet Phobia he is very “I have not told anyone, understanding as he “My sons live far away but even my husband” suffers from panic attacks” I could not visit them and “I did an Anxiety Management they thought I was being course which I found really unsociable” helpful and it helped me to “I eventually got NHS Cognitive “I would rather be considered realise the social aspect Behaviour Therapy after a unsociable than to tell of my problem” considerable wait. This was people the truth” “I will stop drinking hours useful in giving me coping before an appointment. I know techniques” “I had telephone counselling I am ruining my kidneys therapy with NPS which helped but it doesn't matter” “My problem is life-inhibiting “At the moment I am trying to and I live a deviant life” me to learn methods of dealing with general anxiety and help myself by slowly exposing Toilet Phobia” myself to my fear. So, for “After using the toilet I will only example, building up the touch the taps or doors if I “I have curtailed any promotion amount of time I can last on the have a paper towel. If I don't chances I have at work as “I tried Reiki and learned train and stopping myself have a paper towel I will it may involve travelling to to do it for myself. I find constantly going to the use my elbows or feet” meet clients” this quite helpful” toilet before I travel”

20 21 your next step glossary

If you recognise, or are affected by any of the symptoms or Agoraphobia Agoraphobia is a complex phobia Graded A treatment method based on the usually manifesting itself as a Exposure idea that a therapeutic effect is difficulties in this booklet please don't delay seeking help. collection of inter-linked phobias. achieved when sufferers confront For example, many agoraphobics their fears in a systematic manner, fear being left alone (monophobia), discontinuing the escape response. Toilet Phobia is not a sign of weakness. Whatever the cause of dislike being in any situation where they feel trapped (exhibiting NHS National Health Service your difficulty, you do not need to be alone with Toilet Phobia; type tendencies) NICE National Institute for Health and and fear travelling away from their Clinical Excellence help is available. 'safe' place - usually the home. Some agoraphobics find they can NPS National Phobics Society Call the NPS helpline - in total confidence on 0870 122 2325 travel more easily if they have a trusted friend or family member OCD Obsessive Compulsive Disorder. accompanying them, however this An based on can quickly lead to dependency. obsessions, compulsions and The severity of agoraphobia varies rituals. between sufferers from those who are housebound, even room- Panic An anxiety disorder characterised NPS’ Commitment Acknowledgements: bound, to those who can travel Disorder by repeated and apparently specific distances within a defined unprovoked panic attacks. A panic boundary. attack is a period of intense fear or We are committed to providing The Lewis Family Charitable Trust psychological distress, typically of information and support for anxiety is pleased to support the National CBT Cognitive Behaviour Therapy is a abrupt onset. Symptoms may treatment option for anxiety. The include trembling, shortness of sufferers. Furthermore we are Phobics Society in its national focus is on specific psychological breath, heart palpitations, sweating, and practical skills (e.g. in reflecting nausea, dizziness and committed to alleviating the project highlighting the incidence, on and exploring the meaning hyperventilation. attributed to events and situations distress caused by anxiety and to effects and treatment of this Parcopresis Parcopresis can be described as and re-evaluation of those the inability to defecate when other meanings) aimed at enabling the help develop greater important condition 'Toilet Phobia'. people are perceived or likely to be client to tackle their problems by understanding of anxiety disorders In doing so, they hope to support around (e.g. in the same public harnessing their own resources. toilet, the same house, or the same and their treatment. We support those affected, their families and Clinical A treatment that attempts to building). This inability limits the Hypnotherapy address the client's subconscious sufferer to being able to defecate many people with toilet-related professionals. only in a limited number of 'safe' mind. Hypnotherapists often (but places thus restricting their lifestyle. anxiety problems and know that not exclusively) require the client to be in a relaxed state, enlisting the due to the particularly distressing This information has been Paruresis Paruresis is also known as pee power of the client's own , shy kidney, bashful bladder and embarrassing nature of this compiled by Pauline Gregson, imagination and may utilise a wide or shy bladder syndrome. It is a Clare Mayo and Nicky Lidbetter of range of techniques from story type of , that problem, people are often telling, metaphor or symbolism to can affect both men and women, the National Phobics Society with the use of direct suggestions for in which the sufferer is unable to reluctant to seek help. We hope beneficial change. (General urinate in the (real or imaginary) that this guide will go some way to editorial support from Professor Hypnotherapy Register). presence of others, such as in a public restroom. explaining Toilet Phobia, how it Karina Lovell of The University of Cognitions Mental processes such as memory, Manchester. attention, perception, action, Social Phobia/ Social anxiety is an experience of manifests itself and what can be problem solving and mental Social Anxiety fear, apprehension or worry imagery and emotion. Also includes regarding social situations and done in terms of self-help and one's awareness of strategies and being evaluated by others. People treatment. thoughts. vary in how often they experience anxiety in this way or in which kinds Defecate The act or process by which of situations. Anxiety about public We would like to express our humans eliminate solid or semisolid speaking, performance, or waste material from the body. interviews is common. Social thanks and appreciation to all anxiety disorder or social phobia, Emetophobia An excessive or irrational fear of is an anxiety disorder involving those who helped in the vomiting or of being around others overwhelming anxiety and who are vomiting. Sufferers are excessive self-consciousness in compilation of this booklet, known as Emetophobics and are everyday social situations. People particularly those who gave their known to go to great lengths to experiencing social anxiety often avoid people who may be sick or have a persistent, intense, and personal experiences. The where a threat of infection is chronic fear of being watched and perceived contributions of everybody judged by others. Generalisation A premise about a sample is Toilet Phobia A term used to describe a range involved have been invaluable. applied to a conclusion about the of anxiety related conditions population e.g. I had a bad associated with the use of the toilet experience in one toilet - I will have a bad experience in all toilets. Urinate The passing of urine

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