Hit-and-run OCD involves the fear that you accidentally hit someone while driving. It creates unrelenting doubt, which often results in checking behaviors and reassurance-seeking.
What Is Hit-and-Run OCD?
Hit-and-Run OCD, also sometimes called Motor Vehicle Accident OCD (MVA-OCD), is a subtype of obsessive-compulsive disorder characterized by intrusive fears about unintentionally causing harm while driving — most commonly, fears about having hit a pedestrian, or caused an accident, without realizing it.
This OCD subtype revolves around these core features:
- Hyperresponsibility: A magnified sense of personal accountability for preventing harm.
- Intolerance of Uncertainty: An urgent need to know for sure that nothing bad happened.
- Compulsive Behaviors: Physical and mental rituals aimed at reducing doubt.
- Memory Distortions (occurs only for some individuals): Vividly “remembering” hitting something despite no real evidence, with compulsive checking reinforcing these false memories.
When Your Senses Deceive You: How OCD Twists Reality
Although many of us may consider driving to be a rather mundane activity, this is most certainly not the case for people with driving-related anxiety. The act of driving is probably one of the more complex, sensory-rich, high-stakes activities that most of us complete on a regular basis. When you’re driving, you’re constantly scanning your environment, making decisions in real-time, and processing a flood of sensory input; including a variety of noises, bumps, shadows, and flashes of motion.
OCD is a bit like a miscalibrated alarm system that’s prone to false alarms. Because the life-altering consequences of hitting a pedestrian are so severe, OCD’s tendency is to classify any potential threat as a valid one, just in case.
When this happens, a crack in the pavement, the snap of a branch under your tire, or a shadow in your peripheral vision can all be mistaken as evidence of a potential catastrophe.
Moreover, even benign inattention (which is common for experienced drivers), can be weaponized by OCD, making it feel like “proof” of irresponsibility.
Hit & Run OCD: Susan's Story
The garage door slowly groaned shut, and I let out a sigh of relief. Finally, after the longest commute in human history, I was home. I grabbed my keys and walked inside.
As I opened the refrigerator to contemplate dinner, I was inexplicably jolted with a spike of anxiety.
The thoughts came instantly, “Was it possible that I hit something? Someone?”
My drive had been mostly unremarkable; I hadn’t seen, heard, or felt anything unusual. And yet, my fear loomed large. Had I missed something? Was I not paying attention?
My heart began to pound frantically in my chest. Adrenaline surged, and my face became hot. I closed my eyes, trying to mentally replay the last few blocks of my drive, each turn, each slight dip in the road. The streetlights had just come on, blurring the edges of the sidewalk. Had I veered too close? Was that shadow a person?
My body felt wired, every nerve ending buzzing with an urgent, desperate need for answers. I took a shaky breath, then another, but the air in my lungs felt thin, insufficient. I pictured the stretch of road near the park, the slight incline. Was it a pothole? A branch? Or something… worse?
I fumbled for my keys, my hand trembling as I ran back into the garage. I crouched down, running my hand along the bumper, then the side panels, my eyes scanning the ground beneath. Nothing. Just the usual dust and dirt. But the knot in my stomach tightened. No obvious damage, and yet…
Unsatisfied, I backed the car out, the rumble of the engine a dull roar in my ears. I drove slowly, deliberately, around the block, then again, my gaze sweeping every curb, every shadow. Each pass yielded the same result – no body, no accident, nothing seemingly out-of-place.
But the relief I craved remained elusive. I pulled back into my driveway, a feeling of sick dread settling deep in my bones. The garage door began to close, signaling an end to my drive, but not to the grinding, relentless doubt.
Checking & Reassurance Seeking in Hit & Run OCD
If you’re struggling with Hit-and-Run OCD, chances are you’re spending a lot of time engaging in checking rituals and trying to feel certain.
Common compulsions include:
- Excessive mirror checking while driving
- Looping back to re-drive routes
- Inspecting your car for dents or blood
- Googling local accidents or calling police departments
- Mentally replaying the memory of your drive over and over again
- Silently reassuring yourself that you would have noticed if something bad had happened
- Getting reassurance from other people that you’re a safe driver
These rituals may feel necessary, even responsible. But in reality, they keep you stuck. Each time you check, you’re reinforcing the idea that you need to check. And that makes the uncertainty feel even more intolerable next time.
Avoidance Behaviors in Hit & Run OCD
In an effort to prevent future anxiety, many individuals also begin avoiding situations they associate with risk:
- Turning right at red lights (when permitted)
- Driving in school zones or near pedestrians
- Using the radio, Bluetooth, the A/C, or anything else that creates audio distractions
- Driving at night or in poor weather
- Driving alone
- Driving during rush hour
- Driving altogether
While avoidance may provide short-term relief, it tends to shrink your world. The more you avoid, the more threatening those situations begin to feel.
Hit & Run OCD vs. Other Driving Fears
Driving-related anxiety certainly exists outside of hit-and-run OCD. Young drivers with anxiety often attribute their anxiety to inexperience. Older adults might assume their anxiety is a sign that their days of driving are behind them. However, if your fear is irrational, intrusive, and persistent (i.e., when it spirals into compulsive checking or avoidance); OCD should be explored as a possible underlying cause, as hit-and-run OCD distorts our ability to objectively interpret risk and responsibility.
Treatment of Hit-and-Run OCD
Treatment for Hit-and-Run OCD typically involves Exposure and Response Prevention (ERP), a structured, evidence-based approach to interrupting the OCD cycle.
The Basics of Exposure and Response Prevention (ERP) for Hit-and-Run OCD:
- Build a hierarchy. Start by identifying specific driving triggers, from the least to the most anxiety-provoking.
- Engage in targeted exposures. Practice driving in those situations without performing rituals.
- Resist compulsions. No mirror checking. No circling back. No checking accident reports or calling the local police to inquire about accidents. No mentally re-examining your drive. No re-analyzing sights or sounds you might have heard.
- Accept uncertainty. Learn to tolerate the discomfort of not knowing with 100% certainty. A core concept in this process is something called radical response prevention.
In practice, radical response prevention for hit-and-run OCD means that you only allow yourself to circle back and check if (and only if!) you are 100% sure that an accident has occurred. If you have less than perfect certainty, you must continue driving without checking. You can’t make exception for “maybe” or “just in case.” Although this type of response prevention may initially seem extreme (and well…radical), it’s not unlike the decision rule you probably followed before you developed hit-and-run OCD.
This helps retrain your brain to differentiate between real emergencies and OCD-generated doubt.
OCD Treatment in South Florida
If you’re experiencing hit-and-run OCD or other driving-related obsessive fears, know that effective help is available. At my OCD treatment center in Palm Beach County, Florida, we offer specialized ERP services tailored to your needs—including individual therapy, intensive outpatient programs, and group-based treatment.
We serve clients from across West Palm Beach, Palm Beach Gardens, Jupiter, and the greater South Florida area. Many of our ERP sessions occur in real-world settings, including in-car exposures on local roads and highways.
Whether you’re a new driver, a seasoned commuter, or someone who’s stopped driving altogether, we can help you regain control and get back on the road with confidence.
Learn more by visiting the website of my South Florida OCD treatment center, or contact us to schedule an initial consultation.
Questions? Comments? Paralyzed by driving-related doubts? Sound off below!
