Driving and Hit-and-Run OCD: A Common Manifestation of Harm OCD
Obsessive Compulsive Disorder (OCD) knows no limits. While it’s largely believed to be a disease marked by cleanliness or organization, it manifests in all sorts of ways.
One of these ways is through Harm OCD. People with this OCD subset fear that they’ll harm others either accidentally or intentionally. They might be afraid of stabbing their grandmother at the dinner table or pushing a commuter in front of the subway. They might be afraid of tripping someone while they walk by or strangling their child.
One of the most common fears of those with Harm OCD happens behind the wheel: They fear that they’ll cause an accident while driving, run over a pedestrian, or veer into a school or crowd.
As a result, driving can cause immobilizing fear and many of those with Harm OCD abstain from it altogether.
The Basics of OCD
Before we dive into driving with OCD, let’s explore the basics of the disorder.
OCD is an uncommon condition diagnosed in 2.3% of the US population and 1 in 100 children. It involves cycles of intrusive thoughts (obsessions) and rituals performed to regulate anxiety (compulsions).
For example, someone with Harm OCD who hits a pothole while driving to the grocery store may fear that they’ve run over a jogger or bicyclist. This thought triggers overwhelming anxiety, leaving the OCD sufferer to backtrack and check the street to make sure that they didn’t really run over someone. Checking relieves the anxiety for a while but it always returns. For instance, the sufferer may begin to fear that they didn’t check the street closely enough and go back to better inspect once more. Or they may experience an entirely new intrusive thought as they continue driving. As a rule, OCD is never satisfied, which is why it’s defined by repetitive behavior and unrelenting cycles.
OCD, when untreated, is very disabling and dramatically interferes with all aspects of the sufferer’s life, including school, work, friends, and family. Treatment, while it doesn’t offer a cure, reduces symptoms and gives those with OCD back control.
Intrusive Thoughts in the General Public
Intrusive thoughts are a prominent feature of OCD. These thoughts are terrifying, uninvited, and egodystonic, meaning they go against the sufferer’s values, morals, and true desires. But they’re not limited to people with OCD. Nor are they limited to those with mental illness. Rather, intrusive thoughts appear in everyone.
The difference lies in how the person reacts to the intrusive thoughts.
The normal brain essentially has a spam filter that allows people to screen these thoughts and label them as trash. They then ignore the thoughts, removing the power the thoughts have and reducing their frequency as well.
The OCD brain has no spam filter, which means those with OCD take these thoughts seriously and apply meaning to them. Giving these thoughts power assures that they appear more often as OCD is a disorder that only persists if it’s getting attention.
Of note, those with OCD don’t believe their intrusive thoughts deep down. In other words, they’re not fully convinced the thoughts are real and, proverbially gun to the head, they’ll recognize they’re not. But one of the things that makes OCD so difficult to manage is that it demands 100% certainty. Thus, a sufferer can be 99% sure that their thoughts are phony but that leftover 1% weighs heavy and demands that the sufferer act just to be safe. In OCD, any uncertainty (even an iota of it) is too much uncertainty.
The Specifics of Driving and Hit-and-Run OCD
As previously addressed, Driving and Hit-and-Run OCD is a subset of a subset; it’s a subset of Harm OCD, which is a subset of OCD overall.
No one is quite sure how common Harm OCD is largely because many of the sufferers with this type of OCD are ashamed to talk about it and are more likely to hide it and keep it to themselves than discuss it with others. They may be afraid of seeking treatment as well, fearing the therapist will take their harm obsessions as a genuine desire to hurt someone.
Nonetheless, many OCD specialists believe that Harm OCD is much more common than people realize. And, when it does happen, Driving and Hit-and-Run OCD frequently pops up.
For many people, their Harm OCD first begins as Driving and Hit-and-Run OCD. It may start off with a fear that they’ll accidentally run into someone while driving before upping the ante and convincing the sufferer that they’ll run over someone on purpose.
Of course, some people with Harm OCD will never experience Driving and Hit-and-Run OCD simply because they don’t drive. Children who are underage won’t experience it nor will people who don’t need to own a car or have a license (which may be the case for those who live in places like New York City). In these instances, the Harm OCD will find other ways to show up.
Common Driving and Hit-and-Run OCD Obsessions
Driving and Hit-and-Run OCD tends to look similar for sufferers, largely because there’s only so many ways you can commit a hit-and-run.
