Children with defecation phobia form a vicious circle that often involves withholding a bowel movement for days followed by a bowel movement that would accompany ritualistic behaviors.
George, aged 12, believes he will become contaminated from his own feces or certain body areas. In trying to locate George’s fear, he remembers a time when he was out with his mother in which he had a bowel accident in the superstore. He remembers feeling overwhelmed and fearful of becoming sick after his mother quickly rushed him to the rest room to clean him up and had him keep his hands away from his clothes and bottom area or he would “catch germs”.
Sam, aged 14, has a specific fear of contracting HIV and finds using any toilet causes him extreme anxiety should he come into contact with blood or bodily fluids. He refuses to use the school restroom and holds his bodily functions until it is time to shower, and in which case he will only use the toilet at home before his shower. Sam’s specific fear was triggered after learning about sex-education in school. The trigger topic was “safe-guarding against sexually transmitted diseases”.
Jasmine on the other hand remembers feeling embarrassed and somewhat rejected by school friends because she believed they saw her as being “dirty” after accidentally soiling herself in the classroom when she was five-years old. In therapy, she said she was terrified of defecating in public places. Jasmine referred to her OCD “preventing” her from leaving home for university.
Locate the Fear to Overcome the Problem
If a fear around defecation can be located, this can be the first step to help a child overcome their problem. Fears include those related to:
- Social phobia
- Obsessive Compulsive Disorder
- Specific phobia
Let’s explore each of these phobias with a little detail.
Social Phobia and Defecation Phobia
Social phobia commonly involves feeling self-conscious about using the toilet. These feelings may be causing a child to avoid or delay going. Social phobias around defecation may involve being heard while defecating. The child may turn on the tap water to drown out the noise. The child may be afraid of accidentally having an “accident” in public and thus avoid going out.
Obsessive Compulsive Disorder and Defecation Phobia
Obsessive Compulsive Disorder is another form of anxiety relating to defecating. Some children worry that toilets are contaminated with potentially dangerous diseases or harmful substances.
The child is generally known to focus on germ issues such as a fear of becoming ill.
In other cases, the focus might be around a sensation of not feeling clean enough after using the toilet and following appropriate hygiene procedures.
Corresponding compulsions might be to repeatedly shower, change underwear regularly, delay or resist toilet habits, avoid touching certain body parts (self and others) or coming into contact with particular areas or objects.
Specific Phobia and Defecation Phobia
A specific phobia is when a child develops a fear about a certain toilet, or toilet-related situation. For example, “This particular toilet had blood in it, what if I come into contact with HIV?”
Agoraphobia and Defecation Phobia
Agoraphobia is when the child becomes afraid to leave the house because they have irrational fears of not being able to locate a public convenience. The child might only use their own toilet and will remain indoors for fear of needing the toilet outdoors.
Cognitive Behavioral Therapy to the Rescue
George and his Fear of Getting Sick
For George, treatment involved cognitive strategies to help alter his original belief about getting sick. To test out and strengthen a healthier and more rational belief – the likelihood of getting sick was close to zero, he carried out behavioral experiments.
These experiments involved graduated exposures whereby he would touch a certain body part and then agree to delay washing for a certain amount of time. Subsequently, he started to trust that by resisting giving into rituals and avoidance behaviors seen in obsessive compulsive disorder, he would gradually re-learn how to use appropriate hygiene practice whilst taking risks and managing uncertainty.
Sam and his Fear of Contracting HIV
Sam learned in therapy that he had become hyper-responsible in “protecting” himself from a specific sexually related disease. Sam’s fear was that he would contract HIV through blood or bodily fluids left on toilet seats. Once his fear was identified, Sam was able to see the threat of contracting his feared disease was over-exaggerated.
He too began to use behavioral experiments to disprove his fear. Similar to George, the experiments were performed in graded steps. Sam learned to delay his shower for 10 minutes after using the toilet. He then moved onto a 20 minute delay. He continued with the graded delay until he could reach 60 minutes, and longer.
Jasmine and her Fear of Being Clean Enough
For Jasmine, her old belief meant “not being clean enough” translated to “not being good enough”. Her compulsion was to take three lengthy showers a day “just in case friends or extended family popped by”. She also avoided going out much of the time. This suggested she’d developed contamination OCD and also agoraphobia.
In therapy, Jasmine learned to alter her belief. She learned to recognize that her classmates’ sudden reaction was basically an involuntary response to an unexpected event. Subsequently, she was able to reduce her shower times in graduated steps.
Jasmine’s fear of defecating in public places tapered down by using practice goals that took her further away from her “safe” toilet at home. Overtime, she became less vulnerable to fearing rejection and was thus able to prepare for university.
Children who suffer with urination phobia often frequent the toilet, since doing this reduces anxiety, but only momentarily. For example, a child may need to empty their bladders fully before getting into bed either to “feel right” or to prevent contaminating their sheet. As in defecation phobia, the key to overcoming this problem is usually to find out what the fear-link is that’s causing the anxiety. Then, change the focus with cognitive behavioral therapy.
There are times when a particular fear cannot be located for either a defecation or urination phobia. It’s best not to dwell on something that might not be there. Instead, help a child to anchor a more rational concept to the defecation and/or urination phobia. Use behavioral experiments to reduce or eliminate those fears.
This article is information based only. Please consult with your general practitioner or mental health practitioner before doing cognitive behavioral therapies.