Key priorities for implementation

Key priorities for implementation

All people with OCD or BDD

  • Each PCT, mental healthcare trust and children's trust that provides mental health services should have access to a specialist obsessive‑compulsive disorder (OCD)/body dysmorphic disorder (BDD) multidisciplinary team offering age‑appropriate care. This team would perform the following functions: increase the skills of mental health professionals in the assessment and evidence‑based treatment of people with OCD or BDD, provide high‑quality advice, understand family and developmental needs, and, when appropriate, conduct expert assessment and specialist cognitive‑behavioural and pharmacological treatment.

  • OCD and BDD can have a fluctuating or episodic course, or relapse may occur after successful treatment. Therefore, people who have been successfully treated and discharged should be seen as soon as possible if re‑referred with further occurrences of OCD or BDD, rather than placed on a routine waiting list. For those in whom there has been no response to treatment, care coordination (or other suitable processes) should be used at the end of any specific treatment programme to identify any need for continuing support and appropriate services to address it.

Adults with OCD or BDD

  • In the initial treatment of adults with OCD, low intensity psychological treatments (including exposure and response prevention [ERP]) (up to 10 therapist hours per patient) should be offered if the patient's degree of functional impairment is mild and/or the patient expresses a preference for a low intensity approach. Low intensity treatments include:

    • brief individual cognitive behavioural therapy (CBT) (including ERP) using structured self‑help materials

    • brief individual CBT (including ERP) by telephone

    • group CBT (including ERP) (note, the patient may be receiving more than 10 hours of therapy in this format).

  • Adults with OCD with mild functional impairment who are unable to engage in low intensity CBT (including ERP), or for whom low intensity treatment has proved to be inadequate, should be offered the choice of either a course of a selective serotonin re‑uptake inhibitor (SSRI) or more intensive CBT (including ERP) (more than 10 therapist hours per patient), because these treatments appear to be comparably efficacious.

  • Adults with OCD with moderate functional impairment should be offered the choice of either a course of an SSRI or more intensive CBT (including ERP) (more than 10 therapist hours per patient), because these treatments appear to be comparably efficacious.

  • Adults with BDD with moderate functional impairment should be offered the choice of either a course of an SSRI or more intensive individual CBT (including ERP) that addresses key features of BDD.

Children and young people with OCD or BDD

  • Children and young people with OCD with moderate to severe functional impairment, and those with OCD with mild functional impairment for whom guided self‑help has been ineffective or refused, should be offered CBT (including ERP) that involves the family or carers and is adapted to suit the developmental age of the child as the treatment of choice. Group or individual formats should be offered depending upon the preference of the child or young person and their family or carers.

  • Following multidisciplinary review, for a child (aged 8–11 years) with OCD or BDD with moderate to severe functional impairment, if there has not been an adequate response to CBT (including ERP) involving the family or carers, the addition of an SSRI to ongoing psychological treatment may be considered. Careful monitoring should be undertaken, particularly at the beginning of treatment.

  • Following multidisciplinary review, for a young person (aged 12–18 years) with OCD or BDD with moderate to severe functional impairment if there has not been an adequate response to CBT (including ERP) involving the family or carers, the addition of an SSRI to ongoing psychological treatment should be offered. Careful monitoring should be undertaken, particularly at the beginning of treatment.

  • All children and young people with BDD should be offered CBT (including ERP) that involves the family or carers and is adapted to suit the developmental age of the child or young person as first‑line treatment.