Hit-and-run OCD is a lesser-known but very real form of obsessive-compulsive disorder (OCD). Imagine driving down the road, and out of nowhere, you feel this intense fear that you’ve hit someone, even though there’s no evidence of it. You may replay the moment over and over in your head, doubt what you saw, or even turn back to check—sometimes multiple times. This cycle of fear and checking can take over your life.

Symptoms of Hit-and-Run OCD

People with hit-and-run OCD are often plagued by intrusive thoughts. The unwanted intrusive thoughts pop into your mind and bring you a lot of distress. With this specific form of OCD, the thoughts are usually related to accidentally harming someone, especially while driving.

Learn more about OCD.

Common symptoms include:

• Fear that you've hit a pedestrian or caused a car accident, even when there's no sign of it.

• Checking behaviours, like going back to the scene, looking for damage on your car, or searching the news for reports of accidents.

• Constant reassurance-seeking, asking others if they think you’ve hurt someone.

• Avoid driving or taking long trips because of the fear of hitting someone.

These thoughts and behaviours can take up a lot of mental and emotional energy, leaving you feeling drained or even trapped.

Common Avoidances (Triggers) in Hit-and-Run OCD

Avoidance is a big part of hit-and-run OCD. People often start avoiding things that trigger their fears, even if those situations are completely safe. Avoidance helps you cope in the short term but will make your obsessions worse in the long term.

Here are some common avoidances:

• Avoiding Driving. Many people might avoid driving altogether or limit how often they drive. They may feel safer taking public transportation or getting a ride from someone else to reduce the chance of "causing an accident."

• Avoiding Busy Roads or High-Traffic Areas. Some people may still drive but steer clear of places with lots of pedestrians or cars. For example, they may avoid city streets, highways, or school zones. These environments may feel too risky, triggering obsessive fears.

• Avoiding Driving at Certain Times. Driving at night or during bad weather, when visibility is low, can be especially anxiety-provoking. The uncertainty of what they can and can’t see on the road can make you more likely to accidentally hit someone.

• Limiting Driving to Short Trips. Some people may limit how far or long they drive. They might feel like shorter trips are "safer" and less likely to result in harm.

Common Rituals in Hit-and-Run OCD

People with hit-and-run OCD often engage in rituals or "checking behaviours" to relieve their anxiety. While these rituals might offer temporary relief, they usually reinforce the cycle of fear and compulsions. Here are some common rituals:

• Turning Back to Check. After feeling the fear of hitting someone, it’s common to turn around and drive back to the spot. The purpose of this is to check for any signs of an accident. This might happen once or many times and the relief is often temporary.

• Inspecting the Vehicle. People might check their car for damage. They will look for dents, scratches, or anything that suggests they’ve hit something or someone. This can turn into a repeated action, often done after almost every trip.

• Seeking Reassurance. Asking others if they think an accident could have happened. They might ask people if they notice anything wrong with the car is another common ritual. Seeking reassurance can also involve asking loved ones if they heard of any accidents. The person with OCD symptoms may also watch the news to see if there were any accidents. Seeking reassurance may also involve looking up information online. For example, you read comments on Reddit to make sure that you have similar OCD symptoms.

• Mental Replaying. Replaying the drive over and over in their mind, trying to recall every detail, is a mental ritual. People might spend hours mentally scanning the event, trying to reassure themselves that nothing bad happened.

These avoidances and rituals may seem like they’re keeping someone safe. But in reality, they keep feeding the cycle of anxiety and compulsions. With the right help, like therapy and support, it’s possible to reduce these behaviours and regain confidence.

How Common is Hit-and-Run OCD?

OCD, in general, affects about 1-2% of the population. While hit-and-run OCD isn’t as widely discussed, it’s not uncommon. Many people experience intrusive thoughts about harming others or causing accidents. For those with OCD, these thoughts become stuck and lead to compulsive behaviours.

It’s important to remember that hit-and-run OCD doesn’t make you dangerous. These thoughts are symptoms of the disorder, not reflections of who you are. If you or someone you know is struggling with this, reaching out for professional help is a critical first step.

Hit-and-run OCD can feel overwhelming, but there’s hope. Treatment is available, and with the right support, it’s possible to regain control of your life.

Treatment Options for Hit-and-Run OCD

The good news is, like other forms of OCD, hit-and-run OCD is treatable. The most effective treatments usually involve therapy and, in some cases, medication.

1. Exposure and Response Prevention Therapy (ERP). Exposure and Response Prevention (ERP) is a powerful tool for managing OCD, including hit-and-run OCD. It works by gradually exposing you to situations that trigger your fears while helping you resist the urge to check or avoid. Over time, this helps reduce the power those obsessive thoughts have over you.

2. Medication. Some people find that medications, like selective serotonin reuptake inhibitors (SSRIs), can help reduce the intensity of their obsessions and compulsions. Contact your doctor if you would like to discuss medications. You may also want to ask for a referral to a psychiatrist.

3. Mindfulness Practices. These can help you learn how to tolerate distressing thoughts without acting on them. Mindfulness can be especially useful in managing anxiety and intrusive thoughts.

3 ERP Tips If You Have Hit-and-Run OCD

Here are five practical tips if you're working through ERP with hit-and-run OCD:

1. Start Small, but Be Consistent. Begin with less anxiety-provoking exposures, like driving on quieter roads or in familiar areas. As you build confidence, gradually work your way up to more challenging situations, like driving through busier streets. Consistency is key, so aim to practice exposure regularly, even if it’s just for a short time each day.

2. Resist the Urge to Turn Back. One of the hardest parts of hit-and-run OCD is resisting the urge to go back and check if you hit someone. When you're practicing ERP, commit to driving forward without turning back, even if you feel anxious. Each time you resist checking, you're weakening the OCD cycle.

3. Delay Checking Rituals. If you feel the urge to check your car or ask someone for reassurance, try delaying it. Start with a small delay—maybe 10 or 15 minutes—and gradually work up to longer periods. The goal is to break the automatic habit of checking by creating space between the obsession and the compulsion.

ERP can be challenging, but with patience and practice, it’s one of the most effective ways to reduce the power of hit-and-run OCD. Working with a therapist who specializes in ERP can also provide guidance and support throughout the process.

Connect with an ERP Therapist

At Virtual CBT Psychotherapy, we have a variety of experienced OCD therapists to choose from. Book a free consultation and our Clinical Directors with match you with a therapist. You can choose to work with a social worker, psychologist, or registered psychotherapist. * Must be an Ontario resident. Learn more about our therapy fees.