What is the fundamental difference between staring OCD and classic OCD? It is the visual tic. It’s similar to what you might see in Tourette’s syndrome. Hence, its other name Visual Tourettic OCD, or VTO.
Does staring OCD involve obsessions and compulsions? Unfortunately, yes. For example, a person’s obsession might be the fear of staring. The compulsion might be ruminating about the consequences of others catching them staring and calling them a bad name.
Is the tic the obsession? No, the tic is automatic, separate from the obsession, and requires skills to manage it.
Does a person do exposure response prevention, or ERP, to habituate to the tic? No. They do ERP to habituate to the obsession or feared response related to the tic.
How would they do ERP with the tic involved? A therapist will usually instruct people to go out and stare and resist avoidance behaviours and ruminating. Eventually, they would habituate to their fear of staring.
But if they go out and stare, do the exposures not address the tic? That’s correct. It does not address the tic. Specifically, the tic builds tension, and people need to bring it to an endpoint. Therefore, it’s important to recognise the difference between staring randomly as exposure and releasing genuine tics and do the latter instead.
What is the difference between someone who stares without a visual tic and someone with a tic? The first might typically see, then see for longer, by inadvertently holding their gaze, for example, on a person’s private region. They then naturally look away. But if a person with Staring OCD sees, they might instantly go into a fight-flight or freeze response. This is because, unlike the other person, they don’t perceive themselves as seeing and then seeing for longer by unintentionally holding their gaze and then looking away naturally.
So, what happens if they release a tic as though they see? First, they release ocular tension, which is the tic. So, they might get stuck where they unleash it, for example, on a person’s crotch or chest. It looks like they’re staring or seeing for longer, but they are paralysed by fear. Similarly, some will struggle with a fight response, such as covering their eyes, while others might make awkward excuses to flee the scene. Subsequently, their eyes dart around, showing they want to escape, and they panic.
You mentioned random staring as exposure earlier. Does it mean that people mimic tics? It seems that way. For example, suppose a therapist doesn’t fully understand how the tic works in VTO. In that case, their exposure instructions might be to have their client randomly stare and pretend not to care, believing it will lead to fear habituation. But instead, it can affect the habituation process related to the obsessional fear.
Does that mean they need an additional technique for the tic to work alongside ERP? Yes, that’s right. For example, when people feel a pressing urge to tic, they would surreptitiously land it on someone’s private region or peripherally as an exposure. In addition, they must be aware that they will activate anxiety for the habituation process to work. In other words, releasing the tic involves the obsession of getting caught, facing their feared outcome and building a tolerance for anxiety, which is habituation.
Can they suppress the tic to give them time to prepare? Yes, habit reversal therapy, or HRT, allows people to suppress the tic until they are ready to release it. People with Tourette’s Syndrome and other repetitive behaviours such as hair pulling use HRT. But in the case of visual Tourettic OCD, it can help train individuals to see and see for longer the way people who don’t have the disorder do without worrying, as mentioned before. It can also help them glance away naturally and not panic about obsessional scenarios of getting caught.
How would that work? Suppose you’re in a queue, and a person opposite has their lower or upper private region facing you. It is prominent, making it difficult for you not to tic. In this case, ERP might expect you to take a sneaky look, resist escaping, and wait until your anxiety reduces before ending the exposure. That’s all fine, but it might not be releasing a tic but staring haphazardly, as noted earlier. Therefore, suppressing the tic until ready to release it furtively can improve handling such exposures with ritual prevention and be in control of the overall process.
Do you have a specific example of using habit reversal training? Yes, imagine you feel the tension in your eyes where you need to release a visual tic. In this case, recall that you would suppress the tic until you are ready to unleash it. So, first, you can find a focal point, for example, a shop sign or something else, depending on where you are. Next, look at the focal point while simultaneously squeezing the tips of your thumb and each finger with the forefinger and thumb from the opposite hand, then do the same with your other hand. Make it so you can feel the pressure from the squeeze on each thumb and finger to compete with the pressing urge to tic. When ready, release the tic, return to the focal point, and repeat if necessary. At the same time, you would manage anxiety, as noted earlier.
Do people with Staring OCD feel bad for the people they stare at, as though it is intrusive? Yes, they often feel responsible and anxious about the people they “stare” at and how they might have made them feel. But it’s important to realise that Visual Tourettic OCD is a neuropsychiatric disorder, not Criminal Intrusive Staring where people victimise and harass their victims. But, in any case, techniques from habit reversal can help suffers of VTO tailor exposures whereby they stay in control of it from beginning to end, which can help them feel less responsible for the people they appear to stare at.
Assume someone lands a tic on someone’s private region or peripherally and gets caught, which causes a stir. Do you suggest a coping strategy for this, and if so, what would it be? Yes, one thing that can be helpful is handing out an online link on a business-sized card that addresses Visual Tourettic OCD via you-tube or articles and books. It can save unwanted trouble.
Finally, you wrote a book on Staring OCD. Where can people find it? My book “Address Staring OCD: How to Manage Visual Tics and Obsessions” by Carol Edwards can be found on Amazon.
© Carol Edwards, 2/4/2023