Healthcare professionals providing cosmetic procedures should screen patients for body dysmorphic disorder (BDD) and refer suspected cases for specialist assessment, according to draft guidance from the National Institute for Health and Care Excellence (NICE).
The recommendations form part of NICE’s draft guidance on identifying and managing obsessive compulsive disorder (OCD) and BDD, published for consultation in September 2026.
Under the proposals, practitioners carrying out cosmetic procedures should ask patients structured questions about concerns relating to their appearance before proceeding with treatment.
If responses suggest a patient may have BDD, practitioners should refer them for specialist assessment and should not carry out the procedure while the condition is suspected. NICE warns that treatment could reinforce or worsen BDD-related distress and behaviours.
BDD is a mental health condition characterised by persistent preoccupation with perceived flaws in appearance, which may be unnoticeable or appear minor to others. It can involve repetitive behaviours such as mirror checking, excessive grooming and seeking reassurance.
NICE also recommends that healthcare professionals consider assessing people presenting with anxiety or depression for BDD and OCD. People with autism or attention deficit hyperactivity disorder (ADHD) may also require assessment where appropriate.
The draft guidance highlights the under-recognition of both conditions, noting that people may be reluctant to disclose symptoms because of shame, stigma or fear of judgement.
Eric Power, interim director of the Centre for Guidelines at NICE, said earlier identification could help people access appropriate support before symptoms become more severe.
For aesthetic practitioners, the recommendations underline the importance of thorough consultations and recognising when a patient may require psychological assessment rather than cosmetic treatment.
The guidance remains in draft form and is subject to consultation.