Overall, some of the most common obsessions experienced include:
- Fear of causing an accident and not realizing it
- Fear of running over a pedestrian on accident
- Fear of running over a pedestrian on purpose
- Fear of veering the car into crowds
- Fear of veering the car into places like schools, playgrounds, or shopping malls
- Fear of backing into people when reversing
- Fear of running over pets or wild animals
- Fear of sideswiping bicycles as they bike along the road
- Fear that a pothole or storm drain ran over was actually a person
Sometimes, people with Driving and Hit-and-Run OCD may fear causing harm when they’re not actually driving. For instance, if they’re a passenger in the car, they may worry about distracting the driver and causing them to run over someone. Or they may park their car on a hill and then worry that they didn’t pull the parking brake hard enough, fearing that their car will roll into a group of children playing down the street.
Common Driving and Hit-and-Run OCD Compulsions
To manage their fears, the sufferers perform rituals, compulsions intended to reassure them that they haven’t committed a hit-and-run or that no one was harmed. These are time-consuming and repetitive and, because OCD is never satisfied, only temporarily successful in relieving discomfort.
Overall, some of the most common Driving and Hit-and-Run OCD compulsions include:
- Checking for bodies lying in the street (this involves driving back to the scene of the imaginary crime)
- Checking the car for signs of a hit-and-run (such as a shattered windshield or broken light)
- Checking for blood on the car
- Checking news reports for stories of hit-and-runs
- Checking police blotters
- Retracing steps to look for EMS vehicles
- Purchasing a dash cam video and watching the video to make sure no hit-and-runs happened
- Double and triple-checking that parking brakes are on
- Avoiding driving in certain areas (such as residential streets)
- Avoiding pedestrians (for example, if a jogger is running along the street, the OCD sufferer may turn around so that they don’t have to drive by them or they may move into the left lane so they are as far away as possible)
- Avoiding driving during times when it may be harder to see (such as at night or when it rains)
- Avoiding driving altogether (many people with this type of OCD may give up driving entirely as their OCD worsens)
Importantly, all of the above is performed in the absence of evidence. There’s no sign that they’ve run over anyone (such as the feeling of impact). The sufferer only fears they have because their mind tells them so. As a result, they engage in their ritual in an attempt to gain certainty.
People with Driving and Hit-and-Run OCD may spend hours and hours driving back and forth in an attempt to make sure they haven’t caused any harm. Because of this, it’s not unusual for an OCD sufferer to spend an hour getting to a market that is less than a mile away.
What Causes Driving and Hit-and-Run OCD?
There is not a smoking gun that directly causes OCD. But researchers know of several factors that influence why it happens.
People with OCD often have abnormal brains – they’re structured differently and they function differently. Because of this, vital communication between certain areas of the brain is compromised and the amygdala, which scans the environment for threats, is hyperactive, insinuating that a threat exists when none is present. OCD sufferers also tend to have lower than normal levels of serotonin and dopamine, neurotransmitters that help control anxiety.
Genetics are heavily important as well as about 1 in 4 people with OCD has an immediate family member with it. Still, OCD can manifest without a genetic disposition and those with a genetic disposition may never get it.
Behavior conditioning is important too. While this does not cause OCD, per say, it solidifies it as a full-blown disorder. Because compulsions validate OCD, the disorder is unable to fully latch on without them.
In regard to Driving and Hit-and-Run OCD specifically, it’s hard to say exactly why one subset develops in someone over another subset (though many of those with OCD have more than one subset). OCD attacks a person’s values, which means that those with Harm OCD want, more than anything, not to harm.
As previously mentioned, Driving and Hit-and-Run OCD is often how Harm OCD first manifests. Part of this may be due to age as OCD commonly appears in late adolescence (around 18 or 19) when people may possess a lack of confidence behind the wheel due to the fact that they have not been driving very long.
Sometimes, Driving and Hit-and-Run OCD may manifest when a sufferer starts driving a larger car. For example, if they switch from a sedan to a truck, they may find it harder to see pedestrians in front of them and this could act as a trigger. They may also fear that a truck is deadlier and therefore more likely to do harm, further igniting their fear.
How Dysfunctional Beliefs Come In
Obsessive-Compulsive Cognitions Working Group has identified six types of dysfunctional beliefs omnipresent in OCD sufferers. These beliefs act as the foundation of the anxiety and perpetuate its power.
They are as follows:
Hyper-responsibility: OCD sufferers believe they are responsible for things outside reasonable duty as well as things they can’t control.
