What is Hit and Run OCD? Symptoms & Treatment
Find yourself retracing your route every time you run over a bump in the road, wondering if you’ve hit a pedestrian? You could be experiencing Hit and Run OCD, a subtype of OCD involving obsessions and compulsions related to causing a car accident or injuring someone while driving. Dr. Holly Betterly MD, Board-Certified Psychiatrist in Weston, FL explains Hit and Run OCD, reviewing common symptoms, effective treatment options, and how to get connected with care.
This post is provided for educational purposes only, and is not intended as a substitute for professional medical advice. If you have questions, always reach out to your doctor for more information.
Struggling with your mental health? Reach out for professional support. Dr. Betterly is a board-certified psychiatrist in Weston, FL dedicated to helping you overcome depression, anxiety, and OCD. She offers appointments at her office in Weston, FL, conveniently located in Weston Town Center, as well as via telehealth for patients across Florida. Request an appointment today to start your journey to better mental health.
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What is OCD?
Obsessive Compulsive Disorder (OCD) is a common mental health condition that can seriously impact your daily functioning and overall quality of life.
OCD is characterized by the presence of obsessions, or unwanted, intrusive thoughts, images or urges, and/or compulsions, or repetitive behaviors aimed at reducing the distress associated with obsessions. These obsessions and compulsions may be time consuming, taking up more than an hour of your day.
Obsessions and compulsions can look very different from one person to the next. When it comes to OCD, there is no “one size fits all”. With that said, some common obsessions and compulsions include:
Common Obsessions
Fear of contamination/germs/dirt
Fear of harming yourself or others
Fear of losing control
Need for order/ “just right”
Difficulty with uncertainty
Unpleasant aggressive, sexual, or religious thoughts
Common Compulsions
Excessive handwashing and cleaning
Excessive counting, checking, or ordering
Excessive reassurance seeking
Thinking “neutralizing” thoughts
Strict, rigid routines
OCD impacts millions of people worldwide, and is seen in both children and adults. OCD often develops gradually during adolescence or young adulthood, and can take many years to be diagnosed.
Like other mental health conditions, OCD is diagnosed by mental health professionals, such as a psychiatrists and psychologists. Dr. Betterly’s recent article breaks down how mental health professionals diagnose OCD.
What is Hit and Run OCD?
Hit and Run OCD, also known as Driving-Related OCD, refers to a type of OCD in which obsessions and compulsions are centered around a fear of causing a car accident or injuring someone while driving.
The Diagnostic and Statistical Manual of Mental Disorders (DSM) is a tool used by mental health professionals in diagnosing psychiatric disorders. The DSM defines the diagnostic criteria for Obsessive Compulsive Disorder, but it doesn’t break down OCD into formal subtypes based on symptom themes. Because of this, you won’t find formal diagnostic criteria for Hit and Run OCD, or any other subtype of OCD, in the DSM.
With that said, it’s not uncommon for people to refer to OCD by informal subtypes that describe the theme of obsessions and compulsions, such as Hit and Run OCD, Contamination OCD, Harm OCD, Relationship OCD, Just Right OCD, or Pedophilic OCD. These informal subtypes can help people to identify and name the specific ways that OCD impacts their life, and can serve as a reminder that they are not alone in experiencing a particular set of symptoms.
It’s important to note that many people experience OCD symptoms that span multiple themes, so someone who experiences Hit and Run obsessions and compulsions may also experience symptoms related to contamination, or relationships.
How common is Hit and Run OCD?
As Hit and Run OCD is not a formally defined subtype of OCD, it’s challenging to estimate the exact prevalence of this condition.
At the time this article was written, a review of the existing literature did not identify any studies that specifically examined the prevalence of Hit and Run OCD.
The lifetime prevalence of OCD is around 2-3%, but it’s important to note that this number is inclusive of everyone who meets the diagnostic criteria for OCD at some point in their life, not just those who experience symptoms specific to a particular theme, such as hit and run. Because of this, we might infer that the prevalence of Hit and Run OCD would be lower than the overall prevalence of OCD.
The existing literature provides some insight into which symptoms are most common in OCD. A study published in Molecular Psychiatry examined the prevalence of specific types of obsessions and compulsions among people diagnosed with OCD at some point in their lifetime. The results showed that some of the most common symptoms include:
Checking - 79%
Hoarding - 62%
Ordering - 57%
Moral - 43%
Sexual/ Religious - 30%
Contamination - 25%
Harming - 24%
Illness - 14%
Checking and harming obsessions and compulsions are frequently seen in Hit and Run OCD, but it’s important to remember that these symptoms occur in many different subtypes of OCD, not just Hit and Run. So, while 79% of people with OCD may experience checking symptoms, this doesn’t mean that 79% of people with OCD experience Hit and Run subtype. Other common checking compulsions might include checking whether you locked the front door or turned off the stove, while common harming obsessions might include fears of stabbing your friend or dropping your child.
What are the symptoms of Hit and Run OCD?
As we’ve noted above, each person’s experience with OCD is unique. With that said, people who experience Hit and Run OCD generally experience obsessions and compulsions related to the fear of causing an accident or injuring someone while driving.
Here’s some examples of the ways that these symptoms may present:
Common Hit and Run OCD Obsessions
I felt a bump just now while driving. Did I hit something? An animal? A person?
