In this blog we will discuss the symptoms, causes and treatment of Urophobia.
Fear of urine or urinating is called Urophobia. Urinating is a natural process where one gets rid of the toxins in their body.
People don’t fear urine or urinating normally because it’s a neutral process, it causes no harm or damage to one.
However, someone who is suffering from a urine infection or a urinary tract disease might fear urinating because one may undergo pain or a burning sensation.
Though, people suffering from Urophobia are terrified when they see urine or have to urinate.
It is a type of specific phobia which comes under the category of anxiety disorders in the DSM-V.
Sufferers experience extreme anxiety not just when exposed to urine/the process of urination but at the mere thought of it.
Because of these unpleasant, overwhelming levels of anxiety, a sufferer compromises his social and occupational functioning to avoid getting exposed to his fear stimuli.
Watching someone else urinate also causes anxiety, thus they refrain from going to public washrooms in order to avoid encountering urine.
One of the worst types of avoidance is when one hesistests in urinating.
Either they’ll feel uncomfortable urinating in front of people (like public washrooms) or won’t urinate at all.
This will lead to serious health problems as the body is unable to get rid of the harmful toxins.
Though one feels safe when avoiding their fear stimuli, in the long run, they lead to more serious issues.
Someone suffering from Urophobia is very likely to develop OCD and or depression.
When one is unable to avoid urine or urinating they suffer from misery.
Excess anxiety can cause a sufferer to undergo full-blown panic attacks.
Urophobia is an irrational fear of urine or urinating.
It is a type of specific phobia whose name originates from the Greek word ‘uro’ meaning urine and ‘phobos’ meaning fear.
Symptoms of Urophobia
All anxiety disorders, including specific phobias, have anxiety as their pivotal symptom.
Therefore, someone suffering from Urophobia will experience extreme anxiety when exposed to their fear stimuli, urine.
Someone suffering from this phobia is unable to rationalise his fear and ends up getting anxious.
Avoidance as mentioned earlier is repetitive.
These recurrent actions maintain one’s fear by producing feelings of security, which makes one believe that urine and or urination is to be feared of.
According to the DSM-V, to be diagnosed with Urophobia, one needs to experience anxiety lasting for at least 6 months and at least 3-5 symptoms (from the list mentioned below).
- Excessive anxiety when exposed to urine
- Excessive anxiety when thinking about urine or urinating
- Inability to manage anxiety
- Full-blown panic attacks
- Avoiding urine or urination
- Increased heart beat
- Muscle tension
- Feelings of dizziness/fainting
- Fear of an impending doom
- Feeling depressed
- Excessive sweating
- Hot/cold flashes
- Butterflies in the stomach
- Drying up of mouth
Causes of Urophobia
All anxiety disorders, including specific phobias have no real/definite cause. They are caused by either a genetic predisposition and or environmental factors.
According to the genetic/biological model, specific phobias are developed due to a genetic predisposition.
Someone who has a family history of anxiety disorders has a higher chance of developing Urophobia.
This is because any alteration in the genes of his parents will be transferred to him.
An imbalance in the neurotransmitter levels of the brain can also be one of the many reasons as to why one develops Urophobia.
These alterations are low dopamine levels and high serotonin levels.
This genetic tendency to develop a specific phobia is further explained by the Diathesis-stress relationship.
This suggests that someone with a genetic predisposition will develop Urophobia only in the presence of the correct environmental trigger event.
People who suffer from Mysophobia (fear of germs) will fear urine. This is because urine is acidic which may contain certain diseases.
In childhood, someone might have suffered from a urinary tract infection. Urinating would’ve been painful then.
This uneasy feeling may have been the reason why an individual develops Urophobia.
To conclude, genetics and environmental factors, both play significant roles in causing Urophobia.
Treatment of Urophobia
Urophobia, like all other specific phobias, has no exclusive type of treatment that is specifically designed to treat it.
Like all the other specific phobias, Urophobia is treated by a number of different methods: Psychological treatment and Biological treatment.