Someone with Driving and Hit-and-Run OCD may see someone jaywalking and believe it is their responsibility to make sure that person crosses the street safely. Or they may take their car to the mechanic frequently, fearing that the manufacturer made a mistake and that the vehicle will malfunction and hit someone.
Thought-action fusion: Thought-action fusion is a type of “magical thinking” where the sufferer believes that thinking something is the same as doing it.
Someone with Driving and Hit-and-Run OCD who is parked at a crosswalk and waiting for a group of students to walk across the street may imagine themselves flooring the gas and running over a child. They’ll fear that they really did this, simply because of the intrusive thought or image that popped into their head, and they’ll go back and check.
A need to control thoughts: OCD sufferers understandably want to control their thoughts because the thoughts terrorize them so much. But those with OCD, similar to everyone else, can’t control their thoughts and trying to do so makes those thoughts more frequent. This is because you can’t not think about something without thinking about it.
Unfortunately, some therapists who are treating OCD without the proper training encourage their patients to engage in thought-stopping. A common technique prescribed is for the sufferer to wear a rubber band around their wrist and snap it whenever they have an intrusive thought. This makes the OCD worse (and does nothing to make the thoughts less frequent).
Overestimation or invention of threats: OCD sufferers possess brains that either overestimate threats or manufacture them entirely.
In Driving and Hit-and-Run OCD, the sufferer may believe that it’s risky to drive at night and reason that doing so will result in them not realizing they’ve hit a pedestrian who was out for a stroll. While driving at night might be a little riskier than driving during the day, it still doesn’t present a high hit-and-run risk. Yet in the mind of the OCD sufferer, the risk is definite.
Perfectionism: OCD does not have the market on perfectionism; this is to say that plenty of people identify as perfectionists in the absence of mental illness. But perfectionism is frequently present in OCD sufferers as many of those with the disease believe they need to act and/or do things perfectly or else something bad will happen.
In Driving and Hit-and-Run OCD, the OCD sufferer may believe that taking their eyes off the road for any amount of time (even if it’s to check their blind spot) risks them running over someone or causing an accident. Many drivers may hesitate to do things like change the radio station.
A need for 100% certainty: Perhaps the most challenging thing about OCD is that it demands 100% certainty, 100% of the time. That’s why it’s called the “doubting disease” and is perpetuated by a never-ending chain of “What ifs?”
In Driving and Hit-and-Run OCD, a driver may hit a pothole in the road and know it was a pothole. They may have seen it beforehand and braced themselves for the bump. But their OCD will ask, “What if it wasn’t a pothole? What if it was a person? What if it was a child?” and the sufferer will begin to doubt reality. They’ll then go back and check so that they can be 100% sure the bump they felt was the result of eroding asphalt and nothing worse.
Who is Most Likely to Get OCD?
Two periods of life are well known as OCD periods: It most often appears between the ages of 8 and 12 and between late adolescence and early adulthood. It’s common in all ethnicities and parts of the world and equally present in both men and women. In children, however, boys are most likely to be diagnosed because they’re more likely to suffer from early onset OCD. For women, OCD most usually appears at an average age of 19.
Many people have OCD without realizing it, partly because OCD is so misunderstood and partly because more taboo types of OCD (such as Harm OCD and Pedophilia OCD) elicit such shame. This can lead to a very late diagnoses or people growing old without ever being diagnosed at all.
While there is no way to know who will get OCD and who will not, some things influence likelihood or an increase in symptoms, including:
- A genetic predisposition
- Having a family member with OCD or autism
- Suffering a head injury (this may trigger a dormant disorder)
- Having strep throat (in kids, PANDAS can cause OCD-like symptoms to appear overnight in a child who has strep or a similar illness)
- Going through a transition (experiencing a transition, including one that is happy, can cause OCD symptoms to worsen or reappear)
What Doesn’t Cause Driving and Hit-and-Run OCD?
The causes of OCD have changed as more is learned about the disorder. Due to this, some of the things that were once believed to play a role are no longer valid.
