Parcopresis

Parcopresis (pronounced par-kop-ruh-sys)

In mental health, a spectrum condition ranging from a marked reluctance (with associated symptoms of psychological distress) to a physical inability to defecate in situations where others will be aware of the activity.

2010s: The word was modelled on paruresis (the inability to urinate in the presence (even if visually segregated) of others), the construct being par(a)- (abnormal, defective) +‎ uresis (urination).  Parcopresis was built by substituting copro- (relating to excrement or dung), from the Ancient Greek κόπρος (kópros) (excrement) for uro- (urine; relating to urine and the urinary system), from the Ancient Greek οὖρον (oûron).  Parcopresis is a noun.  As a class, medical conditions are an exception to the conventions of the English language governing the construction of a noun plural or adjective.  There is no recognized noun plural for parcopresis because medical conditions tend to be referred to in the singular (in the way neither “diabetes” or “arthritis” has a companion noun plural) so the usual practice would be to use phrases like “cases of parcopresis” or “patients with parcopresis”.  Less controversial would be an adjectival form which, following the conventions of English, presumably would be constructed as parcopretic or parcopresic (modelled on the way “psychosis” becomes “psychotic”).  There seems however no evidence of such use and the practice by clinicians remains to use phrases like “patient(s) suffering from parcopresis” or “patient(s) experiencing parcopresis-related symptoms”.  If the condition becomes more studied and more work is published, there may be inguistic innovation.

The word has in the last decade appeared with greater frequency, use triggered apparently by an appearance in 2011 when a case report on paruresis and parcopresis was published in the Revista Brasileira de Psiquiatria (the Brazilian Journal of Psychiatry), describing parcopresis as a psychogenic condition, sometimes related to social anxiety (though distinct from the better known paruresis).  However, despite that (slight) spike which presumably is indicative of some increase in interest in psychological circles, parcopresis has not yet been classified in major diagnostic systems like the American Psychiatric Association's (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM) or the World Health Organization’s (WHO) International Classification of Diseases (ICD)) although other sources (including the National Phobics Society) do list it as a sub-type of Social Anxiety Disorder (SAD).  By contrast, the urinary counterpart (paruresis) appears in the DSM-5-TR (2022), classified as a social phobia.

In clinical use, parcopresis is known also as psychogenic fecal retention (PFR) or (more conveniently and following the clinical shorthand of paruresis being called “shy bladder”) there’s also “shy bowel” and the even better “poop shy”, defined as “the inability to defecate without a certain level of privacy (and the extent of that level varies between patients)).  It manifests thus as something ranging from a “reluctance or difficulty” associated with the symptoms of significant psychological distress (diaphoresis (excessive perspiration), tachypnoea (hyperventilation), heart palpitations, muscle tension, blushing, nausea & trembling) to actual physical inability.  Although the sample sizes are small, there are instances both of a co-morbidity with paruresis and as a stand-alone condition.  The well-understood reluctance to use public toilets related to their notoriously less than immaculate cleanliness is not an instance of parcopresis; it’s just a product of the fastidiousness in matters of hygiene which civilization has bred into populations enjoying the fruits of modernity and again, this exists on a spectrum (and, impressionistically, women exhibit higher standards than men).  Instead, the triggers for the condition are listed usually as “SSS” (sights, sounds, smells) but this refers not to the revulsion the putative pooper may feel but the fear that others may (1) be in their proximity and thus know what they’re doing, (1) hear them doing it and (3) get a whiff of the aftermath.

While toilets in shared spaces can, for some,  induce parcopresis, for others, in certain circumstances, they can provide a place of sanctuary: Lindsay Lohan in Mean Girls (2004).

