Exploration of the socio-cognitive processes underlying paruresis and parcopresis

  • Kenley L. J. Kuoch
  • Sarina Cook
  • Denny Meyer
  • David W. Austin
  • Simon R. KnowlesEmail author


To date, research exploring the socio-cognitive processes associated with paruresis and parcopresis symptomology is lacking. The current study aimed to investigate how the socio-cognitive processes dysfunctional attitudes (DAs) and fear of negative and positive evaluation (FNE and FPE respectively) relate to paruresis and parcopresis symptomology. In total, 254 undergraduate students (74.0% female; mean age = 31.67 years) completed a cross-sectional online study. A structural equation model indicated the data fit reasonably well (χ2 p value = .209, CMIN/df = 1.514, CFI = .995, TLI = .983, RMSEA = .045, SRMR = .0272), with FPE mediating the relationship between DAs and paruresis symptom severity (p = .001) along with parcopresis symptom severity (p = .001). However, secondary analyses identified that FPE and FNE act as mediators between DAs and paruresis and parcopresis symptom severity when placed in separate models. This is the first study to provide evidence that the psychosocial-cognitive processes DAs and fear of evaluation play an important role in paruresis and parcopresis symptomology. Although this research should be replicated, the current study provides evidence that DAs, and FPE are important contributory factors in paruresis and parcopresis symptoms.


Paruresis Parcopresis Psychopathology Socio-cognitive Psychosomatic 



We would like to thank all participants who took part in our study.


This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. This research was conducted through the support of the Australian Government Research Training Program Scholarship.

Compliance with Ethical Standards

Conflict of Interest

Kenley L. J. Kuoch, Sarina Cook, Denny Meyer, David W. Austin, and Simon R. Knowles declare that they have no conflicts of interest to disclose.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Animal Rights

No animal studies were carried out by the authors for this article.


