Genital Staring OCD - Part of my Approach

Guilt provides us with valuable information. It helps us better understand what is inherently good for us. It also helps us better understand what is morally wrong and 'right.' If someone were to do something morally wrong, that person would be blameworthy and, therefore, warranted of guilt. Guilt guides us to what is considered moral. We are considered desirable if we are moral. Guilt involves forfeiture of trust that the person has in themselves (Cokelet and Maley 2019). I appreciate Patricia Greenspan's account of guilt, "guilt is an important identificatory mechanism in which the individual feels self-directed anger, and that provides motivation to repair damage done to others. (Greenspan 1995). When you observe some OCD subtypes, many of the subtypes are driven by guilt, but not just guilt, but the desire to rid themselves of the feeling of wrongdoing, through the use of a compulsion that is designed not only to reduce the anxiety, but in my opinion, to right the wrong. You will see that many people who attend counselling experience difficulties with uncertainty regarding harm they may have committed in the past or how they will cope if they accidentally do something that goes against what they believe is 'right.' This is sometimes accompanied by a feeling of shame (a feeling that is influenced by how others will perceive you). Your thoughts that influence these feelings need to be challenged. What we know of people who experience difficulties with this subtype is that it is likely influenced by concerns regarding the judgment of others. This means that challenging the belief that you will be judged or that some catastrophe may happen is essential for treatment. This may mean challenging the social anxiety that you experience as a whole. Part of the experience of over coming social anxiety is expecting that they may judge you but you can cope with it. Sometimes, people will think that their friends and family will leave if they are caught staring. Figuring out what coping would look like may require you to challenge some of the thoughts you have regarding the perceived judgment. There are many CBT resources available to help you better understand how best to understand cognitive distortions and how best to restructure your thoughts. A trained OCD therapist can also help you with this. Social judgement may not be the feared consequence and you may have to complete an exercise called the downward arrow technique to fully understand what situations you believe you are not able to cope with (a quick google search will help you find the exercise). Once that is determined, I ask each of my patients to work on coping with each situation.

Some of the thoughts you may have may include: what if they notice me staring, how will my friends and family react? Answering these questions may be important to figure out how you'll cope. This may even mean confiding in your family and discussing the what-if scenario to understand better how they would react. This could bring on the awareness needed to help you better accept your feared outcome.

People with this condition also experience ideas of reference (referential thinking). These individuals believe that people are negatively taking special notice of them and are hyperfocused on their actions and particularly their gaze. Carrying on with the expectation that your gaze will naturally flow to genitalia and it's normal will help challenge this belief. I also explain to my patients that people are not hyper aware of your gaze, because it doesn't give any information. I'll go into more detail in the next section.

What is gathered by the visual field is considered sacred to us. No one has access to that information but you. No one can challenge you regarding what is in your visual field because it's really up to you to disclose what you were looking at. The information collected in your visual field is private and only that of yours. Which means that no one will ever truly know what you are truly ever looking at. However, your body language gives hints about what you are looking at. This means that how your body (neck and torso) are positioned may give information to what you may be looking at. If someone with a low cut top is near me and my gaze, neck and shoulders are positioned towards their breast, one could think I'm looking at their cleavage. What is also most important to note is that even if I was positioned in that way, it's still a guess at what I'm actually looking at. I need to give them access to the information they seek, and it's up to me to make a choice to tell them what I am truly looking at. I could even lie if I truly wanted to. No one I've come across that has STC has ever said they are concerned about the positioning of their body-only their gaze.

Having noted that the information in your visual field is only yours to share, I will say that it's important to recognize that your eyes (not your body) will naturally stare. I mentioned this in a previous article I wrote. Simply put, our eyes will be drawn to the genitalia naturally. Trying to avoid this is the ritual. What I often recommend to my patients in my practice is considering giving yourself permission to stare. This doesn't mean permission for you to move your body and stare, it means if it falls in your visual field than allow yourself for it to be there. What happens is that eventually it doesn't become something that you stare at and it just becomes part of your experience.

When I work with patients who experience difficulties with this condition, I focus on building exposures that promote purposeful staring. How you choose to stare will be determined by the situation. For instance, if you are up close to an individual, a glance may be more appropriate than a stare. A three point stare may also be appropriate or Grayson sneak a peak (peaking at privates when an opportunity calls for it). I don't like to put perimeters on how staring is to occur, but the person in the situation will have to determine what is appropriate. Culture may dictate this. For those living in the west, I would likely recommend no conditions. For those in the east, there may be a need for caution.

