Obsessive compulsive disorder - OCD treatment and therapy from NOCD

Fears about car accidents

By Andrea Fine

Sep 16, 20226 minute read

Car crash OCD involves fears related to being in a car accident. It might involve a more specific fear of causing an auto accident through inattention, running a red light or stop sign, or by making an improper lane change. It might be a fear of being hit by another vehicle, or possibly a large truck. It might also include a fear of causing injury to others due to a collision. It is distinct from hit-and-run OCD, which is the fear that one has hit a pedestrian or animal.

Car crash OCD consists of the same basic features of any subtype of OCD: obsessions, which are unwanted, intrusive, fearful thoughts, images, sensations or urges, and compulsions, which are mental or physical acts done in an attempt to alleviate anxiety or prevent a feared outcome. Compulsions usually provide some temporary relief from anxiety; however, they perpetuate the OCD cycle because they trick the brain into believing that they dealt with a real threat or danger. 

For example, a young man might ask his mother if she thinks he will be safe driving to work on a given day. The mother will likely provide reassurance: “You are a good driver. You have a perfect driving record. I’m sure you’ll be fine.” This may provide short term relief, but later, the young man will likely doubt what his mother has said to him, and might think, “My mom doesn’t know whether I’m a good driver or not. She never rides with me. She is only saying that to make me feel better. She could be wrong. I might do something stupid and cause an accident. I’d better not take the risk. Maybe I can get a coworker to drive me to work today.” 

OCD fear of car accidents can be very debilitating, since many people need to drive in order to meet basic needs and responsibilities, such as getting to and from work, going to the grocery store, and transporting children. Car crash OCD may be triggered by the experience of seeing an accident or being in an accident. Either of those events could set off a cycle of OCD symptoms. However, obsessions can also begin without a known cause/trigger. Regardless of how it begins, it can lead to considerable suffering and impairment for anyone who experiences it. 

Car crash OCD – Common obsessions

  • I might hit another car while I’m driving
  • I might accidentally run a red light, which results in a collision
  • I might not see another car that has run a red light and be hit by it
  • I might be hit by another vehicle

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Common triggers

People with OCD fear of car accidents may be triggered by a variety of things. The most obvious is driving, but other triggers could be anything related to driving or car crashes. 

  • Riding in a car
  • Driving a car
  • Driving or riding in congested areas
  • Driving on highways
  • Seeing pictures or videos of car accidents
  • Seeing or hearing news reports of car accidents
  • Seeing car crashes in tv shows or movies
  • Friends or loved ones leaving for car travel

How can I tell if it’s OCD, and not a normal level of anxiety that any driver might experience? 

Riding in or driving a car involves a certain amount of risk. People assume that risk every time they get in a car, usually without conscious thought. A certain amount of anxiety is normal among new drivers and in particularly stressful driving situations, such as congested areas during rush hour. 

In others, anxiety may even increase after being in an accident or witnessing one. Normally this anxiety subsides with time. People get used to the risk. They are likely to take reasonable precautions, such as wearing a seatbelt and not engaging in additional activities while the car is in motion, such as texting on a phone, eating, or applying makeup. 

OCD develops when someone responds to that anxiety with compulsions, such as seeking reassurance every time they drive or avoiding driving or riding in a car. This is what makes car crash OCD distinct from normative anxiety. People with car crash OCD will experience some level of impairment in their lives due to their fears. In time, when compulsions are done regularly, anxiety and intrusive thoughts are inadvertently reinforced, resulting in a vicious cycle of OCD symptoms.

Common compulsions

When people with car crash OCD experience intrusive thoughts, images, feelings, or urges that cause distress, they may utilize a variety of strategies to reduce anxiety or avoid feared outcomes. Compulsions might range from seeking reassurance to entirely avoiding riding in a car. 

Compulsions performed mentally or physically by people with OCD fear of car crash include:

  • Seeking reassurance about one’s skill as a driver
  • Ruminating on worst-case scenarios prior to and while driving
  • Saying ritualized prayers or phrases before or during driving, to prevent a collision
  • Avoiding driving or riding in a car completely
  • Restricting driving to daylight hours
  • Avoiding congested areas
  • Avoiding expressway driving
  • Asking others to drive
  • Avoiding activities, situations, or jobs that could involve driving

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How to treat fear of car accidents

Fear of car accidents can be debilitating for people who struggle with it, but it is highly treatable. By doing exposure and response prevention (ERP) therapy with a trained therapist, an individual can overcome their fears and compulsions related to driving. 

In ERP, exercises called exposures are tailored to the triggers an individual experiences, and they are guided in response prevention, in which they resist the urge to engage in compulsions, instead sitting with their anxiety and uncertainty and letting it pass. Therapy begins with exposures that trigger lower levels of anxiety, such as reading statistics of auto accidents and the resulting injuries and deaths. A next step might be watching videos of car accidents with or without injuries resulting. After that, exposures could involve riding in a car with another driver and then, eventually, driving by oneself. Ideally a person would begin with short drives in low-traffic places and would work up to longer drives and driving in congested areas. Every step of the way, they are guided by their therapist in resisting compulsions like reassurance-seeking, avoidance, and rituals. 

When this regimen is followed and exposures are done daily, an individual with OCD can expect to experience a reduction of symptoms, often within weeks. When doing exposures, it is crucial to embrace uncertainty about feared outcomes—to acknowledge and live with the thought that one
might be in a car accident any time they are riding in a car, and that they are accepting that danger in order to live their life the way they want. 

For many individuals, ERP therapy results in fewer, less frequent intrusive thoughts and reduced anxiety. For some, anxiety does not decrease significantly, but they succeed in gaining a tolerance of anxiety as they go through exposures. Although challenging, treatment for OCD is highly effective. It requires a willingness to endure some anxiety in the short run for a reduction of anxiety in the long run.

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