Did I injure someone? Would I know if I did?
What if I hit someone last week and I didn’t even know it?
Am I fleeing the scene of an accident? What are the legal criteria for a hit and run? Will I be arrested and charged? Will I go to prison? For how long? What about the death penalty?
Can I live with myself after killing someone?
My GPS says traffic is building up along my route- is it because I caused a crash?
I hear a police siren- are they coming for me?
There’s an ambulance over there- are they transporting the victim to the hospital?
There’s a dent on the bumper of the car in front of me- did I do that?
Common Hit and Run OCD Compulsions
Circling back to check along your route for injuries or signs of damage
Getting out of the car to check for casualties in the surrounding area
Checking your vehicle for scratches, dents, or signs of damage
Mentally reviewing your route
Googling or checking the paper for traffic accidents reported along your route
Calling the local hospital to ask about any new car accident victims
Listening to the police scanner for mentions of car accidents
Googling for information about how you would know if you hit someone while driving
Researching legal consequences for hit and run
Showing up to the police station to confess to a possible hit and run
Driving with excessive caution, constantly checking the mirrors
Avoiding driving in areas with high pedestrian traffic or dim lighting
Avoiding driving altogether
Do people with OCD have a higher risk of traffic accidents?
A study published in Social Psychiatry and Psychiatric Epidemiology posed an interesting question- while people with OCD often experience driving-related obsessions and compulsions, are they actually at a higher risk for traffic accidents? The authors point out that while people with driving-related OCD symptoms could be more cautious drivers (avoiding areas with high pedestrian traffic, staying under the speed limit, etc.), they could also be distracted by their symptoms while driving (such as performing checking rituals while on the road).
To answer their question, the authors of this 2022 study examined data from over 23,000 Swedish adults who had been diagnosed with OCD, attempting to determine whether these individuals had a greater risk of injuries or deaths due to transport or motor vehicle accidents, or of traffic offense convictions, than those without OCD.
The study authors concluded that the risks of serious transport accidents and traffic offense convictions in OCD are negligible.
This objective data may be helpful for those who hold the mistaken belief that they represent a significant threat to public safety because of their Hit and Run OCD. The authors highlight that the results of their study suggest that the majority of people with OCD should be able to drive safely.
What are the treatments for Hit and Run OCD?
The good news: there are multiple effective, evidence-based treatment options available for OCD, and Hit and Run OCD is no exception.
It’s important to note that we use the same types of treatments regardless of the type of OCD- in other words, the treatments for Hit and Run OCD are no different than those that we may use for Contamination OCD, or Relationship OCD.
Specialized forms of therapy, such as Exposure Response Prevention, or “ERP”, can help to break the cycle of obsessive thoughts and compulsive behaviors. Prescription medications are also available, and are frequently prescribed in combination with therapy.
Exposure Response Prevention Therapy (ERP)
Exposure Response Prevention Therapy, or ERP, is a gold-standard treatment for OCD. ERP is a specialized form of Cognitive Behavioral Therapy (CBT) conducted by a trained mental health professional, such as a psychologist. It involves gradual exposure to feared situations/triggers (exposure) while resisting the urge to engage in compulsive behaviors (response prevention). You can visit the International OCD Foundation (IOCDF) website to learn more about ERP.
While the treatments for OCD are the same regardless of symptom theme, ERP itself is tailored to your specific symptoms and triggers. As an example, an ERP exposure for someone experiencing Hit and Run OCD could involve driving around the block without returning to retrace your route to check for injuries, while an exposure for Contamination OCD could look like touching a doorhandle without immediately washing your hands.
ERP exposures are carefully designed, often through the creation of a hierarchy of different exposures that become progressively more challenging. By slowly making your way up the hierarchy, you are able to progress and grow without becoming overwhelmed.
Medications for OCD
There are a number of different medications which have been approved by the FDA for the treatment of OCD. Selective Serotonin Reuptake Inhibitors, or SSRIs, are usually considered to be the preferred first-line medication option in OCD. Common SSRIs include Sertraline, Fluvoxamine, Fluoxetine, and Paroxetine. SSRIs are available by prescription only in the US. They often come in a pill or tablet form to be taken by mouth, and are usually taken on a consistent daily basis.
Clomipramine is another type of prescription medication that has been approved for use in OCD. Because it carries a greater risk of side effects, Clomipramine is often reserved as a second-line option for those whose symptoms haven’t responded to an SSRI.
Check out Dr. Betterly’s article to learn more about the best medications for treating OCD, and how psychiatrists select the most appropriate option for their patient.
How do I find treatment for Hit and Run OCD?
If the aforementioned symptoms sound all too familiar, it’s possible that you could be experiencing Hit and Run OCD. Reach out to a mental health professional for further evaluation of your concerns. A psychologist or a psychiatrist are both great options.
To locate a mental health professional near you, check out these free online directories from leading professional organizations:
American Psychiatric Association (APA) Find a Psychiatrist Tool
American Psychological Association (APA) Locate a Psychologist Tool
Located in Florida? Dr. Holly Betterly is a Board-Certified Psychiatrist who specializes in treating OCD. She offers telehealth appointments for patients across Florida, as well as in-person appointments in Weston, FL. Request an appointment to start your journey to better mental health.