Overall, the following is now not believed to be a cause of OCD:
- Parents or family (how someone is raised won’t cause OCD but being criticized or shamed by family members can worsen the disorder if it already exists)
- Toilet training (Freud believed this was a main cause of OCD and, for years, his theory persisted – nowadays, it’s not believed to be related)
- Stress (stress won’t cause OCD if it isn’t already there but it can increase symptoms and trigger a dormant disorder)
- Past trauma (on its own, trauma doesn’t appear to be a cause of OCD but it can perhaps trigger the disorder in those who are genetically primed)
In Driving and Hit-and-Run OCD specifically, the fears aren’t simply caused by being a bad driver or having a past history of accidents. Even those who are excellent behind the wheel possess these types of fears. But getting into an accident or almost running into someone at a crosswalk can reinforce the fears and worsen symptoms.
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Misconceptions About OCD
OCD, on the whole, is often labeled a minor malady that is quirky or cute. People make fun of it on social media, they declare themselves to have OCD when they’re particular about insignificant things, and they paint it as an annoying neuroses rather than a debilitating illness.
But true OCD is not minor at all – it ruins people’s lives and makes them ten more times likely to commit suicide than the general population. It’s so time-consuming and debilitating that there is not one aspects of the sufferer’s life that OCD won’t interfere with.
Another big misconception about OCD is that it always involves cleaning, organization, or germs. Those with Contamination OCD (which affects about a third of OCD sufferers) are preoccupied with these things but those with other subsets don’t care about cleanliness, organization, or germs more than anyone else. In fact, because they’re focused on other OCD thoughts, they probably care about them less.
In sum, some of the most common misconceptions about OCD include:
- It’s a quirk rather than a life-interfering mental illness
- It involves personal preference (OCD is not based on desires but instead it’s based on fear)
- Those with OCD are always obsessed with germs, cleanliness, or organization
- Those with OCD enjoy performing their compulsions (OCD sufferers get relief from engaging in their rituals but they do not derive joy)
- Everyone is a little bit OCD (OCD, in order to be OCD, must interfere with someone’s life)
- OCD is a minor annoyance (OCD doesn’t annoy its sufferers, it terrorizes them)
- People with OCD are anal, rigid, and need things their way (people who have Obsessive Compulsive Personality Disorder (OCPD), which is different from OCD, may exhibit these traits but those with OCD do not)
- OCD sufferers merely need to relax (in the history of anxiety, telling someone to “just relax” has never resulted in a cure)
- OCD isn’t treatable (OCD can be effectively managed with the right kind of therapy and, perhaps, medication)
- OCD is a phase (OCD is a chronic and lifelong disorder that, even during times of latency, requires vigilance on the part of the sufferer)
Treatment for Driving and Hit-and-Run OCD
OCD isn’t curable though some people can control it so much that they no longer qualify as having it from a diagnostic standpoint.
In general, the only way to get this type of control is through professional help that includes the following:
CBT with ERP: If a therapist is treating OCD without using CBT with ERP, consider it a red flag. CBT with ERP is the gold standard of treatment and the one believed to work the best. Defined as cognitive behavioral therapy (CBT) with exposure and response prevention (ERP), this treatment involves the sufferer exposing themselves to their intrusive thought and then refraining from engaging in their compulsions.
For example, in Driving and Hit-and-Run OCD, the sufferer may be asked to drive around their neighborhood as children play outside and then refrain from backtracking to make sure they didn’t run over any of the children. They will also be instructed to refrain from checking news reports or seeking reassurance (such as asking neighbors if they heard of anything bad happening).
Refraining from engaging in the compulsion is extremely hard on the sufferer as the compulsion offers them relief from crippling anxiety (albeit temporarily). Thus, when they refrain, their anxiety spikes and causes overwhelming discomfort. But in completing the ERPs fully, the sufferer retrains their brain to recognize that thoughts are just thoughts and do not translate to actions or change reality. This takes away OCD’s power by invalidating it, labeling it a liar, and viewing the intrusive thoughts as meaningless things that are not worthy of a reaction. The old saying – “ignore it and it’ll go away” – applies to OCD in spades and refusing to react to it gives the sufferer control.
Sitting in this discomfort also teaches the sufferer that they can handle uncertainty, something that they must accept if they want to heal. What’s more, it teaches the sufferer that seeking 100% certainty is futile as it’s impossible to be 100% sure of most anything.
On paper, ERPs sound simple and straight-forward but they are incredibly challenging for the sufferer, which is why those with OCD usually start out on lower level exposures before moving onto the more difficult ones.
Medication: About 70% of people with OCD respond to medication but the response has limits. So far, no pill exists that eliminates OCD entirely and therapy must be used as the main form of treatment. The present medications are given as a way to make the ERPs less stressful, thus upping the odds that they’ll be completed successfully.
