Hit-and-Run OCD

What is Hit-and-Run OCD?

Hit-and-Run Obsessive-Compulsive Disorder (Hit-and-Run OCD) is a subtype of OCD where individuals experience intrusive fears and doubts about having accidentally hit someone while driving. These thoughts cause overwhelming anxiety, leading to repeated checking behaviors and mental rituals aimed at gaining certainty that no harm occurred. Despite a lack of evidence, sufferers are consumed by doubt and fear of being responsible for serious harm, resulting in intense emotional distress and disruption to daily life.

Sequence of Hit-and-Run OCD

Triggers: Hit-and-Run OCD can be triggered by common driving scenarios, including:

• Driving on roads with pedestrians or cyclists nearby.

• Driving over potholes, bumps, or irregular pavement.

• Passing joggers, bikers, or parked cars.

• Backing out of parking spaces or driveways.

• Hearing sirens or seeing emergency vehicles while driving.

Core Fears: People with this form of OCD often experience core fears such as:

• Hitting and killing someone.

• Being arrested, charged, or sent to jail for a hit-and-run thereby ruining their life.

• Causing harm or death to someone and living with unbearable guilt.

• Having their reputation or relationships ruined because of an accident.

Compulsions / Safety Behaviours: In response to these fears, individuals may engage in compulsive behaviors—mental or physical actions meant to relieve anxiety or gain certainty. Examples include:

• Driving around the block repeatedly to check for bodies or accidents.

• Inspecting the car for dents, blood, or damage.

• Replaying mental images of the drive to confirm no harm occurred.

• Monitoring news reports or police updates for mentions of accidents.

• Seeking reassurance from passengers, bystanders, or authorities that nothing happened.

• Avoiding driving at night or in busy areas to minimize perceived risk.

While these behaviors may briefly reduce anxiety, they reinforce the fear, making the cycle harder to break.

What Causes Hit-and-Run OCD?

Hit-and-Run OCD likely develops due to a combination of biological, psychological, and environmental factors:

• Genetics: A family history of OCD or anxiety disorders may increase susceptibility.

• Brain Functioning: Hyperactivity in regions of the brain that process fear and uncertainty can amplify doubts and over-responsibility.

• Past Experiences: Stressful events, such as prior car accidents or near-misses, or witnessing crashes, may create heightened sensitivity to safety concerns.

• Perfectionism and Responsibility: Individuals with high moral standards or excessive responsibility for others’ safety may fixate on the possibility of causing harm.

• Learned Behaviors: Observing overly cautious driving or fear-based responses to accidents may reinforce hyper-vigilance.

How Do You Treat Hit-and-Run OCD?

Hit-and-Run OCD responds well to Cognitive Behavioral Therapy (CBT), particularly Exposure and Response Prevention (ERP).

ERP Therapy: ERP gradually exposes individuals to feared situations while teaching them to resist compulsive behaviors. Examples include:

• Driving past a cyclist or pedestrian without circling back to check.

• Avoiding the urge to check rearview mirrors excessively.

• Refraining from inspecting the car after every drive.

• Writing hypothetical scenarios (e.g., "What if I hit someone and didn’t realize it?") to confront the fear without seeking reassurance.

ERP helps individuals tolerate uncertainty and anxiety, training the brain to stop treating intrusive thoughts as threats.

Cognitive Therapy: Cognitive therapy challenges irrational beliefs, such as "I must be completely certain I didn’t cause harm." It emphasizes accepting uncertainty and resisting the need for absolute reassurance.

Mindfulness Techniques: Mindfulness encourages observing thoughts without judgment, helping individuals detach from intrusive fears and reduce emotional reactivity.

Medication: SSRIs (Selective Serotonin Reuptake Inhibitors) may be prescribed to reduce anxiety and obsessive thinking, allowing therapy to be more effective.

Summary

Hit-and-Run OCD is characterised by intrusive fears about unintentionally harming someone while driving, leading to distress and compulsive checking behaviors aimed at preventing perceived harm. Despite a lack of evidence, sufferers feel compelled to seek certainty and safety. Treatments like ERP and CBT provide effective strategies to confront fears, reduce compulsions, and build tolerance for uncertainty.

Sources

• https://www.ocduk.org/ocd/clinical-classification-of-ocd/dsm-and-ocd/

• https://iocdf.org/expert-opinions/driven-to-distraction-hit-and-run-ocd/