Hit & Run OCD: What It Is, Symptoms, & Treatment

What Is Hit & Run OCD?

Hit-and-run OCD, also called Driving OCD, is one of a subtype of Obsessive Compulsive Disorder (OCD) called harm OCD, where someone experiences obsessive thoughts over causing harm when driving. It could also be classified as a false memory OCD if the person experiences these obsessions as doubting that they have actually harmed someone or something while driving.

It’s estimated that about 1.2% of the US population has OCD, with females being more likely to have it.¹ Specific statistics on hit-and-run OCD are unknown, but what is known is that harm OCD is one of the most common subtypes to have.²

Hit-and-run OCD is characterized by:

• Obsessions: Unwanted intrusive thoughts, urges, or images that recur and persist, causing anxiety or distress to the one experiencing them.³
• Compulsions: Compulsions are repetitive behaviors or mental acts that a person performs in response to an obsession or rigid self-imposed rules, aimed at preventing or reducing their distress or preventing something from occurring.³

Symptoms of Hit & Run OCD

Everyone with OCD experiences obsessions and compulsions. Symptoms of hit-and-run OCD are unique in that obsessions are typically images or thoughts concerning hitting someone with a vehicle, or worry that they had hit someone and did not realize it. Associated compulsions could include seeking reassurance that they did not hit someone, or avoiding certain driving situations.

Common obsessions in hit-and-run OCD include:

• I am going to jerk the wheel and hit the car next to me
• I will hit a bicyclist on the road
• I will hit a construction worker on the road
• Someone will walk in front of me when driving
• The bump I felt in the road was actually a person I ran over
• I hit a dog driving through the neighborhood, and I did not realize it
• The police lights are after me because I hit someone and did not know it
• I know I must have run over someone yesterday when out driving

Common compulsions in hit-and-run OCD include:

• Repeatedly checking the rearview mirror to see if there are any bodies on the road
• Buying and listening to police scanners to see if there was a hit and run
• Checking the newspaper or watching the news for hit-and-run cases
• Avoiding any pedestrian areas or roads with bike lanes
• Avoiding driving altogether for fear that you will hurt someone
• Driving extremely slow and careful
• Stopping and asking people if they saw someone get hit
• Backtracking your route to check for an injured person
• Inspecting your car repeatedly for dents, bloodstains, or other evidence of hitting someone
• Thoroughly playing through your drive in your head to remember precisely what happened

What Triggers Hit & Run OCD Symptoms?

Hit-and-run OCD can be triggered by various circumstances and situations. This is usually because those situations are related to or remind them of possible hit-and-run scenarios in the person’s mind. These triggering situations can intensify already present obsessions, and lead to the person feeling they need to perform a compulsive behavior.

Common triggers for hit-and-run OCD include:

• Hitting a pothole
• Hearing sirens behind you as you are driving
• Encountering cyclists on the road
• Being in a high pedestrian area, or encountering pedestrian traffic
• Hearing/seeing a news story about a hit-and-run
• Encountering dashcam videos on social media
• Driving in heavy rain
• Driving in construction or encountering detours
• Driving in unfamiliar areas

Causes of Hit & Run OCD

It is thought that there is both a genetic⁴ and developmental component to having OCD. Some people may be predisposed and develop OCD after many years. Rarely is it caused by traumatic brain injuries.⁶ Other environmental factors, such as experiencing abuse, neglect, or bullying, could also impact the likelihood of developing OCD.⁵

Possible causes of hit-and-run OCD include:

• Genetics: Your genes determine how your brain develops and functions, and certain genes give a predisposition to developing OCD.
• Environmental factors: Adverse factors in life, such as experiencing childhood trauma or sexual trauma, can create changes in how your brain processes information and can lead to developing OCD.
• Brain activity: The internal makeup of the brain can influence the onset of OCD symptoms, and this makeup changes over time as one ages.
• Physical trauma: Traumatic brain injury can cause changes in the areas of the brain, such as the frontal lobes, or even a basal skull injury, in rare instances, has influenced the onset of OCD.
• Illness: Neurological conditions, like brain tumors, Huntington’s, and certain dementias, have, in very rare instances, been associated with an onset of OCD symptoms.⁶

Impacts of Hit & Run OCD

Hit-and-run OCD can cause significant impairment in life, especially around transportation and access. People with hit-and-run OCD can develop symptoms so severe that they do not drive, or even ride with others. This can lead to job loss, social isolation, and worsening of other physical and mental health conditions that may be present.

