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研究生:傅璿燁
研究生(外文):Fu, Hsuan-Yeh
論文名稱:廁所是否令你不安?害羞膀胱症之三角檢視及其政策意涵
論文名稱(外文):Does Restroom Make You Unrested? A Triangulation Approach to Paruresis and Its Policy Implications
指導教授:藍忠孚藍忠孚引用關係
指導教授(外文):Chung-Fu Lan
學位類別:碩士
校院名稱:國立陽明大學
系所名稱:衛生福利研究所
學門:醫藥衛生學門
學類:公共衛生學類
論文種類:學術論文
論文出版年:2009
畢業學年度:97
語文別:中文
論文頁數:136
中文關鍵詞:害羞膀胱症社交畏懼症公共廁所
外文關鍵詞:ParuresisAvoidant ParuresisShy Bladder SyndromeSocial PhobiaPublic Restroom
相關次數:
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  • 下載下載:169
  • 收藏至我的研究室書目清單書目收藏:3
中文摘要
研究背景
害羞膀胱症(Paruresis)是一種在有旁人在場時,無法在公共廁所小便的排尿功能障礙。洎1922年國際上出現第一篇害羞膀胱症以來,害羞膀胱症走向「醫療化」的旅程,被病理化的顛峰,是在列入精神疾病診斷與統計手冊第四版及其修訂中,屬於社交畏懼症。但在台灣,迄今仍無任何以害羞膀胱症為題的學術研究。
目的
一、以主題分析探討建構害羞膀胱的形成、因應策略、共病之理論架構。
二、以主題分析結果發展害羞膀胱症量表。
三、以網路問卷調查檢驗理論。
方法
以質量併用之設計探討害羞膀胱症的形成原因。根據Denzin對三角檢視法的分類,本研究使用資料三角檢視,受訪者來源有四:1.透過BBS(PTT實業坊)進行受訪者招募,盡量從合格的報名者中挑選具人口學特徵歧異性之樣本。透過此管道進入研究者共四名。2.透過國際害羞膀胱症協會網站接洽者,透過此管道進入研究者共一名。3.透過身邊友人進入研究者一名,此三者皆參與面對面訪談,皆簽署學術研究知情同意書。4.透過中文版害羞膀胱症討論區之文章進行參照分析,共16名會員參與討論。總計22位。本研究亦使用方法學三角檢視,在主題分析後進行量性網路民調。
結果
主題分析研究結果顯示,形成害羞膀胱症的類型包含:身體「異」象與身體異象、霸凌、A型人格、社交畏懼、環境、性傾向、社會遺傳。而在面對害羞膀胱症上又分為預期性焦慮型、偽裝型/逃避型/自我接納型。將這些概念,進一步以網路民調調察,所得樣本210,最重要的發現為A型人格與害羞膀胱症的相關性,尤以「敵意和攻擊性」最為顯著,符合主題分析的假設。而不明原因昏倒
與害羞膀胱症的相關性,也提供另一個看葉永鋕事件的視角。
結論
本研究發現害羞膀胱症之建構牽涉到三大類因素,而個人因素常為環境所誘發,且多為長期與不良之公廁環境互動之結果。個人為面對不良公廁環境產生各種因應策略,更可能造成其他疾病。政策介入在環境面,宜注重公廁環境對心理之影響,設計以使用者觀感為中心的公廁;在社會面,宜透過學校教育防止校園霸凌的發生;而在個人面,可藉由自我接納與去醫療化的概念,將害羞膀胱症的危害降至最低。
關鍵字:害羞膀胱症、社交畏懼症、公共廁所
Abstract
Background
Paruresis is characterized by fear of not being able to urinate in public bathrooms or in situations in which others might be aware of that subject is urinating. Paruresis, first appeared in Wobus’ research in 1922, then reached its peak of medicalization in The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR), coded as one of the subtypes of social phobia. However, up to now there is still NO paruresis related research in Taiwan.
Objectives
1. To explore the factors contributing to paruresis, the coping strategies as well as
comorbidity framework in Taiwan by grounded theory analysis techniques.
