Like many other anxiety disorders, paruresis can trigger a self-defeating thought cycle and cause ordinary, intelligent people to take seemingly bizarre courses of action as they struggle to avoid venturing out in public, drinking liquids, and other activities that they feel might trigger their disorder. It can occur even if there is no logical way the act of urinating can be witnessed by others, or if the other people are simply imaginary. A similar anxiety disorder, called parcopresis, affects bowel movements.

Obviously, this anxiety can quickly affect a person’s quality of life. Public transportation, long airplane flights, and employment-related drug testing become major ordeals. Paruresis can affect a sufferer’s ability to enjoy physical and emotional intimacy. In the worst cases, sufferers can only find relief through catheterization, where a piece of surgical tubing is passed into the bladder, or surgery, which often causes complications.

Many remember Calvin, the server in the Ryan Reynolds/Justin Long movie Waiting who suffered from anxiety whenever he thought anyone might be watching him pee. For many like Calvin, peeing in public is no joking matter, filling every day with anxiety and concern. Howard Stern has publicly admitted he suffers from the disorder and it’s a subject that the Dear Abby advice column has addressed repeatedly. Other celebrities who have been linked to paruresis are Orlando Bloom, Howie Mandel, and Alan Bennett.