Embargoed: Draft NICE guidance aims to improve identification of OCD and body dysmorphic disorder

The draft guideline introduces new recommendations to help healthcare professionals recognise OCD and BDD more consistently, particularly in people whose symptoms may be mistaken for other conditions or go unnoticed for years because of stigma, shame or limited information. The independent guideline committee said earlier identification could help more people access the support they need before their symptoms become severe.

The draft recommendations advise healthcare professionals to consider assessing for OCD or BDD in people with depression, anxiety, autism or ADHD, as well as in people seeking cosmetic procedures. The committee said symptoms can sometimes be overlooked, misunderstood or attributed to other conditions, contributing to delays in diagnosis and treatment.

OCD affects an estimated 1.2% of the population. People with OCD experience unwanted and distressing thoughts, images, urges or doubts that can feel impossible to ignore. To try to relieve the anxiety these thoughts cause, they may carry out repetitive behaviours or mental rituals, such as repeatedly checking, washing, counting or seeking reassurance. Symptoms are often hidden because of shame, embarrassment or fear of being misunderstood, meaning many people do not receive the right diagnosis or treatment until their condition becomes severe.

BDD is a mental health condition in which a person becomes excessively preoccupied with perceived flaws in their appearance. These concerns can cause significant distress and interfere with daily life. Research suggests BDD affects around 2% of adults in the wider population.

Eric Power, interim director of the Centre for Guidelines at NICE, said: "People with obsessive compulsive disorder and body dysmorphic disorder can experience symptoms for a long time before they receive the right diagnosis and support. These conditions are often misunderstood, and many people find them difficult to talk about because of embarrassment, shame or fear of being judged.

"Our draft recommendations aim to help healthcare professionals recognise symptoms earlier, ask the right questions and support people to access appropriate treatment sooner.

"Earlier identification can help ensure people receive care that reflects their needs, preferences and circumstances, rather than waiting until symptoms become more severe or reach crisis point."

The draft guideline also introduces a new personalised, or "matched care", approach to treatment for OCD. Rather than requiring people to progress through a fixed sequence of interventions, healthcare professionals would be encouraged to offer treatments based on an individual's clinical needs, treatment history and preferences from the outset. The committee concluded that treatment decisions should be tailored to the person rather than determined by a predefined stepped pathway.

For children and young people with OCD, the draft guideline recommends family-based cognitive behavioural therapy as the most appropriate treatment option for many patients, recognising the important role that parents and carers can play in supporting recovery.

The draft recommendations also include measures designed to improve identification of BDD among people seeking cosmetic procedures. Healthcare professionals providing cosmetic treatments, including surgeons, dentists and dermatologists, would be advised to ask structured questions about appearance-related concerns and document their findings. If responses indicate that a person may have BDD, the draft guideline recommends referral for specialist assessment rather than proceeding with the procedure at that stage. The committee noted that cosmetic procedures rarely improve the underlying condition and may sometimes worsen symptoms.

Research suggests that BDD may be particularly common among people seeking cosmetic treatment. A 2024 systematic review and meta-analysis estimated that 18.6% of people attending aesthetic and reconstructive plastic surgery services had clinically significant BDD symptoms, compared with an estimated prevalence of around 2% in the wider adult population.

People, healthcare professionals and organisations are encouraged to take part in the consultation on the draft guideline, via the NICE website, which is open until 21 October 2026.

ENDS

Embargo and interview bids

• This news release and the draft guideline is embargoed until: 00.01 BST, Thursday 17 September 2026.

About the draft guideline

• The draft guideline will be available at https://www.nice.org.uk/guidance/indevelopment/gid-ng10435/documents from 00.01 BST, Thursday 17 September 2026.
• An embargoed copy of the draft guideline is available to download at the bottom of this message.

About the recommendation on identifying BDD in people seeking cosmetic treatment

• The current guideline already recognises the importance of identifying BDD in people seeking cosmetic treatment. The draft guideline provides more detailed recommendations for cosmetic procedure providers, including asking structured assessment questions, documenting findings and establishing referral pathways to specialist mental health services.
• The questions could include:
  • Do you worry a lot about the way you look and wish you could think about it less?
  • What specific concerns do you have about your appearance?
  • On a typical day, how many hours a day is your appearance on your mind? (More than 1 hour a day is considered excessive.)
  • What effect does it have on your life?
  • Does it make it hard to do your work or be with friends?

Information about implementation

• Putting recommendations into practice can take time. How long will vary from guideline to guideline, and will depend on how much change in practice or services is needed. Implementing change is most effective when aligned with local priorities. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.