2. To develop Chinese Paruresis Scale.
3. To compare qualitative outcomes with internet-based survey.
Methods
Triangulation in this study comprises data triangulation, which entails gathering data through several sampling strategies. In this study, data were collected from four ways: (1)on-line recruitment (4 subjects), (2)by registering as contact person of IPA (1 subject), (3)from a friend (1 subject), informed consents were obtained prior to the interviews, and (4)by constructing Chinese paruresis on-line forum (16 subjects), for the reason that in-person interview might gather less reliable data especially to menacing questions. These verbatim transcripts were analyzed based on grounded theory analysis techniques. Methodological triangulation is also used to conduct a web-based survery after qualitative reseach.
Results
Possible pathological construction of paruresis includes body image, bullies, type-A personality, social phobia, environmental factors, sexual orientation and heredity. The types people deal with paruresis comprise anticipatory anxiety, disguise/avoidance/self-acception. By web-based survey, the total sample size is 210. The most important finding is the association between type A personality and paruresis, especially the construct ”aggressiveness and hostility.” The association between syncope and black out sheds lights on the new perspective to Yeh, Yung-Zhi Event.
Conclusion
We emphasize that most of the personal factors are outcomes of adverse interaction between people and environment. Policy interventions include that, from environmental aspect, public toilet should be based on user-centered design to diminish harm to affected persons, and from social aspect, bullying is preventable through school education. Certain personal traits derived from paruresis can be eradicated through self-acception and demedicalization.

Keywords: Paruresis, Avoidant Paruresis, Shy Bladder Syndrome, Social Phobia, Public Restroom
目錄
論文電子檔著作權授權書…………………………………………i
論文審定同意書……………………………………………………ii
誌謝…………………………………………………………………iii
中文摘要……………………………………………………………iv
英文摘要……………………………………………………………v
目錄…………………………………………………………………vii
圖目錄………………………………………………………………ix
表目錄………………………………………………………………x
第一章 緒論………………………………………………………1
 第一節 研究背景與動機………………………………………1
 第二節 研究目的………………………………………………2
 第三節 研究重要性……………………………………………3
 第四節 名詞定義………………………………………………4
第二章 文獻探討…………………………………………………5
 第一節 定義、診斷與疾病分類………………………………5
 第二節 害羞膀胱症個案報告…………………………………9
 第三節 害羞膀胱症基礎醫學…………………………………16
 第四節 害羞膀胱症治療………………………………………18
 第五節 害羞膀胱症流行病學…………………………………22
 第六節 害羞膀胱症量表………………………………………25
 第七節 害羞膀胱症行為科學…………………………………26
 第八節 害羞膀胱症與廁所建築、環境心理、社會心理……27
第三章 研究設計…………………………………………………29
