Hit-and-run OCD involves the fear of causing accidental injury or death while driving.

“Hit and run” OCD involves the fear of accidentally hitting a pedestrian while driving.  In most cases of hit-and-run obsessive-compulsive disorder, fears focus on unintentionally killing, injuring, or maiming a victim.  Other individuals worry about causing car accidents or causing other vehicles to swerve and hit pedestrians.

Fear of Driving

Hit-and-run OCD, or motor vehicle accident OCD, is distinct from other syndromes that involve anxiety about driving or the fear of car accidents. Hit and run OCD differs from panic– or agoraphobia-related driving avoidance, in which individuals fear driving due to the possibility of having a panic attack while in the car. Diagnosis of hit and run OCD is slightly more complicated in cases in which one fears “losing control” while driving, as this symptom can reflect either panic or OCD. In the case of panic, this fear is based on panicking and “losing control” or “going crazy”, whereas in OCD this fear is based on acting on an unwanted impulse (e.g., impulsively swerving).

Hit and run OCD differs from “driving phobia” largely in terms of the rituals/compulsions that are present in OCD. Driving phobia involves more generalized fears. MVA-OCD also has a different symptom profile than post-traumatic stress disorder (PTSD) which might develop following a car accident and include flashbacks and other PTSD symptoms.

Symptoms of “Hit and Run” OCD

Hit-and-run OCD resembles other forms of checking OCD.  Just as checking a stove is used to prevent fire, checking for accidents while driving is a way of preventing (or reducing the severity of) accidental injury or death.  A common form of checking is driving back along the same route in order to scan for victims.

Unfortunately for sufferers, this compulsion actually creates yet another opportunity for having caused an accidental death or injury.  Despite driving along the same road multiple times, the potential for having missed something remains.  Relentless OCD doubt and uncertainty persist.  Many individuals get stuck in checking loops that span many minutes or hours until exhaustion and/or distress make further checking impossible.

Symptoms of hit and run OCD are time-consuming, distressing, and often debilitating.  Let’s review some of the most common symptoms of hit and run obsessive compulsive disorder (OCD).

Common Rituals in Hit-and-Run OCD

Similar to other forms of checking OCD, hit-and-run OCD involves checking and reassurance rituals. These rituals include:

• Circling back and checking for victims/bodies.
• Looking in the rear-view mirror for signs of an accident.
• Looking in the rear-view mirror to assess the reactions of other drivers (e.g., to see if other cars have swerved or pulled over).
• Listening intently while driving in order to hear screeching tires or the sounds of someone who has been hurt.
• Listening for emergency sirens (i.e., from ambulances, police cars, or other emergency vehicles).
• Monitoring the road for bumps that might signal having hit someone.
• Pulling over to the side of the road to look into ditches or gullies for injured people.
• Holding the steering wheel tightly in order to be able to react more quickly.
• Compulsively checking/readjusting mirror positions.
• Compulsive car maintenance (e.g., checking tire pressure).
• Reassurance rituals involving other passengers.
• Asking other passengers questions about whether or not someone has been hit.
• Watching other passengers’ reactions as a way of reassuring oneself that no pedestrians have been injured.
• Mental Rituals.
• Reassuring self, “No one was hit.”
• Reassuring self, “I’m a safe driver.”
• Reassuring self, “Nothing bad is going to happen.”
• Reassuring self, “I’ve driven this route a million times and nothing bad happened.”
• Mentally replaying, reviewing, or retracing one’s driving route.
• Mentally reviewing evidence that indicates that no accident has occurred.
• Praying.
• Thinking “safe thoughts.”
• Replacing “dangerous” thoughts with “good” thoughts.
• Planning what to say to the police if they show up investigating a hit-and-run incident.
• Planning what to say to your victim is s/he survives.

Avoidance Behaviors in Hit and Run OCD

Hit and run OCD is often associated with a wide range of avoidance behaviors. Common avoidance behaviors include:

• Avoiding driving entirely.
• Avoiding schools or neighborhoods where children play.
• Driving only when other people are in the car (to get reassurance that no one was hit).
• Driving only when one is alone (to prevent distraction).
• Driving in silence (i.e., without the radio on) in order to hear the cries of someone who might be injured.
• Avoiding night driving or driving in the rain.
• Avoiding “dangerous lanes” on the highway.
• Driving only on back roads.
• Not driving in unfamiliar places.
• Consolidating errands so that one doesn’t have to leave the house as often.
• Limiting driving distances and staying close to home.
• Avoiding cell phone use or other forms of distracted driving.
• Driving below the speed limit.
• Avoiding parking lots.
• Avoiding busy intersections.
• Avoiding seeing or hearing about car accidents in movies or on TV.

Feared Consequences in Hit-and-Run OCD

Feared consequences associated with hit and run OCD vary. Although the most obvious feared consequence is the actual death or injury of a victim, potential emotional consequences may cause even more distress. For example, individuals often fear the prospect of harming someone because they can’t imagine living the rest of their lives with unrelenting guilt. Common feared consequences include:

• Fear of something falling off your car and causing an accident.
• Fear of killing someone.
• Fear of maiming someone.
• Fear of going to jail.
• Fear of feeling unrelenting guilt over having killed someone.
• Fear of being “irresponsible” or “negligent”.
• Fear of having your life “ruined.”
• Fear of being perceived as “a horrible person.”
• Fear of getting convicted of manslaughter and “ruining” the lives of your friends and family.
• Fear that others will condemn you for what you’ve done.
• Fear of having to face the family members of your victim.
• Fear that life will never be the same.
• Fear of committing an unforgivable crime.
• Fear of unrelenting depression and possible suicide.
• Fear of having to face your victim (if s/he survives).

Effective treatment of hit and run OCD should be based on exposure and response prevention for OCD.  In my South Florida (Palm Beach) psychological practice, I treat many individuals with hit and run OCD and other harm-based obsessions. Treatment involves eliminating avoidance behaviors, resisting rituals, and purposefully tackling your feared consequences according to a personalized anxiety hierarchy.

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