Fear while driving on a highway, like fear of flying, is classified, in the DSM 5, as a situational specific phobia. This fear, however, is a complex phenomenon that consists of two very different diagnostic categories. Under this umbrella there is true driving phobia (Vehophobia), characterized by fear of accident and distrust of skill and fear of having a panic attack while behind the wheel as well as post-traumatic stress disorder (PTSD) subsequent to a motor vehicle accidents (MVA) This page will cover the first two:

A review of research on fear of driving revealed a paradox: clinical attention to this phobia is not proportionate to the high rates of prevalence. A full 17-20 % have mild driving phobia but 4-6% of the population experience severe, debilitating forms of this condition. These are high rates compared to those of many other form of anxiety. Yet the literature on this condition is relatively sparse and limited to only a few countries, principally New Zealand.

Gender distribution is similar to that seem in other anxiety disorder with, affecting twice as many women as men. Age of onset can vary from very early in one’s driving career to mid or later in life. Given the limited data, there is not a clear picture of the risk factors. It does appear that driving phobics almost always have a history of anxiety that predates the condition. Those who fear panic while driving can have history of panic that evolves into when driving or can experience their first panic attack while driving.

Given that MVAs are over represented in the literature, conclusions about the distribution of subtypes should be cautious. Moreover many studies do not parse out subtypes and only describe the general prevalence of the condition. With this caveat in mind, it does appear that fear of accident/skill distrust is more common than fear of panic. Both groups often avoid highways but more than secondary roads. Those with fear of panic, however, can avoid secondary roads or congested traffic situations where they can feel "trapped" while true driving phobia rarely spreads to off road, and even less so to dense traffic.

People with true driving phobia, do not fear that a panic attack will compromise their safety, rather, they worry about the possibility of accidents while driving. Driving phobics avoid highways more than secondary roads because they fear accident fatality, owing to the higher velocity. If they are able to do limited highway driving, they superimpose irrational assumptions of danger that color their interpretations and reactions on the road. For example, driving phobics are hyper-vigilant of other vehicles; they have distorted perceptions of distance, erroneously assume that vehicles behind them are dangerously close and conversely believe that they are too close to vehicles they are following. As a result of this distortion, just seeing a brake light from cars in front can trigger impulsive, unnecessary breaking which can put themselves and other drivers at risk.

Other distortions involve assuming a car could be cutting into their lane. Driving phobics are intimidated by trucks and view them by default as a threat because of their size. As a result they can change lanes or move to the edge of the lane they are in to create as much distance from the truck as possible. They are also extremely tentative during lane changes and avoid them if at all possible, preferring to hug the far right slow lane. They do not trust their ability to merge onto the highway or navigate around rotaries. Consequently, they slow down excessively and often "get stuck" trying to merge, often coming to a complete stop rather than accelerating.

In my practice, I no longer treat this form of driving phobia.I have found helping this group to be extremely challenging. Because treatment involves executing a complex action that elicits fear, the precise behavioral changes required during exposures are extremely difficult to complete and tolerate. Not surprisingly, I receive few inquiries from people with fear of driving, and over the past 10 years, I have had only one true success unfortunately,

In that one case, I observed certain characteristics which set that person apart and, I believe, contributed to success: 1) a remarkably high level of level of motivation 2) less front end fear- that is, fear was not as extreme initially as in other cases; 3) although limited, some HW driving was tolerated 4) age-appropriate mastery of driving skills that predated onset of the phobia 5) There were no co-occurring psychiatric conditions of significance 6) no history of traumatic MVAs and 7) supportive family and friends who were understanding, patient and collaborative.

Early intervention is the key to preventing the progression of this phobia before fear and avoidance become entrenched and chronic. Specifically, seeking help during the teen drivers education phase of skill acquisition would be ideal. I believe that a team approach involving both driving instructor and therapist working in concert would ideal. Also, virtual reality training and habituation on the therapy side would very likely increase treatment success.