Genital Staring OCD and how it may relate to Sluggish Cognitive Tempo
/Genital Staring OCD and how it may relate to Sluggish Cognitive Tempo
Throughout the years there has been an increasing amount of interest and discussions on genital staring within the OCD community. As I devote time to understanding more about this group of OCD sufferers I have come to realize that there is a specific group of individuals that experience difficulties with this subtype but are rarely discussed. From what I have come to understand about this subtype is that there are two prominent subvariations that are more commonly discussed: those that are afraid of staring but never stare and those that are afraid of staring and actually stare. Although much discussion has been made on the link between Tourettic symptoms that may exist within this subgroup, there has been little mention of how Sluggish Cognitive Tempo symptoms may be potentially influencing the group that are afraid of staring and actually stare. This article attempts to explore how Sluggish Cognitive Tempo symptoms may influence genital staring.
Those that are afraid of staring and never stare are treated similarly to other classic ocd conditions and generally have a favourable prognostic outlook. The latter group, those that stare and actually do stare may experience difficulties obtaining treatment as some within this variation may have more classic Tourettic symptoms and are likely to experience better treatment outcome from an augmented exposure and response prevention approach combined with cognitive behavioural training (relaxation training, substitution strategies (e.g. habit reversal training), contingency management, and rote practice). What I have come to notice from this subvariation is that there are sufferers that stare at genitalia but also random objects as well. Staring is a physiological response. Visual stimuli or disturbances that grab our attention draw us into a staring relationship. Generally, staring has a disruptive potential and we likely stare at stimuli that garner our attention (randomness outside of normative discourse, potential threats, what we desire, or what may meet us with bewilderment (Garland-Thomson 2009). From a social perspective in North American culture, the physical impulse to stare is often monitored by social rules and most of us are taught not to stare. As a result, staring can often be met with feelings of uneasiness and interest (Garland-Thomson 2009). When something unexpected comes within our eyes range and grabs our attention, staring can be spontaneous and volatile. Once compelling stimuli are within the visual field we are only left to withdraw our attention (Garland-Thomson 2009). Individuals who suffer from OCD that have this subvariation are striving for predictability within their visual field so that nothing startles and demands visual attention (the avoidance of this is the ritual). Most of us want to control our staring and we do so by engaging in novelty that excites us (sightseeing, new shows etc,), but when we are forced to stare it alarms us. We don’t want to get caught off guard nor do we want to engage with the impulse to stare. The desire to control the startle response is the ritual.
Sluggish Cognitive Tempo has been defined as often feeling confused or in a fog, daydreaming, getting lost in thoughts, underactive behaviour, being slow-moving (lacking energy) or staring blankly (Araujo Jieze et al. 2015) Many individuals with Sluggish Cognitive Tempo experience difficulties with staring. Sensory fixation is quite common for individuals with Sluggish Cognitive Tempo as they are drawn to objects that they are interested in and benign objects as well. Many studies have documented the association between attentional deficit disorders and heightened vigilance around socially threatening stimuli (Klumpp and Amir, 2009; Schofiled et al., 2012; Taylor et al., 2016). Particularly, SCT suffers report experiencing heightened social anxiety as compared to individuals with ADHD. Additional research correlates elevated social anxiety symptoms and attentional disengagement from socially threatening cues (Taylor et al 2016). Sufferers with Sluggish Cognitive Tempo may preferentially attend to relevant threatening social information which may further heighten their response to ritualize (Taylor et al 2016). For sufferers who may have SCT and genital staring OCD, staring may be more prominent because of the SCT condition combined with the OCD fear that they may get caught staring at genitalia. The fixation on genitalia may not be desired but it may likely be influenced by the presence of the feared object that is being processed as a threat. When threats are perceived, our attention heightens and our gaze moves towards the threat. This is likely heightened for those with SCT.
Assessing for SCT may be imperative in providing adequate treatment for those with OCD that experience difficulties with genital staring. If symptoms are present, medication specific to SCT may be helpful in providing symptom relief. Managing the SCT symptoms first may be important to providing support for the OCD symptoms- particularly those with fears that revolve around social repercussions (feared obsessions or core beliefs around being alone/judged).
Araujo Jimenez EA, Jane Ballabriga MC, Bonillo Martin A, Arrufat FJ, Serra Giacobo R (2015) Executive functioning in children and adolescents with symptoms of sluggish cognitive tempo and ADHD. J Atten Disord 19(6):507–514
Garland-Thomson, R. (2009). Staring: How We Look. United Kingdom: Oxford University Press, USA.
Klumpp, H., & Amir, N. (2009). Examination of vigilance and disengagement of threat in social anxiety with a probe detection task. Anxiety, Stress & Coping, 22(3), 283-296.
Taylor, C. T., Cross, K., & Amir, N. (2016). Attentional control moderates the relationship between social anxiety symptoms and attentional disengagement from threatening information. Journal of behavior therapy and experimental psychiatry, 50, 68-76.
Schofield, C. A., Johnson, A. L., Inhoff, A. W., & Coles, M. E. (2012). Social anxiety and difficulty disengaging threat: Evidence from eye-tracking. Cognition & emotion, 26(2), 300-311.