For 1 to 2 million Americans, paruresis means something else entirely. They can only pee if there's no one else in the restroom. If someone can hear you, they can hear that you're not doing anything. It's a sort of performance anxiety that builds and feeds on itself. And soon, by God, you can't.
Extreme things start to happen.
Others become functional agoraphobics, never going to clubs, eating in, avoiding plane travel. Many paruretics even have trouble urinating in their own homes. According to Soifer, most paruretics can't even urinate near their spouses. A third have difficulty relieving themselves even when no one else is home. Bob's problem has, for the past 10 years, kept him from having a relationship with a woman.