MY RESEARCH

Abstract

Background: 

Urinary and faecal incontinence substantially impacts upon physical health and is associated with significant psychological distress and reduced quality of life. Due to stigma and embarrassment, many patients do not present for management of their incontinence.

Aim: 

The objective of this article is to summarise the forms and causes of urinary and faecal incontinence, highlight the psychological mechanisms and psychopathology associated with incontinence, and provide management recommendations.

Conclusion: 

Urinary and faecal incontinence can have a significant impact on an individual's psychological wellbeing and quality of life. Psychological factors may either contribute to or arise from incontinence and should be addressed as part of the overall management plan.

KUOCH, K. L. J., AUSTIN, D. W., & KNOWLES, S. R. (2019). LATEST THINKING ON PARURESIS AND PARCOPRESIS: A NEW DISTINCT DIAGNOSTIC ENTITY? AUSTRALIAN JOURNAL OF GENERAL PRACTICE.

Abstract

Background:

Paruresis and parcopresis are psychogenic conditions that involve a difficulty or inability to void or defecate, respectively, in a public setting (eg public restroom). Both conditions are associated with significant psychological distress. As a result of shame, embarrassment and stigma, individuals with these conditions may not actively identify behaviours or symptoms or seek treatment in general practitioner (GP) consultations.

Objective:

The objective of this article is to provide a summary of the associated psychopathology and comorbidity, and diagnostic challenges associated with paruresis and parcopresis. Treatment recommendations relating to paruresis and parcopresis are also provided.

Discussion:

Paruresis and parcopresis can have a significant impact on an individual’s psychological health and overall quality of life. GPs play a part in identifying these conditions, defusing feelings of shame and embarrassment, and enabling access to psychological interventions, which are likely to provide significant benefits to individuals living with paruresis and/or parcopresis.

KUOCH, K. L. J., MEYER, D., AUSTIN, D. W., & KNOWLES, S. R. (2019). SOCIO-COGNITIVE PROCESSES ASSOCIATED WITH BLADDER AND BOWEL INCONTINENCE ANXIETY: A PROPOSED BIVALENT MODEL. CURRENT PSYCHOLOGY. DOI:10.1007/S12144-019-00496-3

Abstract

The aim of this study was to examine whether the extended bivalent fear of evaluation model (extended BFOE) of Social Anxiety Disorder (SAD) could be used to explain bladder and bowel incontinence anxiety (BBIA). It was hypothesised that the relationship between dysfunctional attitudes (DAs) and BBIA would be mediated by fear of negative evaluation (FNE), fear of positive evaluation (FPE), concerns of social reprisal (CSR), and disqualification of positive social outcomes (DPSO). Three-hundred-and-seventeen undergraduate students (76.7% female; mean age = 31.07 years) completed a cross-sectional online study. A structural equation model (SEM) supported the proposed model (χ2p value = .131, CMIN/df = 1.560, CFI = .996, TLI = .990, RMSEA = .042, SRMR = .0245) with significant relationships found between DAs and FNE (p < .001), DAs and FPE (p = .002), DAs and CSR (p = .007), FNE and CSR (p < .001), FNE and DPSO (p < .001), FPE and CSR (p < .001), FPE and DPSO (p < .001), CSR and DPSO (p < .001), BBIPSS bladder and bowel with incontinence anxiety (p < .001). These results suggest that DAs, FNE, and DPSO are important contributory factors in BBIA. Given that FNE was the strongest mediator in the model, clinicians may find it advantageous to target FNE in treatment of incontinence-anxiety.

KUOCH, K. L. J., MEYER, D., AUSTIN, D. W., & KNOWLES, S. R. (2019). SOCIO-COGNITIVE PROCESSES ASSOCIATED WITH PARURESIS AND PARCOPRESIS SYMPTOMS: A PROPOSED BIVALENT MODEL. CURRENT PSYCHOLOGY, 1-7. DOI: 10.1007/S12144-019-00376-W

Abstract

Paruresis has been recognized as a subtype of Social Anxiety Disorder (SAD). A well-established model of SAD is the extended bivalent fear of evaluation model (extended BFOE) which include socio-cognitive processes such as fear of negative and positive evaluation (FNE and FPE), concerns of social reprisal (CSR), and disqualification of positive social outcomes (DPSO). In addition to the extended BFOE, dysfunctional attitudes (DAs) have also been recognized to contribute towards social anxiety symptoms and distress. The aim of this study was to examine whether an extended BFOE model for SAD could be used to explain paruresis and parcopresis symptoms. Three-hundred-and-sixteen undergraduate students (76.6% female; mean age = 31.25 years) completed a cross-sectional online study. A structural equation model (SEM) indicated the data supported the proposed model very well (χ2p value = .345, CMIN/df = 1.064, CFI = 1.00, TLI = .999, RMSEA = .014, SRMR = .0107) with significant direct relationships being found between DAs and FNE (p = .002), DAs and FPE (p = .002), FNE and CSR (p = .001), FPE and CSR (p = .001), CSR and paruresis score (p = .045), CSR and DAs (p = .006), FPE and paruresis score (p = .001), FPE and parcopresis score (p = .004), FNE and paruresis score (p = .004), and FNE and parcopresis score (p = .002). Although this research should be replicated, the current study provides evidence that DAs, FNE, FPE and CSR are important contributory factors in paruresis and parcopresis symptoms.

KUOCH, K. L. J., MEYER, D., AUSTIN, D. W., & KNOWLES, S. R. (2019). DEVELOPMENT AND VALIDATION OF THE BLADDER AND BOWEL INCONTINENCE PHOBIA SEVERITY SCALE (BBIPSS). JOURNAL OF COGNITIVE PSYCHOTHERAPY, 33(4), 271-285. DOI: 10.1891/0889-8391.33.4.271

Abstract

The current research investigates the development and validation of the Bladder and Bowel Incontinence Phobia Severity Scale (BBIPSS). Over two studies, two independent samples consisting of university students and respondents from the general public were used to validate the scale (study 1 n = 226; study 2 n = 377). A 15-item, two-factor model was confirmed in study 2 where strong construct (convergent and divergent) validity was demonstrated. The BBIPSS did not display significant correlations with openness and gender (divergent validity) and displayed significant correlations with depression, anxiety, and stress scores (DASS), alongside paruresis and parcopresis scores (Shy Bladder and Bowel Scale [SBBS]; convergent validity) and the Bowel and Bladder-Control Anxiety Scale [BoBCAtS]. The BBIPSS also demonstrated strong test–retest reliability (bladder r = 0.89; bowel r = 0.86) in a small sample of adults (n = 13). Overall, this scale provides researchers and clinicians with a reliable and psychometrically valid assessment tool to measure bladder and bowel incontinence phobia severity.

KUOCH, K. L. J., COOK, S. MEYER, D., AUSTIN, D. W., & KNOWLES, S. R. (2019). EXPLORATION OF THE SOCIO-COGNITIVE PROCESSES UNDERLYING PARURESIS AND PARCOPRESIS. CURRENT PSYCHOLOGY. DOI:10.1007/S12144-019-0125-7

Abstract

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 (χ2p 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.

KUOCH, K. L. J., MEYER, D., AUSTIN, D. W., & KNOWLES, S. R. (2017). A SYSTEMATIC REVIEW OF PARURESIS: CLINICAL IMPLICATIONS AND FUTURE DIRECTIONS. J PSYCHOSOM RES, 98, 122-129. DOI:10.1016/J.JPSYCHORES.2017.05.015

Abstract

Objective:

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?

Method:

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.

Results:

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.

Conclusion:

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.