{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T09:59:19Z","timestamp":1790589559278,"version":"4.1.0"},"reference-count":73,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T00:00:00Z","timestamp":1790553600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T00:00:00Z","timestamp":1790553600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Neurourology and Urodynamics"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Overactive bladder (OAB) is associated with substantial psychological burden, yet existing biopsychosocial frameworks acknowledge that psychological factors shape outcomes without explaining the cognitive and behavioral mechanisms through which that influence operates. This paper aimed to propose the fear\u2010avoidance as a missing explanatory framework for OAB symptom maintenance, and to introduce a phenotyping model for clinical application.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We synthesized literature on fear\u2010avoidance theory, cognitive appraisal and coping, and OAB epidemiology and psychosocial burden to construct a theoretical model linking urinary urgency to fear\u2010avoidance mechanisms and developed a phenotyping framework distinguishing idiopathic and physiological OAB subtypes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We propose that urinary urgency, characterized by unpredictability and difficulty deferring, functions as a potent stimulus for catastrophic threat appraisal, initiating a self\u2010sustaining cycle of avoidance, hypervigilance, and perceived uncontrollability that perpetuates symptom burden independent of underlying pathology. We further distinguish two OAB subgroups: idiopathic OAB (iOAB), in which fear\u2010avoidance functions as a primary, symptom\u2010originating mechanism driven by maladaptive toileting behaviors and, in some cases, trauma\u2010related hypervigilance; and physiological OAB (pOAB), in which an identifiable physiological cause (e.g., menopause, prostatectomy, radiation cystitis, neurogenic bladder) drives symptom onset while fear\u2010avoidance operates as a secondary but clinically meaningful amplifier.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This distinction carries direct implications for treatment prioritization, positioning fear\u2010avoidance\u2010informed behavioral care as either a primary intervention or a necessary adjunct to medical management. The framework offers clinicians a testable, mechanism\u2010informed model for understanding and addressing avoidance behavior across the OAB clinical spectrum, and provides direction for empirical research on OAB phenotyping and behavioral intervention.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/nau.70458","type":"journal-article","created":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T09:41:06Z","timestamp":1790588466000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Fear\u2010Avoidance and Overactive Bladder: Toward a Mechanism\u2010Informed Model of Care"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5966-7983","authenticated-orcid":false,"given":"Rupal M.","family":"Patel","sequence":"first","affiliation":[{"name":"Bodywise Physical Therapy Durango Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-2357-1614","authenticated-orcid":false,"given":"Andrea","family":"Wood","sequence":"additional","affiliation":[{"name":"University of Miami Miller School of Medicine Miami Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,28]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-024-06029-2"},{"issue":"1","key":"e_1_2_11_3_1","first-page":"14","article-title":"Overactive Bladder Prevalence Trends in the United States, 2009\u20132018: Nhanes Analysis","volume":"10","author":"Chen M.","year":"2026","journal-title":"Uro\u2010Technology Journal"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/ijcp.12164"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1185\/030079907X159533"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/nau.25152"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00345-002-0301-4"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/nau.24936"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/nau.23719"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12894-015-0009-6"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cger.2017.08.002"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11884-016-0344-9"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1177\/1359105314522084"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1464-410X.2010.10013.x"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/JU.0000000000003985"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2296-15-96"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/nau.25557"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.88539"},{"key":"e_1_2_11_19_1","volume-title":"Stress, Appraisal, and Coping","author":"Lazarus R.","year":"1984"},{"key":"e_1_2_11_20_1","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1002\/9781118993811.ch21","volume-title":"Handbook of Stress and Health","author":"Biggs A.","year":"2017"},{"key":"e_1_2_11_21_1","volume-title":"Health Behavior: Theory, Research, and Practice","author":"Glanz K.","year":"2015"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0304-3959(99)00242-0"},{"key":"e_1_2_11_23_1","unstructured":"M. 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