“Painfully Awkward Rob Lowe” Ad under Attack by “Shy Bladder” Advocates

Have you seen the DirecTV ad where fanny-pack wearing “Painfully Awkward Rob Lowe” is mocked for subscribing to cable? At one point, Lowe is seen standing in front of a urinal saying ” I can’t go with other people in the room.”

Members of the International Paruresis Association are upset with the commercial, as they say it makes fun of a serious medical condition, called paruresis. More commonly referred to as “Shy Bladder,” “Bashful Bladder,” or “Pee-Shy,” sufferers find it difficult or impossible to urinate in the presence of others. For some this can be quite disruptive to their lives.

Steve Soifer, CEO of the International Paruresis Association, has requested that DirecTV remove the ads:

“We don’t mind if people have a little fun with it. It’s a situation that a lot of people don’t understand. In this particular case, the portrayal is making it look ridiculous, that this guy is a loser for having a problem.”

However, DirecTV is standing firm. A spokesperson, Darris Gringeri, said it plans to continue airing the spots:

“The ads will continue to run for the vast majority of viewers who have told us they enjoy the spots and understand that, like all of our commercials, they take place in a fantasy world and are not based in reality.”

What do you think? Should the ads be removed?

What is Paruresis, or “Shy Bladder” ?

Paruresis is a social phobia that involves fear and avoidance of urinating where others may be present. Sufferers feel that are “unable to go” under these circumstances. There is no physical blockage of urine in these patients, as may occur with men with enlarged prostates, or blockage by a kidney stone.

The severity can vary from relatively mild- not being able” to go” at a urinal but being OK in a bathroom stall, to severe- not even being able to urinate at home if someone else is in the house.

Severe paruresis can affect a person’s life in a similar way to agoraphobia, which is anxiety about being in places or situations from which escape seems difficult (typically, fear of crowds or being outside the home). If a person can only successfully urinate when home alone, they may avoid leaving the house. This can reduce quality of life and curtail job opportunities.

It is estimated that about seven percent (7%) of the public, or 21 million Americans (220 million worldwide), may suffer from this disorder.

Social phobia, also called social anxiety disorder, is diagnosed when people become overwhelmingly anxious and excessively self-conscious in everyday social situations. People with social phobia have an intense, persistent, and chronic fear of being watched and judged by others and of doing things that will embarrass them. They can worry for days or weeks before a dreaded situation. This fear may become so severe that it interferes with work, school, and other ordinary activities, and can make it hard to make and keep friends. Paruretics, in particular, face difficulties ranging from work problems (when they have to submit a urine analysis for drug testing), to traveling on long plane rides, to everyday social situations.

While many people with social phobia realize that their fears about being with people are excessive or unreasonable, they are unable to overcome them.

Other physical symptoms may accompany social phobias, and these include blushing, profuse sweating, trembling, nausea, and difficulty talking. When these symptoms occur, people with social phobia feel as though all eyes are focused on them.

It is unknown what causes paruresis. Although many with the disorder can’t identify any specific event that may have triggered it, others “believe their ailment was triggered by a traumatic incident that happened prior to or during adolescence including embarrassment by a parent, teasing by classmates or siblings, harassment in public bathrooms or sexual abuse.”

How is paruresis treated?

Most patients with paruresis should first be seen by a urologist (urinary tract specialist) to ensure that there are no physical problems causing the condition. They can also educate the patient, stressing that there are many others with the same problem. They can also refer the patient to a professional who is qualified to deal with anxiety disorders.

Other forms of treatment include:

  • Behavioral modifications: such as urinating on a schedule, relaxation techniques, and using bathroom stalls instead of urinals.
  • Graduated exposure therapy – a step-by-step program that involves deliberately trying to urinate in increasingly more difficult places. About eight people out of every 10 with paruresis are helped by graduated exposure therapy.
  • Many patients can be taught self-catheterization (inserting a small tube into the urethra) which immediately allows the bladder to be emptied.
  • Some patients with paruresis benefit from the addition of drug therapy. Selective serotonin reuptake inhibitors (SSRIs) may help reduce anxiety levels which may allow graduated exposure therapy to be more effective.


Michele R. Berman, M.D. was Clinical Director of The Pediatric Center, a private practice on Capitol Hill in Washington, D.C. from 1988-2000, and was named Outstanding Washington Physician by Washingtonian Magazine in 1999. She was a medical internet pioneer having established one of the first medical practice websites in 1997. Dr. Berman also authored a monthly column for Washington Parent Magazine.