- Psychological Treatment
• Cognitive-Behavioral Therapy (CBT)
It is one of the most frequently used treatments for patients with almost all kinds of mental disorders.
Urophobia is defined as the irrational fear of urine or urinating. Thus, the therapist helps the patient in replacing these irrational thoughts with more rational ones.
The patients are helped out in analyzing and justifying the way they feel about their fear stimuli.
Therapists assist them in uncovering the reasons behind their fear and later they provide them with alternate, pleasant thoughts.
The patient is told to maintain a thought diary (with ABCD column) which provides them a replacement for every irrational thought they have, when thinking about a particular situation. The ABCD stands for:
i. A (antecedents) a situation or triggering event.
ii. B (belief) the thought that comes to one’s mind when in that triggering situation.
iii. C (consequences) the symptoms/feelings caused by that event/thought
iv. D (dispute) alternate, rational thoughts provided by the therapist in an attempt to dispute/challenge those irrational beliefs.
This last section of the thought diary is what really plays a role in helping the person feel good/less anxious.
• Mindfulness-Based Stress Reduction (MBSR)
MBSR is a meditation therapy, used to manage stress or anxiety. It is an 8-week program which includes group sessions.
Mindfulness meditation and Hatha yoga are practiced in these sessions.
Lectures and group discussions are also done to talk about mental health and increase interactivity.
In mindfulness meditation the person is told to, for example, focus on the sensations felt while breathing or the rhythm of the chest rising and falling during the process.
This distracts the person’s attention from something stressful to something which is neutral and soothing.
For quick and effective treatment, patients are also given a set of home works, for example 45 minutes of yoga and meditation sessions for 6 days a week and to record their results/feelings in a book or diary for 15 minutes a day.
• Exposure Therapy
It is one of the most frequently used ways of treating patients with Urophobia (or any other kind of specific phobia).
In this therapy, the patient is exposed to the source of his fear over a certain span of time.
To begin with the therapy, the therapist exposes the patient to the least triggering stimuli, a picture of urine in a bottle for example.
As the therapy progresses and the patient is able to control his anxious feelings, imagery can be used to take the treatment a step further.
In this part of the treatment the patient is asked to visualize/imagine a situation in which he has to urinate.
During this process of imagery, one actually feels that he’s in that particular situation or place, experiencing various senses.
Once the person successfully, without feeling anxious, clears this step of the therapy, he is then exposed to real urine (asked to urinate).
While the patient is being exposed to different levels of fear during the various stages of therapy, the therapist simultaneously teaches them coping exercises.
These include, breathing techniques or muscle relaxation methods to lower their anxiety, when in an actual fear causing situation.
This teaches them how to remain calm when exposed to their fear stimuli.
Before actually starting the exposure therapy, the therapist needs to figure out the intensity of the patient’s fear, as to deduce whether they will be able to undergo this treatment, without any physical or psychological harm caused to them during the exposure processes.
However, these steps desensitize one to their fear of urine or urinating, by exposing them to that stimuli repeatedly, until they learn to undergo the situation without anxiety/panic attacks.
• Eye Movement Desensitization and Reprocessing (EMDR)
This another form of treatment used with patients suffering from specific phobia or anxiety disorders.
It is used with patients who know the cause of their phobia.
First, the therapist collects the patients’ history of different fears.
They then identify the real cause of the particular fear/phobia the patient has.
They then discuss any new/latest event that triggered their anxiety and fear in the past few weeks.
People coming with specific phobias are told to imagine their distress causing stimuli.
The therapist then works with the individual in order for them to overcome their fear.
In the case of Urophobia, the patient will be advised on how to overcome his fear of urine.
They do this by creating a positive imagery for the patients’ feared stimuli.
• Dialectical Behavior Therapy (DBT)
This is another effective therapy used to treat Urophobia.
It is more commonly used with people suffering from personality disorders, but is also useful with patients suffering from this type of animal specific phobia.
Coping skills are taught in the DBT group which lasts for about 6-months and can have a number of people (depending on how many join the group).
i.Half-smiling is the first module of DBT. It is a technique that is used with patients who are distressed because of their irrational thoughts.