Parcopresis is not (yet) a medically recognized condition although the 2011 paper in the Brazilian Journal of Psychiatry did suggest it should be classified as a form of social phobia and historically there’s no requirement a syndrome being widespread to justify a classification: it needs just to have defined parameters.  The extent of the prevalence is thus less relevant than its existence although for the editors of the DSM or ICD to consider an entry would presumably be contingent upon a certain clinical utility, something which wouldn’t seem to preclude listing it among the social phobias.  As far as is known, the only studies exploring the prevalence of the condition have been those with small sample sizes conducted among university students and while obviously not representative of the broader population, all were gender-adjusted and reported between 10-20% of the study population avoided using public toilets for reasons in some way associated with parcopresis, a prevalence significantly higher in females.  By contrast, the more extensively studied paruresis is reported at a level between 2.8-16.4% of the population and is much more prevalent in males (75–92%) than females (8.1–44.6%), the usually explanation being MPSAD (male penis size anxiety disorder).

Clinicians note that although parcopresis is nominally a mental health condition, there can also be physical implications including “stools becoming lodged in the colon and the onset or exacerbation of haemorrhoids (piles).”  There’s thought to be limited scope for drug treatments beyond what anyway may be prescribed in cases of SAD or related conditions and most clinicians recommended approaches such as hypnotherapy, stress management, relaxation training and CBT (cognitive behavioral therapy), the latter usually in the form of graduated exposure therapy (GGT or systematic desensitization).  The CBT approach is well-documented and begins by suggesting patients be reminded “that everyone poops”.  That may not be true because in 2007, the KCNA (Korean Central News Agency, the DPRK’s (North Korea) energetic and productive state media) published a profile of Kim Jong-il (Kim II, 1941–2011; Dear Leader of DPRK (North Korea), 1994-2011) noting the physiology of the Dear Leader was so remarkable he was not subject to bowel movements, never needing to defecate or urinate.  It’s not known if this is a genetic characteristic of the dynasty and thus inherited by Kim Jong-un (Kim III, b circa 1982; Supreme Leader (originally The Great Successor) of DPRK since 2011) but this seems unlikely because the Supreme Leader is known, while on visits to remote locations within the DPRK (ballistic missile tests etc), to be accompanied by a military detail with a portable toilet for his exclusive (and reportedly not infrequent) use.

Doing The Daily Duty (by Cristina “Krydy” Guggeri); clockwise from top left: Vladimir Putin; b 1952; president or prime minister of Russia since 1999), Silvio Berlusconi (1936-2023; prime minister of Italy 1994-1995, 2001-2006 & 2008-2011), Barack Obama (b 1961; US president 2009-2017), Kim Jong-un (Kim III, b 1982; Supreme Leader of DPRK (North Korea) since 2011), Francis (b 1936; pope since 2013) and Benjamin Netanyahu (b 1949; Israeli prime minister 1996-1999, 2009-2021 and since 2022).

Digital artist Cristina “Krydy” Guggeri in 2015 had a viral hit with her depictions of famous (and infamous) world leaders sitting on toilets.  Her “political pooping” project which she called “The Daily Duty” might be of help to those undergoing CBT for parcopresis, one of the recommended techniques being to “visualise a famous person they admire” in such circumstances.  Although not a clinical recommendation, presumably those suffering constipation could adopt the same therapy by visualizing a politician who “gives them the shits”.  That list might be long.

Still, the DPRK’s late and lamented Dear Leader aside, “almost everybody poops” and one intriguing recommendation for a CBT session is for a patient to visualise some famous person they particularly admire, sitting on the toilet, mid-poop.  Different patients obviously will admire a variety of celebrities so it’s a wholly subjective call although, noting the pop-culture zeitgeist, the most common current illustrative recommendation seems to be summon an image of the singer Taylor Swift (b 1989), an honor on which Ms Swift seems not to have commented.  Other practical tips include (1) carry a small air purifier or sanitizing spray to use in a public facility; depending on one’s diet and physiology, it will be necessary variously to spray pre-poop, mid-poop or post-poop, (2) line the inside of the toilet bowl with toilet paper; this will help absorb some of the sound and (3) flush several times while pooping; this will disguise the sound and reduce the smell (in Japan, this has been integrated into some public facilities by having a piped-music system play “waterfall sounds” at sufficient volume to disguise the activity of all but the most enthusiastic poopers).  Water management and conservation is now a matter of sometimes critical importance in cities so the piped sounds of splashing might become more common, the authorities unlikely much to welcome suggestions folk adopt the “multi-flush” strategy.