Hit and Run OCD: An Unusual Form of Driving Anxiety

Hit and run OCD, sometimes known as “driving OCD,” is a subtype of obsessive-compulsive disorder that involves obsessions about running someone over without realizing it.

Last updated: November 1, 2020

The anxiety caused by this type of OCD can be profound. It has led people to file police reports, listen to ambulance radio calls, or drive around for hours looking for the person they may have hit. It leads some people to stop driving altogether.

Hit and run OCD is sometimes considered a form of “responsibility OCD,” a name for OCD cases when the patient feels overly responsible for their actions’ effects on others. This can also include scrupulosity, a type of OCD marked by hyperfocus on following rules appropriately.

Fortunately, this type of OCD is well understood and responds well to treatment.

Would I Know If I Hit a Pedestrian?

Since the characteristic symptom of hit and run OCD is so distinctive, it’s not difficult for OCD therapists to recognize it. If you’re not in therapy, however, it can be a difficult problem to recognize and to understand.

Recognizing the Problem

If you spend time wondering, “would I know if I ran someone over?” Then you may have hit and run OCD. Other warning signs include:

• anxiety at hitting bumps in the road
• retracing your route looking for signs of an accident
• checking the news in the days following driving, looking for reports of an accident you caused
• checking your car for new dents or bloodstains that could have been caused by an accident
• asking people in the car with you for reassurance that you didn’t hit anyone while driving
• spending a lot of time looking in the rearview mirror when driving to see if you’ve hit someone on the road
• avoiding driving
• getting yelled at by friends/family for driving too slowly out of concern about hitting pedestrians

What Causes Hit and Run OCD?

Hit and run OCD is caused by the same factors as other forms of OCD. These can include your learning history, genetic predispositions, and neurobiological factors.

If you suffer from this condition, try not to focus on what caused it because a) this usually is impossible to ascertain, and b) it will not help you overcome the condition.

So what does help?

How to Beat Hit and Run OCD

Treatment for this type of OCD typically involves exposure and response prevention (ERP/ExRP) therapy. (Read a nice case example of how this therapy helps this type of OCD.) ExRP is a type of cognitive-behavioral therapy that is quite different from traditional therapy — it typically involves you being asked to do specific homework exercises between sessions. These exercises, called “exposures,” gradually reduce the anxiety and fear that happen after driving.

A big part of what makes ExRP effective is the way it teaches you to understand the thoughts, feelings, and behaviors that are part of hit and run OCD. Once you learn to understand these aspects of the disorder and learn how OCD works in your case, then your therapist will have you start doing exposures. Exposures vary from person to person but typically involve you remembering a recent driving experience, feeling the anxiety about whether you hit someone, and refraining from checking or asking for reassurance.

It’s challenging, but when done systematically and under the guidance of a qualified therapist, it can be very effective.

Distinguishing OCD from Other Forms of Driving Anxiety

If you experience anxiety while driving, it may be due to hit and run OCD or it may be due to a different problem. Two other types of anxiety that commonly come up around driving include panic disorder and agoraphobia.

Panic disorder will often involve a fear of specific bodily sensations or events (having a heart attack, passing out, getting dizzy, e.g.). Agoraphobia will often produce elevated anxiety concerning bridges and tunnels, but can present with many variations. Getting evaluated by a mental health professional is the best way to determine which type of anxiety is present.

If you think you or a loved one suffer from hit and run OCD or other forms of driving anxiety, please contact us. Our CBT therapists are doctoral-level psychologists. We also have student therapists who offer reduced-fee services. Our offices are in midtown Manhattan, but we offer teletherapy services to people elsewhere in New York State, New Jersey, and Florida. If you’re looking for CBT therapy in another part of the country or world, please let us know — we are happy to help!