  1. Alden, L. E., Taylor, C. T., Mellings, T. M., & Laposa, J. M. (2008). Social anxiety and the interpretation of positive social events. Journal of Anxiety Disorders, 22(4), 577–590. Scholar
  2. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington: American Psychiatric Association.CrossRefGoogle Scholar
  3. Beck, A. T. (1976). Cognitive therapy and the emotional disorders. New York: New American Library.Google Scholar
  4. Beck, A. T., Brown, G., Steer, R. A., & Weissman, A. N. (1991). Factor analysis of the dysfunctional attitude scale in a clinical population. Psychological Assessment, 3(3), 478–483.CrossRefGoogle Scholar
  5. Boschen, M. J. (2008). Paruresis (psychogenic inhibition of micturition): Cognitive behavioral formulation and treatment. Depression and Anxiety, 25(11), 903–912. Scholar
  6. Brown, T. A., & Naragon-Gainey, K. (2013). Evaluation of the unique and specific contributions of dimensions of the triple vulnerability model to the prediction of DSM-IV anxiety and mood disorder constructs. Behavior Therapy, 44(2), 277–292. Scholar
  7. Carleton, R. N., Collimore, K. C., & Asmundson, G. J. (2007). Social anxiety and fear of negative evaluation: Construct validity of the BFNE-II. Journal of Anxiety Disorders, 21(1), 131–141. Scholar
  8. Dai, N., Cong, Y., & Yuan, H. (2008). Prevalence of irritable bowel syndrome among undergraduates in Southeast China. Digestive and Liver Disease, 40(6), 418–424. Scholar
  9. de Graaf, L. E., Roelofs, J., & Huibers, M. J. (2009). Measuring dysfunctional attitudes in the general population: The dysfunctional attitude scale (form A) revised. Cognitive Therapy and Research, 33(4), 345–355. Scholar
  10. Dryman, M. T., Gardner, S., Weeks, J. W., & Heimberg, R. G. (2016). Social anxiety disorder and quality of life: How fears of negative and positive evaluation relate to specific domains of life satisfaction. Journal of Anxiety Disorders, 38, 1–8. Scholar
  11. Finch, H. (2005). Comparison of the performance of nonparametric and parametric MANOVA test statistics when assumptions are violated. Methodology, 1(1), 27–38. Scholar
  12. Gilbert, N., & Meyer, C. (2005). Fear of negative evaluation and eating attitudes: A replication and extension study. The International Journal of Eating Disorders, 37(4), 360–363. Scholar
  13. Hambrook, D., Taylor, T., & Bream, V. (2017). Cognitive behavioural therapy for paruresis or "shy bladder syndrome": A case study. Behavioural and Cognitive Psychotherapy, 45(1), 79–84. Scholar
  14. Hammelstein, P., & Soifer, S. (2006). Is "shy bladder syndrome" (paruresis) correctly classified as social phobia? Journal of Anxiety Disorders, 20(3), 296–311. Scholar
  15. Hammelstein, P., Pietrowsky, R., Merbach, M., & Brahler, E. (2005). Psychogenic urinary retention ('paruresis'): Diagnosis and epidemiology in a representative male sample. Psychotherapy and Psychosomatics, 74(5), 308–314. Scholar
  16. Khan, S. R., & Naqvi, I. (2016). Self-criticism and fear of negative evaluation among university students with and without obesity. Pakistan Journal of Psychological Research, 31(2), 509–530.Google Scholar
  17. Knowles, S. R., & Skues, J. (2016). Development and validation of the shy bladder and bowel scale (SBBS). Cognitive Behaviour Therapy, 45(4), 324–338. Scholar
  18. Kumari, R. S., Sudhir, P. M., & Mariamma, P. (2012). Perfectionism and interpersonal sensitivity in social phobia: The interpersonal aspects of perfectionism. Psychological Studies, 57(4), 357–368. Scholar
  19. Kuoch, K. L. J., Meyer, D., Austin, D. W., & Knowles, S. R. (2017). A systematic review of paruresis: Clinical implications and future directions. Journal of Psychosomatic Research, 98, 122–129. Scholar
  20. Laposa, J. M., Cassin, S. E., & Rector, N. A. (2010). Interpretation of positive social events in social phobia: An examination of cognitive correlates and diagnostic distinction. Journal of Anxiety Disorders, 24(2), 203–210. Scholar
  21. Maia Barros, R. E. (2011). Paruresis and parcopresis in social phobia: A case report. Revista Brasileira de Psiquiatria, 33, 416–417.CrossRefGoogle Scholar
  22. Malouff, J. M., & Lanyon, R. I. (1985). Avoidant paruresis. Behavior Modification, 9(2), 225–234.CrossRefGoogle Scholar
  23. Mattick, R. P., & Clarke, C. (1998). Development and validation of measures of social phobia scrutiny fear and social interaction anxiety. Behaviour Research and Therapy, 36, 455–470.CrossRefGoogle Scholar
  24. McClintock, J. M., & Evans, I. M. (2001). The underlying psychopathology of eating disorders and social phobia. Eating Behaviors, 2(3), 247–261. Scholar
  25. Merikangas, K. R., Avenevoli, S., Acharyya, S., Zhang, H., & Angst, J. (2002). The spectrum of social phobia in the Zurhic cohort study of young adults. Biological Psychiatry, 51, 81–91.CrossRefGoogle Scholar