How Is Hit & Run OCD Diagnosed?

Hit-and-run OCD, and OCD generally, is diagnosed by a mental health professional by interviewing the person about their symptoms and how they impact their life. A Clinically Licensed Social Worker, Psychiatrist, Psychologist, or Licensed Counselor can usually diagnose OCD.

OCD diagnosis typically starts with a simple questionnaire, typically performed by your general physician. With a positive screen, they will typically refer you to a licensed professional, as listed above, where a more in-depth assessment would be conducted to confirm or rule out the diagnosis.

Questions to ask your doctor about hit-and-run OCD include:

• Where can I find specialized OCD treatment?
• What does a typical treatment plan look like for hit-and-run OCD?
• Can medication help with my symptoms?
• Can this be anything else besides OCD?

Treatment for Hit & Run OCD

OCD treatment typically includes medication and therapy. Exposure and Response Prevention, a type of Cognitive Behavioral Therapy used specifically to treat OCD, has been show to be quite effective. Therapy is typically paired with medication, like an SSRI, in the beginning to help manage symptoms.

Treatment options for hit-and-run OCD include:

• Exposure response therapy (ERP): Exposure therapy for OCD involves controlled exposure to triggers with the use of tools provided in therapy. For hit-and-run OCD, this may look like incrementally increasing driving scenarios participated in without engaging in compulsions.
• Medications: Medications for OCD can be beneficial for managing symptoms, especially when first starting exposure therapy. Typically SSRI’s are tried first before moving on to other options if they prove ineffective.
• Cognitive behavioral therapy (CBT): CBT for OCD is a proven approach to addressing obsessive thoughts and confronting them in a rational manner, managing the emotional and behavioral reactions to them.

8 Tips for Coping With Hit & Run OCD

There are healthy ways to cope with hit-and-run OCD. However, treatment is recommended to learn to manage the condition fully. It is important, even with treatment, to develop healthy coping mechanisms that can get you through experiencing symptoms in the moment, such as calling someone trusted, or using Socratic questioning methods.

Here are 8 number tips for coping with hit-and-run OCD:

• Call a loved one on loudspeaker: Calling a loved one is a healthy way to cope in the moment, and have someone to talk through your situation with to avoid having to act on a compulsion.
• Learn to identify your compulsions: Identifying your compulsions and when they are triggered is the first step in managing your compulsive behavior.
• Find a Support Group: OCD support groups exist across the globe and online. They can be a great resource for people with OCD, and support groups may exist for hit-and-run or driving OCD subtypes.
• Limit caffeine, alcohol, or stimulants: These types of substances can contribute to anxiety around obsessions and worsen symptoms if taken before or when driving.
• Learn Mindfulness & Relaxation Techniques: These types of exercises can help you feel grounded and remain secure to handle the emotional distress of obsessions better.
• Be kind to yourself: Practicing self-compassion is essential in living with OCD. Having these obsessions and compulsions does not make you a bad person, and you are doing the best you can with the tools you have.
• Don’t drive tired: When you are tired, you are more prone to anxiety and stress, possibly exasperating obsessions and their impact. Be sure you’re getting plenty of rest before hitting the road.
• Talk with a therapist: Talking with a therapist can be one of the best ways to cope with your OCD and learn ways of effectively living with hit-and-run OCD.

When to Seek Professional Support

Talking with a therapist is recommended if your symptoms are negatively impacting your life or the lives of those around you. An online therapist directory or online OCD resources are both good starting places for finding a therapist who specializes in OCD treatment. If you cannot, you may consider contacting your primary care physician or calling your insurance provider for a referral.

Online psychiatrist options are a good choice for finding OCD medication management. Many insurance providers cover them now, but it’s a good idea to check with your insurance company before accessing one if that is a concern for you.