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Obsessive-compulsive disorder
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Introduction
This pathway covers core interventions in the treatment of obsessive-compulsive disorder (OCD) and body dysmorphic disorder (BDD) for children young people and adults.
OCD is characterised by the presence of either obsessions or compulsions, but commonly both. Symptoms can cause significant functional impairment and/or distress. An obsession is an unwanted intrusive thought, image or urge that repeatedly enters the person's mind. Compulsions are repetitive behaviours or mental acts that the person feels driven to perform. These can be either overt and observable by others, such as checking that a door is locked, or a covert mental act that cannot be observed, such as repeating a certain phrase in one's mind.
It is thought that 1–2% of the population have OCD, although some studies have estimated 2–3%.
BDD is characterised by a preoccupation with an imagined defect in appearance, or in the case of a slight physical anomaly, the person's concern is markedly excessive. BDD is characterised by time-consuming behaviours such as mirror gazing, comparing particular features to those of others, excessive camouflaging tactics to hide the defect, skin picking and reassurance seeking.
It is thought that 0.5–0.7% of the population have BDD.
Source guidance
The NICE guidance that was used to create the pathway.
Obsessive compulsive disorder (OCD) and body dysmorphic disorder (BDD). NICE clinical guideline 31 (2005)
Computerised cognitive behaviour therapy for depression and anxiety. NICE technology appraisal guidance 97 (2006)
Quality standards
Quality statements
Effective interventions library
Successful effective interventions library details
Implementation
Commissioning
These resources include support for commissioners to plan for costs and savings of guidance implementation and meeting quality standards where they apply.
These resources will help to inform discussions with providers about the development of services and may include measurement and action planning tools.
Education and learning
NICE produces resources for individual practitioners, teams and those with a role in education to help improve and assess users' knowledge of relevant NICE guidance and its application in practice.
Service improvement and audit
These resources provide help with planning ahead for NICE guidance, understanding where you are now, and conducting improvement initiatives.
Pathway information
Information for the public
NICE produces information for the public that summarises, in plain English, the recommendations that NICE makes to healthcare and other professionals.
NICE has written information for the public explaining its guidance on each of the following topics.
Patient-centred care
Patients and healthcare professionals have rights and responsibilities as set out in the NHS Constitution for England – all NICE guidance is written to reflect these. Treatment and care should take into account individual needs and preferences. People should have the opportunity to make informed decisions about their care and treatment, in partnership with their healthcare professionals. If someone does not have the capacity to make decisions, healthcare professionals should follow the Department of Health's advice on consent, the code of practice that accompanies the Mental Capacity Act and the supplementary code of practice on deprivation of liberty safeguards. In Wales, healthcare professionals should follow advice on consent from the Welsh Government.
If the person is under 16, healthcare professionals should follow the guidelines in Seeking consent: working with children. If a young person is moving between paediatric and adult services their care should be planned and managed according to the best practice guidance described in the Department of Health's Transition: getting it right for young people.
Updates to this pathway
22 February 2013 minor maintenance updates.
Supporting information
NICE has produced guidance on treating OCD when planning a pregnancy, during pregnancy and while breastfeeding (see the antenatal and postnatal mental health pathway).
All healthcare professionals offering psychological treatments for OCD or BDD to people of any age should:
- receive appropriate training in these interventions
- there should be ongoing clinical supervision in line with recommendations in the Department of Health's organising and delivering psychological therapies
- advise patients who request other forms of psychological therapy, such as psychoanalysis, transactional analysis, hypnosis or marital/couple therapy, that there is no convincing evidence to support their use.
Assessment by multidisciplinary teams
- comprehensive assessment of symptom profile
- previous pharmacological and psychological treatment
- adherence to prescribed medication
- history of side effects
- comorbid conditions, such as depression
- suicide risk
- psychosocial stressors
- relationship with family/carers
- personality factors.
Glossary
Obsessive-compulsive disorder
Body dysmorphic disorder
Cognitive behavioural therapy
Exposure and response prevention
Selective serotonin re-uptake inhibitor
Serotonin and noradrenaline re-uptake inhibitors
Monoamine oxidase inhibitors
Person with possible obsessive-compulsive disorder
Person with possible obsessive-compulsive disorder
Routinely consider and explore the possibility of obsessive-compulsive disorder
Routinely consider and explore the possibility of obsessive-compulsive disorder
Routinely consider and explore the possibility of obsessive-compulsive disorder
Routinely consider and explore possibility of comorbid OCD for people:
- at higher risk of OCD, such as those with symptoms of:
- depression (NICE has also produced a pathway on depression)
- anxiety (NICE has also produced a pathway on generalised anxiety disorder)
- alcohol or substance misuse (NICE has also produced a pathway on alcohol-use disorders)
- BDD
- an eating disorder
- attending dermatology clinics.
Source guidance
Failed to load fragment (default behaviour with no loader supplied): staticcontentfragments/source-guidance-nodeAsk direct questions to help identify obsessive-compulsive disorder
Ask direct questions to help identify obsessive-compulsive disorder
Ask direct questions to help identify obsessive-compulsive disorder
Ask direct questions about possible symptoms, such as those below.
- Do you wash or clean a lot?
- Do you check things a lot?
- Is there any thought that keeps bothering you that you'd like to get rid of but can't?
- Do your daily activities take a long time to finish?
- Are you concerned about putting things in a special order or are you very upset by mess?
- Do these problems trouble you?
Source guidance
Failed to load fragment (default behaviour with no loader supplied): staticcontentfragments/source-guidance-nodeAssessment for any person diagnosed with obsessive-compulsive disorder
Assessment for any person diagnosed with obsessive-compulsive disorder
Assessment for any person diagnosed with obsessive-compulsive disorder
Assess risk of self-harm and suicide (particularly if depression already diagnosed).
Include impact of compulsive behaviours on the patient and others in risk assessment.
Consider other comorbid conditions or psychosocial factors that may contribute to risk.
Consult mental health professionals with specific expertise in OCD if uncertain about risks associated with intrusive sexual, aggressive or death-related thoughts. (These themes are common in OCD and are often misinterpreted as indicating risk.)
Source guidance
Failed to load fragment (default behaviour with no loader supplied): staticcontentfragments/source-guidance-nodeChildren and young people
Children and young people
Steps 3–5: Treatment options for children and young people with obsessive-compulsive disorder or body dysmorphic disorder
View the 'Steps 3–5: Treatment options for children and young people with obsessive-compulsive disorder or body dysmorphic disorder' pathAdults
Adults
Steps 3–5: Treatment options for adults with obsessive-compulsive disorder or body dysmorphic disorder
View the 'Steps 3–5: Treatment options for adults with obsessive-compulsive disorder or body dysmorphic disorder' pathPaths in this pathway
- Principles of care for people with obsessive-compulsive disorder and body dysmorphic disorder
- Step 2: Recognition and assessment of possible obsessive-compulsive disorder
- Step 2: Recognition and assessment of possible body dysmorphic disorder
- Steps 3–5: Treatment options for adults with obsessive-compulsive disorder or body dysmorphic disorder
- General principles when offering and using treatments for obsessive-compulsive disorder and body dysmorphic disorder in adults
- Steps 3–5: Treatment options for children and young people with obsessive-compulsive disorder or body dysmorphic disorder
- General principles when offering and using treatments for obsessive-compulsive disorder and body dysmorphic disorder in children and young people
Pathway created: June 2012 Last updated: February 2013
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