  26. Middlemist, R. D., Knowles, E. S., & Matter, C. F. (1976). Personal space invasions in the lavatory: Suggestive evidence for arousal. Journal of Personality and Social Psychology, 33(5), 541–546.CrossRefGoogle Scholar
  27. Mogg, K., & Bradley, B. P. (1988). A cognitive motivational analysis of anxiety. Behaviour Research and Therapy, 36(809–848).Google Scholar
  28. Munck, I. M. E. (1979). Model building in comparative education: Application of the LISREL method to cross-national survey data. Stockholm: Almqvist & Wiksell International.Google Scholar
  29. Rapee, R. M., & Heimberg, R. G. (1997). A cognitive -behavioural model of anxiety in social phobia. Behaviour Research and Therapy, 35(8), 741–756.CrossRefGoogle Scholar
  30. Reiter, S. R., Otto, M. W., Pollack, M. H., & Rosenbaum, J. F. (1991). Major depression in panic disorder patients with comorbid social phobia. Journal of Affective Disorders, 22, 171–177.CrossRefGoogle Scholar
  31. Soifer, S., Zgourides, G., Himle, J., & O'Brien, N. (2017). The secret social phobia: Shy bladder syndrome (Paruresis). The International Paruresis Association Inc.Google Scholar
  32. Teloken, C., Caraver, F., Weber, F. A., Teloken, P. E., Moraes, J. F., Sogari, P. R., & Graziottin, T. M. (2006). Overactive bladder: Prevalence and implications in Brazil. European Urology, 49(6), 1087–1092. Scholar
  33. Tillfors, M., & Furmark, T. (2007). Social phobia in Swedish university students: Prevalence, subgroups and avoidant behavior. Social Psychiatry and Psychiatric Epidemiology, 42(1), 79–86. Scholar
  34. Vidyanidhi, K., & P, M. S. (2009). Interpersonal sensitivity and dysfunctional cognitions in social anxiety and depression. Asian Journal of Psychiatry, 2(1), 25–28. Scholar
  35. Vroling, M. S., & de Jong, P. J. (2009). Deductive reasoning and social anxiety: Evidence for a fear-confirming belief bias. Cognitive Therapy and Research, 33(6), 633–644. Scholar
  36. Vythilingum, B., Stein, D. J., & Soifer, S. (2002). Is "shy bladder syndrome" a subtype of social anxiety disorder? A survey of people with paruresis. Depression and Anxiety, 16(2), 84–87. Scholar
  37. Watson, D., & Friend, R. (1969). Measurement of social-evaluative anxiety. Journal of Consulting and Clinical Psychology, 33(4), 448–457.CrossRefGoogle Scholar
  38. Weeks, J. W., & Howell, A. N. (2012). The bivalent fear of evaluation model of social anxiety: Further integrating findings on fears of positive and negative evaluation. Cognitive Behaviour Therapy, 41(2), 83–95. Scholar
  39. Weeks, J. W., & Howell, A. N. (2014). Fear of positive evaluation: The neglected fear domain in social anxiety. Chichester: John Wiley & Sons, Ltd.Google Scholar
  40. Weeks, J. W., Heimberg, R. G., & Rodebaugh, T. L. (2008a). The fear of positive evaluation scale: Assessing a proposed cognitive component of social anxiety. Journal of Anxiety Disorders, 22(1), 44–55. Scholar
  41. Weeks, J. W., Heimberg, R. G., Rodebaugh, T. L., & Norton, P. J. (2008b). Exploring the relationship between fear of positive evaluation and social anxiety. Journal of Anxiety Disorders, 22(3), 386–400. Scholar
  42. Weissman, A. N., & Beck, A. T. (1978). Development and validation of the dysfunctional attitude scale. Chicago: Paper presented at the The Annual meeting of the Association for the Advanced Behavior Therapy.Google Scholar
  43. Werner, K. H., Jazaieri, H., Goldin, P. R., Ziv, M., Heimberg, R. G., & Gross, J. J. (2012). Self-compassion and social anxiety disorder. Anxiety, Stress, and Coping, 25(5), 543–558. Scholar
  44. Wong, S. S. (2008). The relations of cognitive triad, dysfunctional attitudes, automatic thoughts, and irrational beliefs with test anxiety. Current Psychology, 27, 177–191.CrossRefGoogle Scholar
  45. Wong, D. F. K., & Sun, S. Y. K. (2006). A preliminary study of the efficacy of group CBT for people with social anxiety in Hong Kong. Hong Kong Journal of Psychiatry, 16, 50–56.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Kenley L. J. Kuoch
    • 1
  • Sarina Cook
    • 1
  • Denny Meyer
    • 2
  • David W. Austin
    • 3
  • Simon R. Knowles
    • 1
    • 4
    • 5
    • 6
    Email author
  1. 1.Department of Psychological SciencesSwinburne University of TechnologyMelbourneAustralia
  2. 2.Department of Statistics, Data Science and EpidemiologySwinburne University of TechnologyMelbourneAustralia
  3. 3.School of PsychologyDeakin UniversityGeelongAustralia
  4. 4.Department of Mental HealthSt Vincent’s HospitalMelbourneAustralia
  5. 5.Department of PsychiatryThe University of MelbourneMelbourneAustralia
  6. 6.Department of GastroenterologyRoyal Melbourne HospitalMelbourneAustralia

Personalised recommendations