  1. Daniel Imas

    November 10, 2014 at 4:12 pm

    This story shows the significant effects that media portrayal can have on public perception of diseases. In this case, “shy bladder” syndrome is branded as awkward and socially undesirable. In fact, the entire purpose of the ad is to show that anything associated with cable is less appealing than DirecTV, attempting to guilt viewers into believing that they will be less cool and socially acceptable if they choose it. This style of advertisement has become fairly common for advertising different types of technology. For example, the iconic Mac ads featuring Justin Long show him as a personified Mac computer next to a personified PC. Long is portrayed as cooler, better dressed, and more sociable than his PC counterpart, indicating that, if you buy a Mac, you can be just like Long.
    It’s clear that this type of advertising can have a significant impact – Apple has long been lauded for their advertisement abilities and this campaign was no exception, as it had wide appeal to younger generations that would be deciding whether to purchase a Mac or a PC. However, there is a clear difference in how DirecTV approaches the ad compared to the Apple ad. In the case of Apple, they are simply playing on social perceptions, while in the DirecTV ad they are directly targeting a certain segment of the population with a medical condition that is not under their control.
    This kind of targeting is problematic for both public perception of the condition and for the individuals with the condition. In terms of public perception, the way that diseases are portrayed in the media can influence how seriously a condition is treated and the lives of those with the condition. For example, those diagnosed with HIV were stigmatized during the HIV epidemic, harming progress towards research into treatments are cures. Media has an impact on public perception of illness, so it should not attribute negative traits to those who have an uncontrollable disease. For individuals with the condition, seeing their illness openly mocked by the media can cause significant psychological trauma, potentially discouraging them from trying to seek help or treatment. Even worse, it could lead to misdiagnosis because those who see the ad assume that it is their own fault for being too “awkward,” preventing them from realizing that they do in fact have a medical condition. Although this is not a condition with life-threatening consequences, the patients suffering from it must deal with it every day. Beyond that, this creates a perception that it is acceptable to mock a disease. Even if it is a disease some may consider funny, it’s important to think about the potential implications of advertisements on those who cannot simply subscribe to escape DirecTV their “awkwardness.”

  2. Angelina Iyinbor

    November 18, 2014 at 9:16 am

    There are a variety of shows and ads that utilize medicine and health as their subjects, and in many cases these forms of entertainment influence viewers’ opinions of the disease or procedure portrayed. However, should shows and ads that include diseases in a minor or even unintentional way have the same responsibility to accurately depict medicine? According to the International Paruresis Association (IPA) mentioned in the article above, they should. IPA was offended by the message sent by a DirecTV ad that depicted a man with paruresis (shy bladder), a social phobia of urinating in the presence of people. They argued that the ad makes light of a serious disease that affects 7% of the American population, however, after viewing the ad I question whether the IPA is being overly sensitive.
    It is understandable that as an association it is the IPA’s duty to advocate for the paruresis sufferers, and because the disease is a social phobia, a category of diseases that is still somewhat stigmatized and misunderstood by the public, it is understandable that the IPA would take offense. Furthermore, for sufferers of paruresis, especially those whose phobia is so severe that they can’t leave their homes, seeing this ad and the negative connotation that it places on people with shy bladders would be very discouraging – these people could be less likely to seek treatment out of fear of similar judgment. The ad’s goal, however, was not to educate the public on paruresis or to even illuminate it as a disease, but simply to create a comedic situation that would juxtapose what a cool DirecTV user would look like as compared to a boring Cable TV user. In this respect, the ad is very effective and clearly conveys its message to the audience – buy DirecTV and you will be an attractive, confident man (woman). The ad is less than a minute long, and due to this format, the use of stereotyping is important in quickly engaging the viewer and orienting them to the “good” and “bad” guy, in this case the cable company they want you to subscribe to and the one they don’t. Therefore the writers and directors of the ad had to make Painfully Awkward Rob Lowe painfully awkward by giving him characteristics that most “attractive, confident” people don’t have and would be considered strange if they did have. Hence, being unable to use a public restroom – something most people can do without a problem – is “painfully awkward”.
    If all other advocacy groups of social phobias and other less publicized psychological diseases became as upset with such accidental portrayals of diseases used in entertainment, then there would not be horror movies, comedies, and other forms of entertainment that rely on odd characters to create an interesting and engaging plot. Although this has been interpreted by the IPA as insensitive, the context – a non-medical ad with no agenda to depict anything medically related – does not warrant the ad such backlash.

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