Abstract
Background. In September 2026 the National Institute for Health and Care Excellence (NICE) opened consultation on the first batch of its update to the 2005 guideline for obsessive-compulsive disorder (OCD) and body dysmorphic disorder (BDD) (GID-NG10435). The draft replaces stepped care with matched care and reviews first-line treatment.Methods. We appraised the draft and its supporting documents against six questions informed by selected AGREE II domains, analysing NICE’s published effect estimates, sample sizes, sensitivity analyses and economic results descriptively; every value was checked against its source document. Comparison guidelines were identified by a documented search.Results. The adult OCD review included 82 randomised controlled trials and the BDD review 13 studies. The committee cited small samples and wide credible intervals when it did not recommend metacognitive therapy (52 participants) or eye movement desensitisation and reprocessing (EMDR; 59 participants). Self-administered cognitive behavioural therapy with therapist support, the second adult option, rests on 61 participants, with a wider credible interval than EMDR’s, and was recommended on other documented grounds. The top-ranked adult option had a probability of 0.17 of being the most cost-effective. The first-listed BDD option ranked fifth of nine in the network meta-analysis. The draft gives no drug-specific dose targets, no consolidated definition of an adequate trial and no primary severity measure for allocation or response. Treatment after non-response to an adequate trial is outside the scope of Batch 1; on the assumptions in NHS England’s 2013 specification, a cascade beginning with 48 million adults in England and Wales yields approximately 48,000 people not responding to a serotonin reuptake inhibitor followed by local graduated exposure. All six selected multimodal OCD comparison guidelines address augmentation; none provides a treatment pathway for BDD.Conclusions. The draft rests on a substantial evidence synthesis. The published rationale does not fully explain why small samples and imprecision precluded recommendations for some treatments but not others; several operational parameters are not specified; and further-line treatment is outside the first batch.