{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T14:06:57Z","timestamp":1790086017365,"version":"4.0.1"},"reference-count":34,"publisher":"BMJ","issue":"11","license":[{"start":{"date-parts":[[2024,11,15]],"date-time":"2024-11-15T00:00:00Z","timestamp":1731628800000},"content-version":"unspecified","delay-in-days":14,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2024,10,26]]},"published-print":{"date-parts":[[2024,11]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To assess the prevalence and severity of paruresis (\u2018shy bladder syndrome\u2019) in a population of university staff and students and to determine if there was any relationship between demographics, self-esteem, presence of social anxiety disorders and negative toilet experiences and paruresis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>We undertook an anonymised cross-sectional online survey using Microsoft Forms. We invited participants aged 18 and over to complete the survey which included demographic information; any pre-existing medically or self-diagnosed anxiety-related conditions; Shy Bladder Scale (SBS); Rosenberg Self-Esteem Scale (RSES) and questions about using school toilets in their younger life. We defined \u2018mild\u2019 and \u2018severe\u2019 paruresis based on total SBS cut-off scores of greater than or equal to 31 and greater than or equal to 40. We calculated prevalence of paruresis, and explored differences in self-esteem, school toilet experience and social anxiety disorders between individuals with and without paruresis. Multivariable logistic regression was used to determine which variables had any influence on having a \u2018mild\u2019 and \u2018severe\u2019 paruresis diagnosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>We distributed the survey to all staff and students via their university email address as well as promoting the survey on university social media sites.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We received responses from 356 individuals. Most participants (237, 66.6%) were within the 18\u201330 year age category and most (277, 77.8%) were white. There were 221 (62.1%) females, 119 (33.4%) males and 16 (4.5%) other genders. The prevalence of \u2018mild\u2019 paruresis was 25.8% and of \u2018severe\u2019 paruresis 14.9% in this sample. 73.0% indicated that they had at least one medically or self-diagnosed anxiety disorder. There was a statistically significant difference in the total SBS score between individuals with and without an existing anxiety disorder (8 vs 19, &lt;0.001). The adjusted odds of \u2018mild\u2019 paruresis were higher for men than women (OR 3.39; 95%\u2009CI 1.90 to 6.06), lower for those with a lower RSES score (OR 0.90; 95%\u2009CI 0.85 to 0.96), lower for those for a lower school toilet experience score (OR 0.88; 95%\u2009CI 0.78 to 0.99) and higher for those with at least one anxiety disorder (OR 3.164; 95%\u2009CI 1.52 to 6.59). The adjusted odds of \u2018severe\u2019 paruresis were higher for men than women (OR 2.60; 95%\u2009CI 1.32 to 5.12), lower for those with a lower RSES score (OR 0.90; CI 0.84 to 0.97) and higher for those with at least one anxiety disorder (OR 2.99 (1.18\u20137.56)).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Large organisations should consider measures to help manage anxiety and improve toilet experiences. These could include resources and signposting to manage anxiety disorders and single-occupancy toilets and toilets in quiet areas to limit anxiety associated with shy bladder syndrome.