The technique is known as ‘Half-smiling’ because the person is first advised to think about the stimuli that fears or upsets them, and while doing so they are told to lift the corners of their mouths by subtly smiling. Smiling is not that will help one get rid of these unpleasant thoughts, it is the person’s ability to constrain itself from thinking about those thoughts while half smiling.
ii.Mindfulness, the second module, is another technique used in DBT groups which helps the individual in getting rid of those negative thoughts.
Individuals are told to focus on the present and be attentive to what is going on around them at the moment.
This helps in breaking the link between their mind and any negative thought that might come to them then.
For example, a person is told to focus on his breath or on the sound of the wind around them, making use of their auditory sense.
iii.The third technique or module of the DBT is distress tolerance skills.
This module teaches people to calm themselves down in healthy ways when they are distressed or emotionally overwhelmed.
Individuals are allowed to make wise, rational decisions and take immediate action, rather than being captured by emotionally destructive thoughts that might make the situation worse.
Reality acceptance skills are also learnt under this model so that people fully accept reality and later make plans on how to address the problem.
They are not just one of the many treatment therapies used for Urophobia, instead they are one of the most common ways of relaxation used by many people.
Yoga tends to stimulate the meditative state of one’s mind while the person is in a particular yoga posture.
Through yoga/meditation the mind is diverted towards something more productive and calm, allowing the person to escape the negative, distress causing thoughts.
Out of a number of yoga types, one can benefit from any yoga type/pose they like. Hatha yoga is one of the different types of yoga.
The breathing techniques or the imagery one creates while in a yoga posture are the real factors that makes the person feel less anxious and diverts their mind, away from the thoughts about their fear stimuli.
- Biological Treatment
• Drug Therapy
Drugs are used to reduce the physical symptoms caused by Urophobia. Drugs are very quick in effectiveness, as they start showing progress in the patients’ health at least 2 weeks after the medicine is taken.
This type of biological treatment is usually more effective if the cause of the phobia is only genetic.
However, these drugs/medicines are not to be taken without a doctor’s prescription or consultation.
Two types of drugs are used in the treatment of this phobia:
i. Antidepressant Drugs
These drugs, as the name suggests don’t only treat depression but are also very effective in treating phobias.
Medicines like Paxil reduce the anxious feelings of a person and makes him feel calm. They need to be taken on a daily basis but not without a doctor’s advice.
Medicines like Klonopin are anti-anxiety drugs.
They are most commonly used with patients who experience panic attacks and also lowers their anxiety by binding to receptor cells of the brain that cause these unpleasant symptoms.
Whether the cause of Urophobia, or any other type of specific phobia is genetics, environmental or both, the best and the most effective way of treating them is by using a combination of both biological treatments (drugs) with cognitive treatment (for example CBT/exposure therapy).
Titles to read
- The Secret Social Phobia: Shy Bladder Syndrome (Paruresis)
by Steven Soifer, George Zgourides, et al.
- The American Psychiatric Association Publishing Textbook of Anxiety, Trauma, and Ocd-related Disorders
by Edited by Naomi M. Simon, M.D., et al.
- Anxiety Disorders and Phobias: A Cognitive Perspective
by Aaron Beck, Gary Emery, et al.
- Anxiety and Its Disorders, Second Edition: The Nature and Treatment of Anxiety and Panic
by David H. Barlow
Frequently Asked Questions
Q1) What is the fear of urine?
Urophobia is an irrational fear of urine.
Q2) Is being Pee Shy a real thing?
Paruresis is a type of social phobia. One is fearful of urinating in front of people.
Q3) How is Urophobia diagnosed?
By the help of the criteria mentioned in the DSM-V for specific phobias, one can be diagnosed with Urophobia.
The criteria mentions, one should have anxiety lasting for at least 6-months, accompanied by other physiological symptoms.
Q3) What causes Uroophobia?
Urophobia is caused by a genetic predisposition (family history) and or environmental factors (past traumatic experiences).
Below is a complete list of all Phobias which we currently cover.