“What If I Hit Someone With My Car?” Understanding Hit-and-Run OCD
Imagine you're driving home from work. You feel a slight bump under your tire—maybe a pothole, maybe nothing—and suddenly, your heart drops. “What if that wasn’t just a bump? What if I hit someone?” You glance in the rearview mirror, but it doesn’t satisfy you. You turn the car around, circle back, check for signs of an accident. Still unsure. The thought grows louder. You check the news when you get home. You might even call the police.
This cycle of distress and doubt could be a sign of Hit-and-Run OCD, a form of Obsessive-Compulsive Disorder (OCD) that centers on fears of unintentionally harming others while driving.
What Is Hit-and-Run OCD?
Hit-and-Run OCD is a subtype of Harm OCD, where the person is haunted by fears of having caused a tragic accident—typically while driving—even when there is no actual evidence of harm. The core fear is accidentally hurting or killing someone and not knowing it, which can lead to devastating consequences like legal punishment, moral guilt, or loss of control.
This isn’t typical driving anxiety or concern about road safety. These are intrusive thoughts—unwanted, repetitive, distressing mental images or doubts—that trigger intense anxiety and lead to compulsions meant to neutralize or check the feared outcome.
But what if?
Even when there’s no evidence, the doubt feels unbearable.
Common Obsessions in Hit-and-Run OCD
“What if I ran someone over and didn’t realize it?”
“What if that bump was a pedestrian?”
“What if I hit a cyclist and no one saw?”
“What if I get arrested for a crime I didn’t mean to commit?”
“What if I ruined someone’s life and never know it?”
These thoughts often pop up suddenly and feel urgent, horrifying, and deeply out of character—yet the doubt they plant can feel impossible to shake.
Common Compulsions
To reduce the anxiety caused by these thoughts, people with Hit-and-Run OCD may engage in a variety of compulsions:
Checking the rearview mirror repeatedly
Circling back to the scene to look for injured people or signs of a crash
Inspecting the car for dents, blood, or scratches
Seeking reassurance from friends, loved ones, or even law enforcement
Avoiding driving altogether or only driving with another person present
Reviewing mental images of the drive to “make sure” nothing happened
Watching local news or police scanners obsessively for accident reports
While these behaviors may temporarily reduce anxiety, they strengthen the OCD cycle over time by reinforcing the idea that maybe something did happen.
Why Reassurance Doesn’t Help
People with Hit-and-Run OCD often say things like, “I just need to be sure.” But the truth is—OCD is an expert at exploiting uncertainty.
The more someone checks, seeks reassurance, or avoids driving, the more powerful the doubt becomes. It’s not that they’re careless or guilty—it’s that their brain is misfiring threat signals and demanding certainty in a world where 100% certainty doesn’t exist.
OCD lies. You are not dangerous—you’re overwhelmed by doubt.
How Is Hit-and-Run OCD Treated?
There are two leading evidence-based approaches to treating this form of OCD:
1. Exposure and Response Prevention (ERP)
ERP is the gold-standard treatment for OCD. With the help of a trained therapist, clients are gradually exposed to feared situations (like driving the same route) while resisting compulsions (like circling back or checking). Over time, the brain learns that the feared outcome doesn’t occur—and even if doubt remains, it can be tolerated.
Examples of ERP for Hit-and-Run OCD might include:
Driving a familiar route without checking mirrors or turning back
Purposefully imagining “what if I hit someone?” without doing any mental review
Writing imaginal scripts about being uncertain and living with it
2. Inference-Based Cognitive Behavioral Therapy (I-CBT)
I-CBT focuses on how a person comes to believe their feared thought is true. It challenges faulty reasoning patterns—like trusting imagination over reality, or equating possibility with likelihood. For example, just because you can picture hitting someone doesn’t mean it actually happened.
I-CBT helps people shift from the “OCD narrative” (the feared story) to the “here-and-now reality” (the facts available through your senses).
How Do I Know It’s OCD and Not Just Guilt?
This is one of the hardest parts of living with OCD—it feels so real. But here are a few clues that the fear is being driven by OCD:
There’s no objective evidence of harm
You feel morally responsible for something hypothetical
The fear comes with intense distress, doubt, and a need for certainty
You’ve tried to get reassurance or checked multiple times without lasting relief
You know the thought is unlikely or irrational, but you still feel haunted by it
What To Do If You Think You Have Hit-and-Run OCD
If you’re avoiding driving, constantly checking for signs of harm, or living in fear of having hurt someone accidentally, you are not alone—and you are not dangerous.
The first step is to reach out to a mental health provider who specializes in OCD. Not all therapists are trained in ERP or I-CBT, so be sure to ask specifically about their experience with OCD treatment.
At the OCD & Anxiety Center of Minnesota, we provide compassionate, evidence-based care for all forms of OCD, including Harm OCD and Hit-and-Run fears. We’re here to help you break the cycle of doubt and reclaim your life.
