When should I consider referring a patient with BDD to a specialist mental health service?

Consider referring a patient with body dysmorphic disorder (BDD) to a specialist mental health service when:

• They are seeking cosmetic surgery or dermatological treatment, as they should be assessed by a mental health professional with specific expertise in BDD before any procedures are undertaken.
• There is suspicion or diagnosis of BDD, especially if the patient experiences significant distress or impairment in daily functioning due to their appearance concerns.
• There is a risk of self-harm or suicide, particularly if the patient has comorbid depression or other psychosocial risk factors; a full risk assessment should be conducted and appropriate risk management strategies implemented.
• They are children or young people diagnosed with BDD, as they require assessment for suicidal ideation and comprehensive risk evaluation before treatment.
• Primary care professionals are uncertain about the diagnosis or management, or if the patient’s symptoms are complex or severe, given that specialist multidisciplinary teams have expertise in assessment and evidence-based treatment of BDD.

Referral should be made to specialist OCD/BDD multidisciplinary teams that provide age-appropriate care, expert assessment, and specialist cognitive-behavioural and pharmacological treatment, ensuring collaboration with cosmetic and dermatology professionals to improve recognition and management of BDD.

In all cases, the referral decision should be guided by clinical judgement, considering the severity of symptoms, risk factors, and the need for specialist intervention to provide high-quality care.

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