OCD medication is not a one-pill-fits-all and sufferers respond differently based on their genetic makeup (that’s why some sufferers don’t respond at all). People who metabolize drugs faster or slower than normal may require more trial-and-error in figuring out what kind of prescription may prove beneficial (while weighing side effects with factors like age and pre-existing conditions).
In general, the drugs most commonly used first are Serotonin Specific Reuptake Inhibitors (SSRIs), a class of antidepressants that work to increase levels of serotonin (an important neurotransmitter). These types of medications include:
Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) may be used as well. These act as cousins to SSRIs by increasing both serotonin and norepinephrine.
Drugs in this class include:
Anafranil (or Clomipramine) is another drug commonly used. This is a tricyclic antidepressant that appears to be among the most effective drugs for OCD but it also comes with some of the strongest side effects.
In recent years, doctors have begun to prescribe off-label drugs more readily. These are drugs that are not approved to treat OCD by the FDA (though they’re approved to treat other things).
These might include:
Some people also use over-the-counter supplements to treat OCD. There’s not a lot of scientific research backing their efficiency but plenty of anecdotal reports attest to their power.
A sample of supplements used include:
- St. John’s Wort
- Milk thistle
If considering supplements, talk with a doctor before taking them. Certain supplements may interact with prescription meds and increase the odds of serious side effects. For example, St. John’s Wort should not be taken with SSRIs or SNRIs.
ACT Therapy: ERP is considered front-line OCD treatment but Acceptance and Commitment Therapy (ACT) is becoming more commonly use in treatment (it’s used with other mental illness too). This therapy focuses on accepting intrusive thoughts and feelings instead of reacting to them in any way (or avoiding them in any way).
In ACT, the OCD sufferer is taught to view their thoughts as nothing more than thoughts and view them as dispassionately as possible. They may be advised to imagine their thoughts on television screens, in books, or on billboards as a way to diffuse their potency.
ACT works on the idea of facing one’s fears and requires self-compassion, psychological flexibility, mindfulness, and, most of all, nonjudgmental acceptance (no matter how horrendous the OCD thoughts may be).
For example, in Driving and Hit-and-Run OCD, the sufferer may believe that they ran over the neighbor’s dog when backing out of their driveway. Instead of saying, “I ran over Rover,” the sufferer will be instructed to say, “I’m having the thought that I ran over Rover” or “I’m having an OCD thought that I ran over Rover.” This helps remove the thought from reality (since it’s not in reality).
Lifestyle: While OCD needs to be treated by a professional, there are things people can do at home to further reduce symptoms. These include:
- Eat a diet low in fat and high in fruits, veggies, and whole grains
- Exercise daily
- Meditate, practice yoga, or engage in mindfulness
- Limit caffeine, alcohol, and tobacco (or ideally avoid them altogether)
- See a therapist each week
- Take part in support groups
- Foster social relationships
- Speak openly about the disorder
- Use apps to help performing ERPs
TMS: A new type treatment called Transcranial Magnetic Stimulation (TMS) may be used in cases of severe OCD that don’t respond to more traditional interventions.
TMS is a non-invasive procedure that uses magnetic fields to regulate the areas of the brain related to OCD, resulting in a reduction of symptoms. It requires daily treatments for a period of four-six weeks followed by maintenance appointments.
Finding an OCD Therapist
Finding a good OCD therapist can be a challenge. Many clinicians treating OCD are doing so without any specialized training, which leaves them unqualified to treat the disorder adequately.
For those who have some specific types of OCD (such as Harm OCD and its subsets, Self-Harm OCD, or Pedophilia OCD), going to a therapist who lacks the necessary understanding can be especially traumatic. Some therapists misunderstand what intrusive thoughts represent and erroneously conclude that obsessions of harm indicate a desire to harm. Some clinicians have reported those with OCD to the police as a result of their misconceptions.
Needless to say, this damages to the OCD sufferer by worsening their disorder, validating their fears, and leaving them afraid to seek help in the future.
All of this means that no clinician should treat OCD unless they have specific training in the area. But as long as clinicians continue to treat OCD without proper understanding, it’s up to OCD sufferers to choose their therapist very carefully and make sure they avoid anyone who lacks the proper credentials.
Those with OCD can assure they get proper help by seeing a therapist who specializes in OCD and has completed OCD-specific training programs. The International OCD Foundation offers a directory of providers with the proper qualifications, allowing those looking for help to search by zip code and location.