That little bump in the road was probably just a pothole. But…what if?
What if it was actually a person, who you hit with your car? And now you’re cruising away from the scene without a care in the world? What kind of monster are you? Shouldn’t you, at the very least, I don’t know… stop and check? Maybe take a few simple minutes to make the block and confirm that some poor stranger isn’t lying in the road, yelling for help, or worse?
For drivers with obsessive-compulsive disorder, this anxious thought loop may be all too familiar. In light of Mental Health Awareness Month, let’s take a closer look at the challenges here—and some possible solutions.
OCD on the road
Most people associate OCD with behaviors like excessive hand-washing and fear of germs, but the disease is wily and creative, and manifests eclectically. Getting behind the wheel can become a time-consuming nightmare, leading some OCD sufferers to hang up their keys altogether.
I’ve had fairly severe OCD for most of my life, but it was only until college that the disorder began to affect my driving. It happened suddenly, and without warning. I was stopped at an intersection while a mother and daughter crossed the street. A few blocks later, a strange and troubling doubt bubbled up: Had they actually gotten across the street safely? Or had I hit them with my car? And if I hadn’t hit them with my car, why would this thought be occurring to me in the first place?
OCD is known as the “doubting disease” for a reason. Logic doesn’t come into play. And it dangles a carrot of reassurance at all times. In this case: Why not simply go back and check? Rather than spending the rest of your life wondering if you caused an accident, isn’t it simpler to just prove that this wasn’t the case?
What seems like an easy out only feeds the beast. Going back to check “just this one time” tells OCD that it has found a fun new trick to make you miserable. It ensures that these little spikes of doubt and worry will start popping up with more and more frequency.
And sure enough, driving soon became a Sisyphean task for me. A quick trip across town became epic—if I’d been able to chart my journeys via GPS, what should have been straight lines would have appeared as baroque, abstract drawings, full of loops and circles.
OCD is a long road (but it’s not endless)
I’m 40 now, and for about a decade I didn’t drive at all. This was partly because OCD had made it an absolute anguish, and partly because I lived in New York and could get along without a car. But midway through the pandemic—and with a one-year-old baby in the mix—I was desperate to take trips that didn’t require crowded public transportation.
The TL;DR, happy(ish) ending to this story? My OCD is in check these days, thanks to therapy and medication, and driving—in Brooklyn, or even through Manhattan’s crowded streets—is… something close to fun. Relaxing, even. Facing my fears and getting back behind the wheel was a much-needed burst of confidence and achievement during those angst-ridden, unsure pandemic days.
I mention all of this only to give a glimmer of hope—that OCD can get better, with time, effort, and a bit of luck. But if you’re struggling with driving-related OCD behaviors, you don’t just have to wait a decade and hope that your problems dissolve. There are tactics and techniques that can help you push beyond the crippling anxiety.
The bad news? Putting the work in will likely be tough, stressful, and frustrating. The good news? It can’t possibly be as shitty as living with OCD itself.
Tips for driving-related OCD
Big caveat here: I’m not a mental health professional. My experience has always been as a patient, not a therapist. OCD involves a spectrum of behaviors, and there’s no one-size-fits-all cure. And of course, this post is not a substitute for personalized, professional mental health treatment.
For a bit of expertise from an actual expert, I turned to Jenna Overbaugh, a licensed professional counselor whose Instagram is a helpful goldmine for OCD sufferers. She also runs an OCD-focused podcast, All The Hard Things.
“OCD can really latch onto anything, and onto so many things related to cars and driving,” Overbaugh says. Below is a bit of our conversation, edited for length and clarity.
What sort of OCD behaviors make driving difficult, or even dangerous?
Jenna Overbaugh: Some behaviors would include, but are not limited to, driving significantly slower or under the speed limit; repeated and persistent checking in various mirrors, such as the rearview mirror; driving back to a route numerous times to check something; and generally being preoccupied so much that you’re not mindful or being as attentive as you need to be to the road and your surroundings.
The obsessive worry about having hit someone or something (e.g. an animal) is definitely common, a subtype that we often refer to as ‘hit and run OCD,’ but there are also other fears that could happen. A lot of times people are fearful of having a panic attack while driving, especially while stuck in certain environments—in lines, or on bridges or traffic.
