What is the diagnosis?

Just psychiatry podcast

A 29-year-old man consulted you with the complaint that he experiences extreme distress whenever he must use a public toilet or one where people are close. He detailed that because of this fear of humiliation, he often avoids traveling. Sometimes, he experiences severe tenesmus and yet he will make sure to reach home to pass feces. He does not have widespread worries, but his mood is low. Sleep and appetite are also normal. The rest of his assessment including physical examination and labs were all within normal limits. What diagnosis is most appropriate? Agoraphobia Social Phobia Depressive illness Specific Phobia Obsessive-Compulsive Disorder Paruresis and parcopresis are subtypes of toilet phobia. Parcopresis is the term used for "fear and inability-to-defecate where other people are close." Individuals with parcopresis defecate in toilets, they consider safe and private. Their anxiety is high when others are close enough to listen to their bowel movements. The DSM-5 has not listed parcopresis under social anxiety disorder, ICD-10 recognizes it as social phobia, however. The other form of toilet phobia, i.e. paruresis (also known as shy bladder syndrome or psychogenic urinary retention) refers to "a difficulty or inability to urinate in public." These individuals are comfortable urinating in the privacy of their own home. In a place where others may observe them urinating, they feel distressed and anxious, just like people with parcopresis. The online version of ICD-10 (2016) and ICD-11 have not listed this phobia. [e-mail]