There is a difference between giving yourself permission to stare vs permission to look. At a far distance, I would give permission to stare. At approximately 10 feet of social distance, the rules change, and you will have to give yourself permission to look only. This is where you can sneak a peak and continue to do so as needed until the fear wanes. When courting someone, we may be inclined to want to observe the person's features (buttox, breasts, etc), but we do this in a subtle way and when an opportunity presents itself to do so without them fully knowing we are doing so. We admire and look away. This is what needs to happen when you give yourself permission to look. Again, this isn't permission to stare- it's to look acknowledge and move on. Even if you are looking, it's for the purposes of exposure and not for intent or desire. Your intrusive thoughts will have you believe that you are doing so because you desire it- it's only protecting you because you've trained yourself to fear the consequence of what could happen if you get caught. You won't be able to do any of this unless you accept the consequences of getting caught. This could be a one-liner, such as, "Sometimes I stare blankly, excuse me."

This means only using the gaze and not the body. Before every exposure, each person accepts that they might get caught, and they are aware of how they would handle it- this doesn't just include the situation they are about to participate in regarding the exposure; this means they have come up with figuring out how to cope with the social ramifications from their friends and family as well. It's only when they truly have come to acceptance that all of these bad things can happen, and they can figure them out, that they will truly be able to move past this concern.

Your mind will always think you are staring as a way to protect you. This means you will likely always be triggered. The goal is to understand that when you are triggered, you label it as your ocd and carry on. You are really working on how long you're triggered for. As long as you have a plan regarding how you'll cope with the outcome of being caught, then the story has no power.

Meditation is a mandatory part of the work. Every client of mine is required to meditate for 20 minutes a day. The meditation helps by reducing your general levels of anxiety. You will also have more tolerance to the feeling of anxiety when triggered. Suppose you are more willing to tolerate the anxiety than you are less likely to want to ritualize. Remember, it's the rituals that maintain the ocd cycle. Once you stop, you no longer maintain the cycle, and you can move on to habituation and extinguishing the fear. Remember, you can't do any exposure unless you are willing to accept that you will stare, and someone may call you on it. You will have to figure out how to cope with it to manage through.

Part of the disorder is understanding the rituals that contribute to the ocd cycle. Anytime you ritualize, you maintain the OCD cycle. One ritual that is important to note is how you meet the intrusive thoughts. If you meet the intrusive thoughts regarding genital staring with a negative emotion, you will maintain the fear. This means that your thoughts of wanting to 'rid' yourself of this or meeting the intrusive thoughts with anger will only further contribute to the cycle. The meditation will help with this. The thoughts will always be there, just allow them to be there and carry on. The thoughts are only trying to protect you from the bad thing happening- that's all. Avoiding staring or neutralizing the intrusive thought (mirrored sunglasses, putting objects in front of you, humming to disrupt the thought) will only contribute to the cycle. You may try to prevent others from being uncomfortable; this is a ritual. There is no need to protect others from discomfort. Again, it's natural to stare, and sometimes people want you to stare and admire, nothing creepy about that.

Many people often overthink what to do in social situations (for example, what to wear). If you are attempting to figure this out, then you are ruminating. I recommend that my patients walk away from attempting to figure out what to do. This means not making a choice to figure out where to look and just continuing the conversation and their day. Any thoughts you have regarding how the person is reacting are likely based on an idea of reference (see above). Hyperfixating is also a choice. You can make the choice not to hyperfixate and move on. Hyperfixating is a ritual.

When it comes to those that actually stare, I do believe that the sufferer must still give themselves permission to stare. However, the permission is based on an acceptance that they do stare and have to explain the condition to their peers and family. Labelling it as part of the Tourette's disorder (most people will not understand the terms used in the ocd world that desire these conditions, and so it's better to use terms that most people are familiar with) can be very empowering for individuals who struggle with the condition. It reduces any anxiety about perception and forces a reaction from others, and positions the sufferer to cope. I do believe in Grayson's approach when it comes to isolating those who stare vs those who don't: if you've been caught staring by someone and they've been vocal about it, then you stare, if not, then you fall into the category of those who don't stare but are afraid of getting caught.

Lastly, each patient is reminded that they are not to have any alcohol or drugs (complete abstinence). What we know of alcohol and drugs is that it can exacerbate OCD symptoms. My patients also work on maintaining a consistent sleep schedule as poor sleep quality and quantity can interfere with the work.

Understanding Genital Staring OCD, a video describing rituals and avoidance behaviours of those who experience this subtype of OCD.