Q:  I am thinking of joining the military, what kind of barrier will paruresis be for me?

A: People in military service face three major barriers from paruresis: Urine drug testing, the difficulties of dealing with restrooms that have very little privacy, and unpredictable combat situations. While we have heard stories of people with paruresis who served in the military and managed to get through it, you need to carefully weigh the impact paruresis has on your life and whether it is worth dealing with the problem in a military environment. Generally, it’s not a good idea to join the military in order to get over paruresis. Working on a recovery program is a much better way to go about it. In a combat situation, you need to be in peak condition and able to think clearly and give every ounce of energy and strength. A full bladder in pain will prevent that. As a result, your paruresis could become life threatening for yourself and the others on your squad. Don’t put others’ lives in danger for the purpose of working on your own problems.

That said, for economic or other reasons there are going to be people who have few options but to consider military service. If you have any time at all, please get into a recovery program, go to a workshop, attend a support group, and schedule a few sessions with a civilian psychologist skilled in cognitive-behavior therapy before enlisting so that you can begin a program of graduated exposure therapy before going to boot camp. Those skills will give you the ability to cope better once in the service.

Regarding urine drug testing in the services, you can work on simulated drug testing drills to reduce the anxiety in that situation. Find a person you are willing to work with who can help you practice. Drink enough water so that your kidneys are working, but don't overdo it. Ask your partner to choose random times when he will take out a cup, and say "it's time, give me a sample". Then go to a private location and do it. If the military test is witnessed, have your partner do exactly the same thing the monitor would do, stand in the same place, say the same things, do any searches they do, strip clothes to the same degree, etc. Try to use a restroom layout that looks like the one where the tests are performed. That way you are simulating as closely as possible the conditions of the real test. Go through this drill LOTS of times. Do it until you notice you are quite relaxed in the situation.  

If you practice this routine a good number of times, the test should become a lot easier. There's no difference between this and any other aspect of the military. Training and practice makes perfect.   Be sure to get a physical that rules out any other reasons for paruresis.  Get the physical from a civilian doctor so there's nothing on your military record.