GPs should consider assessing people with depression, anxiety or ADHD for signs of obsessive compulsive disorder (OCD) and body dysmorphic disorder (BDD), NICE has recommended.

Under new draft guidance for healthcare professionals, people seeking cosmetic procedures should also be asked about symptoms of BDD and be refused treatment if showing signs of the disorder.

NICE said the guidance would help healthcare professionals recognise OCD and BDD more consistently as they can often go unnoticed for years or mistaken for other conditions.

If a healthcare professional suspects someone may have OCD, they should ask if they experience distressing thoughts, images, urges, impulses or doubts that are intrusive.

With suspected BDD, clinicians should look for clues that individuals are trying to conceal or alter their experience.

People with suspected OCD or BDD should be asked if feel they have to do things repeatedly or carry out compulsive behaviours or mental acts, NICE said.

Those at higher risk of the conditions who should be considered for assessment include people with depression or anxiety, thoughts of self-harm or suicide, actual self-harm or suicidal intent and an eating disorder.

An assessment should also be considered in people with autism or ADHD and people who misuse alcohol or use drugs, the draft guidance said.

Others at high risk include people seeking help for irritant contact dermatitis or cosmetic procedures, NICE said.

The committee said healthcare professionals do not routinely ask about or explore whether people have intrusive thoughts, images, urges, impulses, doubts, or worries about appearance and people may not disclose their experience unless specifically asked, due to stigma and shame.

Evidence also shows these experiences can be misinterpreted or misunderstood, by both the people experiencing them and their healthcare professionals, ‘which may contribute to delayed or missed diagnoses’, the committee noted.

Healthcare professionals are often reluctant to ask about BDD specifically because of sensitivities around body image, they continued.

NICE hopes the recommendations will lead to ‘a more structured and consistent’ approach to identifying people with the conditions.

It suggests specific focused questions (see box) for diagnosing and informing treatment plans, and prompt ‘earlier recognition in settings where it is not routinely considered’, including primary care.

The draft guideline also introduces a new personalised, or ‘matched care’, approach based on an individual’s clinical needs, treatment history and preferences from the outset.

Options for treatment include CBT and medication, such as SSRIs, although the guidance notes this is an off-label use of the drugs.

When assessing children with suspected OCD, clinicians should take into account that compulsive behaviours may be easier to recognise than obsessions, the guidance added.

For children and young people with OCD, the draft guideline recommends family-based cognitive behavioural therapy.

Figures suggest OCD affects an estimated 1.2% of the population and BDD affects around 2% of adults but has been shown to be as high as 18.6% in people attending aesthetic and reconstructive plastic surgery services.

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.

‘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.’

A consultation on the guidance is open until 21 October 2026.

NICE draft guidance on OCD and BDD

Ask people with suspected OCD and those who may be at risk of OCD and their families or carers (if appropriate), the following questions:
Are there any persistent thoughts, images, urges, impulses or doubts that bother you, cause anxiety and that you would like to get rid of but cannot?
Are there behaviours or repetitive mental acts that you have to do over and over to feel right?
On a typical day, do obsessions (persistent thoughts, images, urges or impulses) or compulsions (repetitive behaviours or repetitive mental facts) take up a lot of time (for example, more than 1 hour)?
Do obsessions or compulsions get in the way of day-to-day life (for example, make it hard to do work or go to school, be with friends or join activities) or cause distress?
- Ask people with suspected BDD and those who may be at risk of BDD, and their families or carers (if appropriate), the following questions:
Do you worry a lot about your appearance, or find yourself preoccupied with it, and wish you could think about it less?
If you worry about your appearance, what are your specific concerns?
On a typical day, how long do you think about your appearance or how long is it on your mind for more (for example, more than 1 hour)?
How much time do you spend checking or comparing your appearance to others (including online)?
How much time do you spend trying to change, hide or conceal your appearance?
What effect do your thoughts about your appearance have on your life? For example, do you repeatedly:
- try to avoid social situations?
- check your appearance in reflective surfaces?
- compare yourself with other people?
Do thoughts about your appearance get in the way of day-to-day life (for example, make it hard to do work, be with friends or join activities) or cause distress?

Source: NICE

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Assess people with depression, anxiety or ADHD for OCD and BDD, NICE recommends