The National Institute for Health and Clinical Excellence (NICE) Guidelines for OCD

The National Institute for Health and Clinical Excellence (NICE) is part of the NHS and is the independent organisation responsible for providing national guidance on treatments and care for people using the NHS in England and Wales and is recognised as being a world leader in setting standards for high quality healthcare and are the most prolific producer of clinical guidelines in the world.

The National Institute for Health and Clinical Excellence (NICE) and the National Collaborating Centre for Mental Health launched their set of clinical guidelines for the identification, treatment and management of Obsessive-Compulsive Disorder and Body Dysmorphic Disorder for children and adults on 23rd November 2005.

OCD-UK was involved as a stakeholder in the initial development of the guidelines for OCD and the subsequent press launch.

The guidance is intended for health care professionals, patients and their carers to help them make decisions about treatment and health care. The information that follows is a summary of the basic points that the NICE Guideline recommend for the management of OCD for children and adults. 

What the guidelines recommend – Basic points

• 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.
• 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.
• 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 therapyin 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 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.
• 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.
• Provide appropriate care for all ages and a seamless transition between services for different age groups.
• Consider seeking, with the patient’s consent, the advice of an appropriate religious or community leader to support the therapeutic process if the boundary between religious or cultural practice and obsessive-compulsive symptoms is unclear.
• Consider informing people with OCD or BDD and their family/carers about local self-help and support groups, and encourage them to participate where appropriate
• Promote a collaborative approach with the patient and their family/carers wherever possible and appropriate.
• For people with severe, chronic, treatment-refractory OCD/BDD: – continuing access to specialist treatment services staffed by multidisciplinary teams of healthcare professionals with expertise in the management of the disorders should be available.
• Neurosurgery is not recommended in the treatment of OCD.
• A mental healthcare professional should regularly review a person of any age with OCD or BDD who is in remission (symptoms are not clinically significant and the person is fully functioning for 12 weeks).
  • Review for 12 months.
  • Agree frequency of contact with the patient and/or family/carers and record in the notes.
  • Patients can be discharged to primary care after 12 months if recovery is maintained.

But despite the breakthroughs in awareness and understanding and treatment of OCD, many GPs and mental health professionals may not recognise the symptoms of OCD or even know how to correctly treat the disorder.  Therefore, you may also wish to refer your GP to National Institute for Health and Clinical Excellence (NICE) guidelines for the identification, treatment and management of OCD and BDD.
In general, doctors, nurses and other healthcare professionals in the NHS are expected to follow NICE’s clinical guidelines.

If you would like a copy of the NICE guidelines you can download them from the NICE website:

• NICE Guidelines for OCD (247.7 Kb)
• Quick reference guide (564.98 Kb)
• NICE guidance written for patients and carers (236.27 Kb)
• Full Guidelines (1.2 Mb)
• Web format

You can also order copies by calling the NHS Response Line on 0845 003 7783 (national rate) and asking for:

• N0920 Information for the public or
• N0919 Quick reference guide (for health professionals)

Alternatively, you can obtain a copy from OCD-UK. Please send two first class stamps when requesting your copy.

OCD-UK Comment
23rd Nov 2005: OCD-UK are delighted that the new NICE guidelines for OCD have been released and hopefully will now provide more consistent treatment for this often disabling condition. We are pleased to see that the guidelines recommend psychological treatments such as Cognitive Behaviour Therapy (CBT) as the first line of treatment for OCD.

However, we have huge concerns that the guidelines will benefit the majority of OCD sufferers unless much needed investment is made available to improve psychological services.

The NICE guidelines are undoubtedly a step in the right direction and we certainly welcome their introduction but we doubt a beneficial impact from the guidelines without more accurate and earlier diagnosis of OCD.

OCD-UK Comment
9th Feb 2011: With a review of the NICE guidelines for OCD currently under consideration, OCD-UK remain concerned that the NICE guidelines for OCD are still largely not fully being implemented by the majority of local MH Trusts. OCD-UK also remain concerned that the treatment recommended by NICE often remains ineffective due to the lack of quality, often due to a failure to fully understand OCD by the treatment provider.

Whilst believing the NICE guidelines generally offer the correct advice on treating OCD, OCD-UK would like to see NICE work harder to enforce the implementation of the guidelines across all Trusts, and that the quality of treatment provided is if of a high standard.

NICE FAQ's
What are NICE clinical guidelines?
Clinical guidelines are recommendations on the appropriate treatment and care of people with specific diseases and conditions within the NHS in England and Wales. They are based on the best available evidence. Guidelines help healthcare professionals in their work, but they do not replace their knowledge and skills.

What are clinical guidelines for?
Good clinical guidelines can change the process of healthcare and improve outcomes. For example, well-constructed and up-to-date clinical guidelines:

• Provide recommendations for the treatment and care of people by health professionals.
• Can be used to develop standards to assess the clinical practice of health professionals.
• Can be used in the education and training of health professionals.
• Can help patients to make informed decisions, and improve communication between the patient and health professional.

How does NICE develop its clinical guidelines?
The guideline topics referred to NICE by the Secretary of State for Health and the Welsh Assembly Government are published on the NICE website. Stakeholder organisations are then invited to register their interest in individual guidelines through the website.

The boundaries of the guideline – what it will and will not cover – are drawn up by the National Collaborating Centre (NCC) commissioned by NICE to develop the guideline. They are written up in a document called the scope. NICE, registered stakeholders and an independent Guideline Review Panel have input into the development of the scope.

The NCC then establishes a Guideline Development Group comprising health professionals, lay representatives and technical experts. This Group assesses the evidence available on the guideline topic and makes recommendations based on this evidence. These form the core of the guideline.
Registered stakeholders have two opportunities to comment on the draft guideline, which is posted on the NICE website during the consultation periods. The Guideline Review Panel also reviews the guideline and checks that stakeholders’ comments have been addressed.

Following the final consultation period, the Guideline Development Group finalises the recommendations and the NCC produces the final documents. These are then submitted to NICE. NICE formally approves the guideline and issues its guidance to the NHS in England and Wales.