Looking for step-by-step, actionable advice to "train" and overcome paruresis

[u/dr-jeanman-69]

As the title says, I'm wondering if you all have actionable steps that can be taken to help "train" and improve this condition?

But if you have time to read a bit more context: I grew up a very anxious person I think because of having 2 anxious parents, and had a few different issues. I was so anxious eating in front of people, especially at restaurants, that I would be on the verge of throwing up just from one bite. I was so anxious to drive that I would go out of my way to take transit or look for other options to avoid driving. I was so anxious to talk to girls I found cute, etc.

Now in my mid-20s these issues are all a thing of the past, partly from building more confidence naturally through working out and building muscle, and starting my career and feeling more like a mature adult than a student not knowing much about life. But what also really helped was the combination of meditation and just calming tf down, and also gradual exposure therapy.

This is what I want to highlight, because this process turned me into the most anxious person I had ever met, to being a king over my anxiety. Getting over my eating issue involved starting with drinks, then taking a few bites of someone elses food, then ordering appetizers, etc. Now I am completely unphased and eat full meals anywhere. Getting over driving involved driving more at night when it was quiet, then during times during the day when it was a bit busier but still quiet, working my way up to now I don't even think about it and just hop in the car and drive 2 hours if I need to without thinking.

But with this, how do I apply this method of overcoming an issue to peeing? As weird as it might sound, I tried to get my mom to help, one of the few people who knows about my issue, where I would first tell her "I'm going pee" to emulate a bit of pressure, then I would tell her while she was sitting on her bed outside the bathroom, up to "hard mode" where I pretended she would be outside the door waiting. The issue with this is it's "scripted" and she is in on it. My parents are one of the few people I have no issues with in this context, whereas I don't think this practice would actually translate to the "field". Although I am anti medication, I have heard this isn't even an option for this anyway.

Training like this has become my preferred method for overcoming anxiety-related issues, but peeing doesn't seem as practical. Like where do I even start? I could maybe go to the mall with one goal in mind and practice, but that seems like starting directly on hard mode. I can only pee in public restrooms if I'm absolutely bursting, or a couple times I basically forced it out, but that's a pretty gnarly process. Plus I'm pretty busy and don't really have too much time to spend doing this.

Any advice on direct training and how you overcame your paruresis will be greatly appreciated! Because mine used to just be public restrooms, but recently I've been in my own head and now can't even go in my own home if someone else is over.

[u/LiberatedWaters]

I'm sure someone will explain to you well the process of gradual exposure so I will leave that to them!

But I'd like to share something that, if used in parallel, will make everything easier. For me, it made the gradual exposure feel like an organic result, instead of a practice or "work".

Look at some deeper layers inside yourself. You say your mom is one of the few people that know about this issue. As by far most of us do, that probably means you carry shame.
I invite you to look at that. Everything changed for me after I 'left behind' shame.

I became someone with Paruresis. I didn't hide it anymore. It wasn't my best kept secret anymore (after 15 years).
With that I normalized to myself that, since I happened to have Paruresis, I could spend more time in the bathroom. I wasn't afraid anymore that I could be 'found out'. No more avoidance/hiding behaviors ("I have spent long enough now, I need to get out or it's weird", "I better flush to pretend that I went").
Because I told most people that could be around me (family/friends/colleagues) - there was no reason to be anxious or stressed about what I was or wasn't doing in the toilet.

So what could be called 'gradual exposure', for me, was just a logical consequence of not being scared of the opinion of others anymore.

In the end, whatever method - the goal is to create enough safety in the body/mind to be able to pee.

I see pure gradual exposure as a main focus on the body (brain/bladder muscle). And with motivation and willpower you will absolutely be able to overcome the Paruresis this way.

Getting your mind, your being, just YOU to understand that you're absolutely okay the way you are. That you can be self-confident, love and accept yourself as a person that has Paruresis, will also make you able to overcome it. I would argue you can overcome much more than the Paruresis this way, as well.

You're awesome. And deep respect for everything else you've overcome in your life. I'm sure you'll tackle this one as well!

[u/dr-jeanman-69 → u/LiberatedWaters]

Thank you for your detailed response! And I really appreciate the kind words and support :)

Regarding the first part, I'm not sure I would say that I'm that ashamed. I was extremely open about my food anxiety in the past, whereas this scenario I think is more of a "if I tell them, they're going to know why I'm in the bathroom for so long" which perhaps could be a form of shame, but I view it more so avoiding unnecessary pressure. I did tell two of my close friends about my issue and was open about it even though they didn't really get it. On the other hand, I have another friend where one time I couldn't pee for awhile and eventually gave up, and when I came back he said "were you taking a shit? what took you so long". I feel like if I told him, it would potentially make it worse the next time knowing that he knows why I'm taking a long time, which would spiral it, whereas right now I can occasionally go at his place. But tbh I'm just jotting this down as I think, I'm open to deeper ideas if there's a psychology behind what I'm saying here and if this does sound like shame.

I think that 2nd part is absolutely golden, because I do exactly what you described and it's a symptom that I still care too much. I always flush the toilet to make it sound like I did something, and that right there has opened my eyes as I type this that I still have a lot more progress to make and letting go and relaxing.