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2024-086097","type":"journal-article","created":{"date-parts":[[2024,11,17]],"date-time":"2024-11-17T21:52:27Z","timestamp":1731880347000},"page":"e086097","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Exploring paruresis (\u2018shy bladder syndrome\u2019) and factors that may contribute to it: a cross-sectional UK survey study"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4155-1741","authenticated-orcid":false,"given":"Hayley Anne","family":"Hutchings","sequence":"first","affiliation":[{"name":"School of Medicine, Swansea University, Swansea, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abi","family":"Kehinde","sequence":"additional","affiliation":[{"name":"School of Medicine, Swansea University, Swansea, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,11,17]]},"reference":[{"key":"2025121514091795000_14.11.e086097.1","doi-asserted-by":"publisher","DOI":"10.1002\/da.20367"},{"key":"2025121514091795000_14.11.e086097.2","doi-asserted-by":"publisher","DOI":"10.1016\/0005-7967(79)90042-1"},{"key":"2025121514091795000_14.11.e086097.3","doi-asserted-by":"publisher","DOI":"10.1177\/01454455850092006"},{"key":"2025121514091795000_14.11.e086097.4","doi-asserted-by":"publisher","DOI":"10.1080\/00221309.1954.9920203"},{"key":"2025121514091795000_14.11.e086097.5","first-page":"1738","article-title":"New treatment of psychogenic urinary retention using behavior therapy","volume":"103","author":"Lamontagne","year":"1973","journal-title":"Union Med Can"},{"key":"2025121514091795000_14.11.e086097.6","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1002\/da.10061","article-title":"Is \u201cshy bladder syndrome\u201d a subtype of social anxiety disorder? A survey of people with paruresis","volume":"16","author":"Vythilingum","year":"2002","journal-title":"Depress Anxiety"},{"key":"2025121514091795000_14.11.e086097.7","doi-asserted-by":"crossref","DOI":"10.1176\/ajp.151.10.1520a","article-title":"Urosepsis: an unusual presentation of a social phobia","volume":"151","author":"Brandt","year":"1994","journal-title":"Am J Psychiatry"},{"key":"2025121514091795000_14.11.e086097.8","doi-asserted-by":"crossref","first-page":"228","DOI":"10.17744\/mehc.36.3.703453j7780t1384","article-title":"Paruresis: What Counselors Need to Know about Assessment and Treatment of Shy Bladder Syndrome","volume":"36","author":"McGraw","year":"2014","journal-title":"J Ment Health Couns"},{"key":"2025121514091795000_14.11.e086097.9","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpsychores.2017.05.015"},{"key":"2025121514091795000_14.11.e086097.10","doi-asserted-by":"publisher","DOI":"10.2466\/pr0.1987.60.3c.1171"},{"key":"2025121514091795000_14.11.e086097.11","unstructured":"International Paruresis Association . Shy Bladder, Bashful Bladder, Pee Shy, Available: https:\/\/paruresis.org"},{"key":"2025121514091795000_14.11.e086097.12","unstructured":"UKParuresis Trust . What is shy bladder syndrome?, Available: https:\/\/www.ukpt.org.uk"},{"key":"2025121514091795000_14.11.e086097.13","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1159\/000086322","article-title":"Psychogenic urinary retention ('paruresis\u2019): diagnosis and epidemiology in a representative male sample","volume":"74","author":"Hammelstein","year":"2005","journal-title":"Psychother Psychosom"},{"key":"2025121514091795000_14.11.e086097.14","first-page":"308","article-title":"Personality Correlates of Urinary Hesitancy (Paruresis) and Body Shyness in Male College Students","volume":"23","author":"Gruber","year":"1982","journal-title":"J Coll Stud Pers"},{"key":"2025121514091795000_14.11.e086097.15","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1080\/16506073.2012.658852","article-title":"Development and validation of the shy bladder scale","volume":"41","author":"Deacon","year":"2012","journal-title":"Cogn Behav Ther"},{"key":"2025121514091795000_14.11.e086097.16","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1016\/j.janxdis.2005.02.008","article-title":"Is \u201cshy bladder syndrome\u201d (paruresis) correctly classified as social phobia?","volume":"20","author":"Hammelstein","year":"2006","journal-title":"J Anxiety Disord"},{"key":"2025121514091795000_14.11.e086097.17","doi-asserted-by":"publisher","DOI":"10.1080\/16506073.2016.1178800"},{"key":"2025121514091795000_14.11.e086097.18","doi-asserted-by":"crossref","first-page":"494","DOI":"10.1080\/00981381003684898","article-title":"Paruresis (shy bladder syndrome): a cognitive-behavioral treatment approach","volume":"49","author":"Soifer","year":"2010","journal-title":"Soc Work Health Care"},{"key":"2025121514091795000_14.11.e086097.19","doi-asserted-by":"crossref","first-page":"1429","DOI":"10.1016\/S0140-6736(81)92616-7","article-title":"Coping with the \u201cbashful bladder\u201d syndrome","volume":"1","author":"Beary","year":"1981","journal-title":"Lancet"},{"key":"2025121514091795000_14.11.e086097.20","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1949.02910160029007"},{"key":"2025121514091795000_14.11.e086097.21","doi-asserted-by":"publisher","DOI":"10.1037\/0022-3514.38.4.668"},{"key":"2025121514091795000_14.11.e086097.22","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1037\/xge0000668","article-title":"Experimental manipulation of extraverted and introverted behavior and its effects on well-being","volume":"149","author":"Margolis","year":"2020","journal-title":"J Exp Psychol Gen"},{"key":"2025121514091795000_14.11.e086097.23","doi-asserted-by":"publisher","DOI":"10.1037\/0033-2909.134.1.138"},{"key":"2025121514091795000_14.11.e086097.24","doi-asserted-by":"publisher","DOI":"10.1093\/pubmed\/24.2.85"},{"key":"2025121514091795000_14.11.e086097.25","doi-asserted-by":"publisher","DOI":"10.1093\/pubmed\/fdl039"},{"key":"2025121514091795000_14.11.e086097.26","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-020-10099-4","article-title":"Analysis of factors affecting students going to school toilets in a rural primary school in China","volume":"21","author":"Shao","year":"2021","journal-title":"BMC Public Health"},{"key":"2025121514091795000_14.11.e086097.27","unstructured":"Wellor J . School toilets \u2013 convenient or inconvenient, Available: https:\/\/www.ukpt.org.uk\/paruresis-news-and-information\/school-toilets-convenient-or-inconvenient"},{"key":"2025121514091795000_14.11.e086097.28","doi-asserted-by":"crossref","unstructured":"Jordan CH . Rosenberg-esteem scale. In: Zeigler-Hill V , Shackelford TK , eds. Encyclopedia of personality and individual differences. Cham: Springer, 2020.","DOI":"10.1007\/978-3-319-24612-3_1155"},{"key":"2025121514091795000_14.11.e086097.29","unstructured":"Rosenberg M . RosenbergSelf-Esteem Scale (RSE). Conceiving the self. New York: Basic Books, 1979."},{"key":"2025121514091795000_14.11.e086097.30","first-page":"22","article-title":"The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10","volume":"59 Suppl 20","author":"Sheehan","year":"1998","journal-title":"J Clin Psychiatry"},{"key":"2025121514091795000_14.11.e086097.31","doi-asserted-by":"publisher","DOI":"10.5812\/ijem.3505"},{"key":"2025121514091795000_14.11.e086097.32","doi-asserted-by":"publisher","DOI":"10.1136\/bmjebm-2019-111264"},{"key":"2025121514091795000_14.11.e086097.33","doi-asserted-by":"crossref","first-page":"122","DOI":"10.21315\/mjms2018.25.4.12","article-title":"Sample Size Guidelines for Logistic Regression from Observational Studies with Large Population: Emphasis on the Accuracy Between Statistics and Parameters Based on Real Life Clinical Data","volume":"25","author":"Bujang","year":"2018","journal-title":"Malays J Med Sci"},{"key":"2025121514091795000_14.11.e086097.34","first-page":"438","article-title":"Substance abuse effects on urinary tract: methamphetamine and ketamine","volume":"25","author":"Yee","year":"2019","journal-title":"Hong Kong Med J"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2024-086097","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T22:09:25Z","timestamp":1765836565000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2024-086097"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11]]},"references-count":34,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2024,11,17]]},"published-print":{"date-parts":[[2024,11]]}},"alternative-id":["10.1136\/bmjopen-2024-086097"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2024-086097","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,11]]}}}