New national guidance for the NHS aims to tackle delays in the diagnosis and treatment of obsessive-compulsive disorder (OCD) and body dysmorphic disorder (BDD).
People with OCD and BDD should be identified earlier, according to draft guidance published today by the National Institute for Health and Care Excellence (NICE).
“Earlier identification can help ensure people receive care that reflects their needs, preferences and circumstances”
Eric Power
Many people with OCD or BDD are currently misdiagnosed or remain undiagnosed for years because their symptoms can be “overlooked, misunderstood or attributed to other conditions”, according to NICE.
It noted that OCD affected around 1.2% of people in the UK and caused unwanted and distressing thoughts, images, urges or doubts that can feel impossible to ignore.
To relieve the anxiety these thoughts cause, people with OCD often carry out repetitive behaviours or mental ‘rituals’ including repeatedly checking, washing, counting or seeking reassurance.
Less common symptoms can include obsessions related to rules, fairness, honesty or ‘doing the right thing’, said NICE.
Meanwhile, BDD affects around 2% of adults in the UK and causes people to be excessively preoccupied with perceived flaws in their appearance. It can cause significant distress and interfere with daily life.
Patients with either OCD or BDD often suffer from stigma, shame and fear of judgement that can make it difficult for them to disclose their symptoms.
New draft NICE guidance includes recommendations to help health professionals recognise OCD and BDD more consistently, so people with the conditions can access support before their symptoms become severe.
The guidance recommends healthcare professionals ask people who they think might have OCD or BDD two simple questions about intrusive and distressing thoughts.
These are whether they experience distressing thoughts, images, urges, impulses or doubts that are intrusive, and if they feel they have to do things repeatedly or carry out compulsive behaviours or mental acts.
Clinicians should also look for visual signs of possible BDD and normalise people’s experiences as much as possible.
Anyone identified as possibly having OCD or BDD should then receive further assessment to determine a diagnosis and treatment plan.
The guidance recommends specific groups of people who are at higher risk of OCD or BDD and should be considered for assessment.
As well as those with a history of OCD or BDD, these include people with depression or anxiety, anyone with thoughts of self-harm or suicide, or with actual self-harm or suicidal intent, or an eating disorder.
Others who may need assessment for OCD or BDD include people with ADHD, autistic people, those who misuse alcohol or drugs and people seeking help for irritant contact dermatitis, according to NICE.
The guidance flags that people seeking cosmetic procedures, including dermatological or dental procedures, may be at particularly high risk of BDD.
A recent study found that more than 18% of people who engaged with aesthetic and reconstructive plastic surgery services had clinically significant BDD symptoms.
The guidance recommends that healthcare professionals providing cosmetic procedures should carry out a BDD assessment of people seeking their services and not carry out the procedure if they may have BDD.
Interim director of the NICE Centre for Guidelines, Eric Power, 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,” he added.
He said that the draft NICE recommendations aimed 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,” he said.
The draft NICE guideline is open for consultation from 17 September until 21 October 2026. The final guidance is due to be published in February next year.
Once published, the new guidance will replace an existing NICE guideline on treating OCD and BDD, which was published in 2015.
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