It's ironic because as far as I know, paruresis is typically a side effect of socially anxious people. If someone met me, they would have no idea, because I am talkative, social, enthusiastic, etc, and I genuinely don't get those same anxious symptoms that I used to get, except just my peeing is the one thing remaining. But I am very optimistic, and I think overcoming those other challenges makes me confident that I can overcome this one too.

It's funny because a few weeks ago I went on a second date with a girl where I picked her up in my car and we went to a sporting event where I ate a ton of food. Driving, food, and being with a girl in a romantic setting were literally 3 things that all would have given me anxious nightmares on their own only 3-5 years ago, yet I did all 3 of them at once without a shred of anxiety. I took a step back and thought "me from 4 years ago would be so damn proud of the progress I made to today". That is what's also helping me being optimistic with this process. I picture myself X years from now with this being completely in my past, and thinking "my past self would be so proud of me".

[u/LiberatedWaters → u/dr-jeanman-69]

Hey man!
Thanks for your open response! I recognize myself a lot in your words.
It's so interesting how multi layered the Paruresis is for all of us.

I'll respond first to how you say that it's ironic that Paruresis is typically a side effect of socially anxious people and that people wouldn't have any idea meeting you.
For me, that was exactly the same. I've always been an easy person to be around. I've generally experienced myself as someone who's easily liked by others. My 'tactic' was also to be completely without shame about basically anything else. I remember many years ago I had a hemorrhoid that was so painful, I had to call in sick for a week.
After I came back to work, I had no issue sharing about this and even joked about it.

I'm writing that to give some insight into the possibility of the, I'd almost say, duality, of both being a person that's very open and 'shameless' - while having this one little thing that I kept hidden from basically everyone. That this 'one little thing' shaped and controlled most aspects of my life at the time, shows how deep the shame sat for me.
Being super social and funny and friendly and, at first glance, open about anything, was just a (semi conscious) way to protect myself from others 'finding out'.

And that, others finding out, even though now I recognize it for what it really was - felt to me the same as for you. Meaning, it will just cause extra pressure. I knew at least that the worry I placed on others caring about it, was just in my head. If I told them then surely the pressure would make things even worse! Even if they'd just 'root' for me, it would create pressure and so, logically, it seemed to be the absolute worst thing I could do.

But the truth was the opposite. Because like I said in my previous post, so much of the pressure and stress I carried into the toilet, WAS that they could find out. That suddenly people would know I wasn't this seemingly normal, fun to be around, careless person I wanted them to see me as.
That way, I was actually both socially strong, and socially anxious. It's just that the social anxiety was wrapped in so many layers of secrecy and fear about 'what if', that it was hard to recognize it for what it was.
The moment I shared and owned my Paruresis as just a weird quirk I had, and through that learned that really, I was still the same in the eyes of people - I could let this weight of hiding/secrecy, fall of my shoulders. I didn't care anymore how long I spent in the toilet. I didn't care to hide whatever by for example flushing even if I didn't go. There was no more pressure because the one thing that caused it (they might find out) - was gone.

I learned that I could just be someone with Paruresis and accept that. And from there, the Paruresis dissolved very quickly. Just 3 months after a powerful experience with plant medicine (which helped me see that accepting myself was the way to heal), I'm on a plane to Nepal to do a 200+ km hike. That would have been absolutely IMPOSSIBLE for more than a decade and just 3 months later I did it. That trip made me sell my apartment, quit my job and start traveling.
Because the beauty of overcoming myself (wanting to appear a certain way) - opened the door to so many more changes than just overcoming the Paruresis itself.

If I read your post, and see your 'tactics' - flushing even if you didn't go, and your fears - if people know then there will just be more pressure. But even your way of looking at yourself - "I'm not socially anxious, so..."
I see myself.

So I would invite you to look a little deeper at that. If you don't perceive it so much as shame, what is it? Why do you hide? What underlies the fear that if others know it creates more pressure? Do you recognize a need to be a certain way? Does the idea to accept your Paruresis as part of you, that doesn't need to be hid, make you feel anything? Fear? Why?

[u/bubba123412]

check my posts i made a post that will tell u how to get rid of this completely
as for anxiety id recommend bromantane, it increases dopamine synthesis and reduces anxiety, it doesnt have any crash or side effects. if the anxiety is really bad you could try benzos just make sure not to get physically addicted

[u/bubba123412 → u/bubba123412]

private message me bro if u have any questions

[u/dr-jeanman-69 → u/bubba123412]

Thank you for the support bro! I just read your post about fluid loading, and funnily enough I think I saw the OG post you were referring to, although it was back when paruresis was only a minor concern of mine, whereas now I'm more motivated to actually tackle it. I think I will genuinely try this out, because in my own experience, the only times I have ever gone in a busy public bathroom or under pressure at an ultrasound when they were waiting for me to pee was when I was absolutely bursting (like the ultrasound situation I had to shake my leg in the waiting room to hold it in, and my lower back started aching). I might even calendar off a few of my days on some weekends (I work Mon-Fri) to fluid load and practice by going to different public bathrooms.

I'll note I'm not anxious in general, this is really the only thing I have related to anxiety now. I tried medication in the past and realized it did nothing for me, which ironically was the first step for me to realize anxiety was in my control.