 第一節 研究流程圖……………………………………………29
 第二節 三角檢視………………………………………………31
 第三節 質性研究………………………………………………33
 第四節 量性研究………………………………………………36
第四章 質性研究結果……………………………………………40
 第一節 形成害羞膀胱症的七種類型…………………………40
 第二節 面對害羞膀胱症的五種類型…………………………53
 第三節 環境因子與社會因子…………………………………58
第五章 文學分析…………………………………………………61
 第一節 中國文學中的如廁障礙………………………………61
 第二節 人格類型分析…………………………………………64
第六章 社會事件詮釋……………………………………………69
 第一節 葉永鋕事件……………………………………………69
 第二節 害羞膀胱症與昏倒……………………………………70
 第三節 一個社會建構出害羞膀胱症的歷程…………………71
第七章 網路民調結果……………………………………………73
 第一節 問卷建構過程…………………………………………73
 第二節 以DSM-IV-TR為診斷標準之統計結果………………76
 第三節 以害羞膀胱症量表為診斷標準之統計結果…………79
第八章 討論、結論與建議………………………………………113
 第一節 討論……………………………………………………113
 第二節 結論與建議……………………………………………120

參考文獻……………………………………………………………124
附錄一 網路民調問卷……………………………………………130
附錄二 八題版害羞膀胱症量表…………………………………134
附錄三 學術研究知情同意書……………………………………135
附錄四 A型人格量表使用授權書………………………………136

圖目錄
  圖2.1 人體神經系統分類……………………………………16
  圖3.1 研究架構圖……………………………………………29
  圖6.1 害羞膀胱症的病理建構—以葉永鋕事件為例………72
  圖7.1 害羞膀胱症形成之三角模式理論……………………82
  圖7.2 個人因素與害羞膀胱症的互動………………………83
  圖7.3 個人因素之間的互動…………………………………84
  圖7.4 害羞膀胱症行為與共病之間的互動…………………85
  圖7.5 十題版害羞膀胱症量表各切點危險對比值及
其變化量………………………………………………95
  圖7.6 八題版害羞膀胱症量表各切點危險對比值及
其變化量………………………………………………104

表目錄
  表3.1 本研究之三角檢視分類………………………………32
  表3.2 受訪者基本資料………………………………………34
  表7.1 個人特質描述性統計…………………………………86
  表7.2 A型人格量表描述性統計……………………………87
  表7.3 害羞膀胱症量表描述性統計…………………………98
  表7.4 害羞膀胱症歷程描述性統計…………………………89
  表7.5 環境與社會因素描述性統計…………………………89
  表7.6 共病描述性統計………………………………………90
  表7.7 人口學變項描述性統計………………………………91
  表7.8 十題版害羞膀胱症量表得分分布情形………………92
  表7.9 十題版害羞膀胱症量表鑑別力檢定與相關性檢定…93
  表7.10 以DSM手冊中社交畏懼症為基準,計算十題版害羞
      膀胱症量表各切點之危險對比值變化量………… 94
  表7.11 十題版害羞膀胱症量表建構效度分析……………96
  表7.12 個人特質與害羞膀胱症(簡單邏輯斯迴歸)
      (以DSM-IV-TR診斷標準E分類為診斷標準)………97
  表7.13 A型人格與害羞膀胱症(以DSM-IV-TR診斷標準E分
      類為診斷標準)………………………………………98
  表7.14 環境與社會因素(簡單邏輯斯迴歸)(以DSM-IV-TR
      診斷標準E分類為診斷標準)………………………99
  表7.15 家族群聚性檢定(利用費雪精確檢定)(以DSM-IV-
      TR診斷標準E分類為診斷標準)……………………99
  表7.16 共病(以DSM-IV-TR診斷標準E分類為診斷標準)…100
  表7.17 人口學變項與害羞膀胱症(以DSM-IV-TR診斷標準
      E分類為診斷標準)…………………………………101
  表7.18 建構效度分析(以八題版害羞膀胱症量表為診斷
      標準…………………………………………………102
  表7.19 以DSM手冊中社交畏懼症為基準,計算八題版害
      羞膀胱症量表各切點之危險對比值變化量………103
  表7.20 各切點在共病上之危險對比值分析(以八題版害
      羞膀胱症量表為診斷標準) ………………………105
  表7.21 八題版害羞膀胱症量表得分分布情形……………106
  表7.22 八題版害羞膀胱症量表鑑別力檢定與相關性檢定107
  表7.23 個人特質與害羞膀胱症(簡單邏輯斯迴歸)(以八
      題版害羞膀胱症量表為診斷標準) ………………108
  表7.24 A型人格與害羞膀胱症(以八題版害羞膀胱症量
      表為診斷標準) ……………………………………109
  表7.25 環境與社會因素(簡單邏輯斯迴歸)(以八題版害
      羞膀胱症量表為診斷標準) ………………………110
  表7.26 家族群聚性檢定(利用費雪精確檢定)(以八題版
      害羞膀胱症量表為診斷標準) ……………………110
  表7.27 共病(以八題版害羞膀胱症量表為診斷標準)……111
  表7.28 人口學變項與害羞膀胱症(以八題版害羞膀胱症
      量表為診斷標準) …………………………………112
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