A systematic review of paruresis: Clinical implications and future directions

Paruresis refers to the inability to initiate or sustain urination where individuals are present due to the fear of perceived scrutiny from others. The aim of this systematic review was to evaluate four key questions: (1) What is the prevalence of paruresis and its associated demographic features; (2) What is the prevalence of psychopathology in paruresis cohorts, how does it compare to other chronic-health conditions, and what percentage of paruresis patients also have social anxiety disorder? (3) How does quality of life, and levels of anxiety and depression compare between those with and without paruresis; and (4) do psychological interventions for paruresis patients reduce paruresis symptoms, or, anxiety, or depression, or improve quality of life?

A review was conducted using PRISMA protocol for search strategy, selection criteria, and data extraction. Searched databases included PubMed, CINAHL, and PsychINFO. Over the 1418 studies screened, ten were found relating to at least one review question.

The prevalence of paruresis ranged between 2.8 and 16.4%, and around 5.1-22.2% of individuals with paruresis also had Social Anxiety Disorder. Paruresis symptoms were shown to reduce in one intervention study. Paruresis was also associated with poorer quality of life. A key limitation of the research to date has been the notable methodological problems and lack of standardisation relating to the measurement of paruresis.

Little is known about the prevalence of paruresis and more rigorous studies of paruresis are required. Recommendations in terms of clinical implications, diagnostic criteria and future research relating to paruresis are discussed.