Condition keeps some from drug testing

Anxiety disorder makes using public restroom difficult

September 15, 2006|By Deborah L. Shelton | Deborah L. Shelton,St. Louis Post-Dispatch

The only thing standing between Vicki White and a new job as a bank teller was a plastic cup.

Like job candidates at many companies, she was required to undergo drug screening. But she has a condition called paruresis, which can make providing a urine sample difficult, if not impossible.

Paruresis (pronounced: par-YOU-ree-sis) is a type of social anxiety disorder that prevents a person from using the toilet in a public restroom.

To prepare for the test, White, 19, of Wentzville, Mo., guzzled water nonstop before showing up at a testing laboratory last month. Still, even after waiting almost two hours, she could not urinate.

Her friends and family sometimes had ribbed her about the problem. But now it was no laughing matter.

White called New Frontier Bank in O'Fallon, Mo., and asked for a second chance, but a manager told her the job offer had been rescinded, she said.

New Frontier Bank declined to answer questions about White's situation, referring questions instead to ADP TotalSource, a human resources and employee assistance company. ADP TotalSource did not respond to requests for an interview.

In an era of widespread drug testing - in workplaces, schools and elsewhere - the inability to urinate on demand is a serious matter.

White is one of about 17 million people nationwide who are unable to use the toilet in close proximity with others or when they are under time pressure, being observed or traveling on moving vehicles.

The condition is also called "shy bladder" and "bashful bladder."

Having a job offer rescinded without first being given an opportunity to be drug tested by an alternative method, such as with a hair or blood sample, is "simply outrageous," said Steven Soifer, staff director of the International Paruresis Association, based in Baltimore.

The group advocates for people who say they have been unfairly discriminated against in drug testing because of their condition.

Soifer, an associate professor of social work at University of Maryland, Baltimore, said he had been involved with hundreds of cases like White's since he started the group a decade ago.

"It's a very common situation - and that's just the cases we hear about," he said. "I can't tell you how prevalent this kind of discrimination is."

Soifer started the group after he realized at age 40 that he wasn't "the only person in the world with this problem."

He struggled from childhood with shy bladder until he read a magazine article about it 10 years ago.

He said the condition develops in childhood. It affects men and women equally, but more men seek treatment, probably because public restrooms for men offer less privacy, he said.

Genetics also seems to play a role, he said. Soifer's 7-year-old son has it.

The condition occurs on a continuum - from mild to severe.

Those with a severe case are unable to use the toilet, even at home, if others are nearby.

"They experience this problem all the time in public situations," Soifer said. "They worry about it and obsess about it. It becomes an albatross around their neck. I know people who never travel, never date, never marry, never have children, can't take the job or promotion they want, all because of this disorder."

Some people working in jobs that require frequent drug testing even carry a catheter.

White has had the condition for as long as she can remember. She can't use bathrooms unless she is alone or her surroundings are really loud, such as at a baseball game.

"When I found out it had a name, it was kind of a relief," she said. "It was nice to know that it's not just me, that I'm not alone."

White has been screened for drugs three times before, twice under a nerve-wracking four-minute deadline. Each time, she succeeded only after being allowed a second chance - and sometimes, extra time.

Soifer recommended tests that utilize saliva, blood or hair samples instead of urine. Some companies already use such tests because they are easier to administer, he said.

Soifer said some people had sued for discrimination and won.

"It's one of these really gray areas," he said. "Once our lawyer gets involved and contacts the company's legal counsel and explains the situation, and explains that it could be a violation under the Americans with Disabilities Act, the company often realizes they should provide reasonable accommodation."

The federal government is proposing new regulations for federal employees that would expand drug screening methods to hair, saliva, blood and sweat tests, which would prevent the dilemma.

No medications can cure shy bladder, but cognitive behavioral therapy is effective in about 90 percent of cases, Soifer said.

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