This guideline has been developed to advise on the identification, treatment and management of obsessive-compulsive disorder (OCD) and body dysmorphic disorder (BDD). Although distinct disorders, OCD and BDD share a number of common features and there is a high degree of similarity between the treatments for the two conditions. The guideline recommendations have been developed by a multidisciplinary team of healthcare professionals, people with OCD, a carer and guideline methodologists after careful consideration of the best available evidence. It is intended that the guideline will be useful to clinicians and service commissioners in providing and planning high quality care for those with OCD and BDD while also emphasising the importance of the experience of care for people with OCD, BDD, and carers.

This guideline addresses aspects of service provision, psychological and pharmacological approaches for those with OCD and BDD from the age of 8 upwards. Although the evidence base is rapidly expanding, there are a number of major gaps and future revisions of this guideline will incorporate new scientific evidence as it develops. The guideline makes a number of research recommendations specifically to address these gaps in the evidence base. In the meantime, we hope that the guideline will assist clinicians, people with these disorders and their carers by identifying the merits of particular treatment approaches where the evidence from research and clinical experience exists.

Contents

• GUIDELINE DEVELOPMENT GROUP MEMBERS
• ACKNOWLEDGEMENTS
• 1. INTRODUCTION
  • 1.1. NATIONAL GUIDELINES
  • 1.2. THE NATIONAL OBSESSIVE-COMPULSIVE DISORDER GUIDELINE
• 2. OBSESSIVE-COMPULSIVE DISORDER AND BODY DYSMORPHIC DISORDER
  • 2.1. OCD
  • 2.2. BDD
  • 2.3. TREATMENT AND MANAGEMENT IN THE NHS
  • 2.4. DETECTION, ASSESSMENT AND DIAGNOSIS
  • 2.5. STEPPED CARE
  • 2.6. CLINICAL PRACTICE RECOMMENDATIONS
• 3. THE EXPERIENCE OF PEOPLE WITH OCD AND BDD AND THEIR FAMILIES AND CARERS
  • 3.1. PERSONAL TESTIMONIES FROM PEOPLE WITH OCD AND BDD
  • 3.2. THE PERSPECTIVE OF PEOPLE WITH OCD AND BDD
  • 3.3. SUMMARY OF THE NEEDS OF PEOPLE WITH OCD AND BDD
  • 3.4. PERSONAL TESTIMONIES FROM FAMILY MEMBERS/CARERS OF PEOPLE WITH OCD
  • 3.5. UNDERSTANDING THE IMPACT OF OCD ON FAMILY MEMBERS AND CARERS
  • 3.6. SPECIFIC ISSUES FOR CHILDREN AND FAMILIES
  • 3.7. SOURCES OF USER AND CARER ADVICE
  • 3.8. CLINICAL PRACTICE RECOMMENDATIONS
• 4. METHODS USED TO DEVELOP THIS GUIDELINE
  • 4.1. OVERVIEW
  • 4.2. THE GUIDELINE DEVELOPMENT GROUP
  • 4.3. CLINICAL QUESTIONS
  • 4.4. SYSTEMATIC CLINICAL LITERATURE REVIEW
  • 4.5. HEALTH ECONOMICS REVIEW STRATEGIES
  • 4.6. STAKEHOLDER CONTRIBUTIONS
  • 4.7. VALIDATION OF THIS GUIDELINE
• 5. PSYCHOLOGICAL INTERVENTIONS
  • 5.1. INTRODUCTION
  • 5.2. BEHAVIOUR AND COGNITIVE THERAPIES
  • 5.3. PSYCHOANALYSIS
  • 5.4. OTHER PSYCHOLOGICAL INTERVENTIONS
  • 5.5. PSYCHOLOGICAL INTERVENTIONS FOR CHILDREN AND YOUNG PEOPLE WITH OCD
  • 5.6. PSYCHOLOGICAL INTERVENTIONS FOR PEOPLE WITH BDD
  • 5.7. CLINICAL PRACTICE RECOMMENDATIONS
• 6. PHARMACOLOGICAL INTERVENTIONS
  • 6.1. CURRENT PRACTICE
  • 6.2. SSRIs
  • 6.3. CLOMIPRAMINE
  • 6.4. OTHER TRICYCLIC ANTIDEPRESSANTS
  • 6.5. TRICYCLIC-RELATED ANTIDEPRESSANTS
  • 6.6. SEROTONIN AND NORADRENALINE REUPTAKE INHIBITORs (SNRIs)