Some other driving-related OCD anxieties or obsessions might be having to have the dials or numbers a certain way (e.g. [the radio’s] volume). Someone else might have contamination OCD and be fearful of getting gas, or being in their car in general, for fear that it is contaminated or may become contaminated.
Exposure Response Prevention is a common type of OCD treatment that’s defined as “a behavioral therapy that gradually exposes people to situations designed to provoke a person’s obsessions in a safe environment.” How can ERP be helpful for driving-related obsessions?
ERP can be applied to all difficulties related to OCD and anxiety. We work to gradually expose individuals to their fears in challenging but manageable ways, while helping them resist or reduce the compulsions or safety behaviors that they would normally do.
We work with people to create a plan before they start driving, so that they can be aware of what will likely happen when they start driving and start to have anxiety or obsessions. We can also teach individuals other basic strategies, like defusing from thoughts (just because you have a thought does not mean that that thought is ‘fact’ or is true or requires any additional behavioral response on your part).
Is there a standard or recommended ‘process’ to ease back into driving if someone’s OCD has made driving difficult or impossible previously?
The ERP process is highly individualized and tailored to that unique person, their fears, their goals, and how challenging they would find various aspects of the process.
Someone who has contamination OCD around their car being contaminated is going to have a much different treatment plan than someone who has hit-and-run OCD. And someone who has hit-and-run OCD might have a completely different treatment plan than someone else who has hit-and-run OCD; one might be fearful of highways while the other might be fearful of back roads.
But Exposure and Response Prevention is the go-to treatment and is often referred to as the gold standard, regardless of the nuances of OCD or anxiety. It will always come back to a recipe: exposing oneself to one’s fears in a gradual way, reducing avoidance, and reducing/resisting safety behaviors associated with these fears.
What would you say to someone who suggests, “Isn’t it good to be a ‘little OCD’ while driving?? Doesn’t that just make you a safe and attentive driver?”
It is never a good thing to be a little OCD while doing anything.
Is it good to be functionally careful, attentive, and purposeful while driving? Absolutely—but this is not the same as OCD.
OCD takes this to a different extreme to where the person is so highly anxious about driving or their feared outcome that they are actually less mindful, less responsive to actual threat, and more panicked than if they had a normal or balanced level of anxiety about driving.
The Yerkes-Dodson curve is a well-established depiction of the relationship between anxiety/stress and performance (of any task, but it could also apply to driving).
At low levels of anxiety, we have low performance. If we aren’t anxious about driving, we are careless and can also be dangerous. But we also see, at high levels of anxiety, we have low performance—this is because we’re so panicked and frightened that we aren’t able to respond efficiently to legitimate threats. It’s in the true middle ground of “a little bit anxious but not enough to impair my function” that someone would be a safe and truly attentive driver.
Are you still reading, and is this all sounding familiar?
When coping with a mental health issue or disorder, simply recognizing that you’re not alone is an important first step. It’s a cliche, but realizing that your particular struggle has a shared name or diagnosis is empowering.
One important thing to note is that the wrong kind of therapy might not help OCD sufferers, and might even exacerbate the disorder. For instance, a psychotherapist still applying Freudian methods might fixate on what childhood memories related to driving are causing your obsessions. This could be fruitless at best, and harmful at worst.
NOCD and other organizations (like the Center for Cognitive-Behavioral Therapy in New York City) specialize in the disorder and how to treat it.
Below is a slightly idiosyncratic list of resources and readings that might be helpful if you’re battling OCD, driving-related or otherwise.
- The online writings of Dr. Steven Phillipson are comprehensive (and his lengthiest OCD overview, “Choice,” is available in audio format).
- Brain Lock is a straightforward, actionable guidebook to “rewiring” the OCD brain.
- Jenna Overbaugh’s podcast All the Hard Things covers a range of OCD topics over nearly 100 episodes.
- If you’re a graphic novel fan: Jason Katzenstein’s Everything Is An Emergency tackles OCD with wit and humor.
- Comedian Maria Bamford is one of the funniest people in existence. She’s also an OCD sufferer who is passionate about advocating and education. Here’s her keynote at the 2020 Online OCD Conference (and here’s a Netflix special in which she performs at home for her parents).