  • 6.7. MONOAMINE-OXIDASE INHIBITORs (MAOIs)
  • 6.8. ANXIOLYTICS
  • 6.9. SSRIs/CLOMIPRAMINE VERSUS NON-SRIs
  • 6.10. OTHER PHARMACOLOGICAL INTERVENTIONS
  • 6.11. TREATMENT STRATEGIES FOR PATIENTS SHOWING AN INCOMPLETE RESPONSE TO SRIs
  • 6.12. PHARMACOLOGICAL INTERVENTIONS FOR CHILDREN AND YOUNG PEOPLE WITH OCD
  • 6.13. PHARMACOLOGICAL INTERVENTIONS FOR PEOPLE WITH BDD
  • 6.14. CLINICAL PRACTICE RECOMMENDATIONS
• 7. COMBINED INTERVENTIONS AND INTENSIVE INTERVENTIONS
  • 7.1. INTRODUCTION
  • 7.2. PSYCHOLOGICAL VERSUS PHARMACOLOGICAL INTERVENTIONS
  • 7.3. COMBINATION INTERVENTIONS
  • 7.4. CLINICAL PRACTICE RECOMMENDATIONS
• 8. OTHER MEDICAL INTERVENTIONS
  • 8.1. INTRODUCTION
  • 8.2. ELECTROCONVULSIVE THERAPY
  • 8.3. TRANSCRANIAL MAGNETIC STIMULATION
  • 8.4. NEUROSURGERY
  • 8.5. MEDICAL INTERVENTIONS IN CHILDREN WITH OCD DUE TO PANDAS
  • 8.6. CLINICAL PRACTICE RECOMMENDATIONS
• 9. USE OF HEALTH SERVICE RESOURCES
  • 9.1. METHODS OF ECONOMIC EVALUATION
  • 9.2. USE OF HEALTH SERVICE RESOURCES
  • 9.3. PRIMARY CARE DRUG THERAPY VERSUS SECONDARY CARE CBT VERSUS COMBINED CBT PLUS SSRI THERAPY
  • 9.4. INTERPRETATION
  • 9.5. NON-HEALTHCARE BURDEN
  • 9.6. CONCLUSIONS AND FUTURE RECOMMENDATIONS
• 10. SUMMARY OF RECOMMENDATIONS
  • Key priorities for implementation
  • 10.1. GOOD PRACTICE POINTS RELEVANT TO THE CARE OF ALL PEOPLE WITH OCD OR BDD AND THEIR FAMILIES OR CARERS
  • 10.2. STEPPED CARE FOR ADULTS, YOUNG PEOPLE AND CHILDREN WITH OCD OR BDD
  • 10.3. STEP 1: AWARENESS AND RECOGNITION
  • 10.4. STEP 2: RECOGNITION AND ASSESSMENT
  • 10.5. STEPS 3–5: TREATMENT OPTIONS FOR PEOPLE WITH OCD OR BDD
  • 10.6. STEP 6: INTENSIVE TREATMENT AND INPATIENT SERVICES FOR PEOPLE WITH OCD OR BDD
  • 10.7. DISCHARGE AFTER RECOVERY
  • 10.8. RESEARCH RECOMMENDATIONS
  • 10.9. AUDIT
• 11. APPENDICES
  • Appendix 1. Scope for the development of a clinical guideline on the management of obsessive-compulsive disorder
  • Appendix 2. Stakeholders who responded to early requests for evidence
  • Appendix 3. Stakeholders and experts who responded to the first consultation draft of the guideline
  • Appendix 4. Researchers contacted to request information about unpublished or soon-to-be published studies
  • Appendix 5. Clinical questions
  • Appendix 6. Search strategies for the identification of clinical studies
  • Appendix 7. Systematic review quality checklist
  • Appendix 8. RCT methodological quality checklist
  • Appendix 9. Clinical study data extraction forms
  • Appendix 10. Formulae for calculating standard deviations
  • Appendix 11. Health economics search strategy
  • Appendix 12. Selection criteria for economic studies
  • Appendix 13. Data extraction form for economic studies
  • Appendix 14. Quality checklist – full economic evaluations
  • Appendix 15. Diagnostic criteria
  • Appendix 16. Characteristics of reviewed studies
  • Appendix 17. Clinical evidence forest plots
  • Appendix 18. Evidence statements
• 12. REFERENCES
• 13. ABBREVIATIONS
• 14. GLOSSARY

The views presented in this book do not necessarily reflect those of the British Psychological Society, and the publishers are not responsible for any error of omission or fact. The British Psychological Society is a registered charity (no. 229642).