Cosmetic surgeons should question patients about their body image to screen out those with a mental disorder before agreeing to operate, doctors say.

Body dysmorphic disorder (BDD), in which people become obsessed about perceived defects in their appearance, affects an estimated 250,000 people in Britain, 0.5 per cent of the adult population. Many sufferers turn to surgery instead of psychiatry for treatment.

Guidelines issued yesterday by the National Institute for Health and Clinical Effectiveness say specialist teams should be established in every primary care trust to diagnose and treat BDD sufferers and the allied condition obsessive compulsive disorder (OCD), which affects about 1 million people.

Obsessive compulsive disorder is ranked as one of the 10 most disabling illnesses by the World Health Organisation in terms of lost income and quality of life, yet can be effectively treated with brief therapy or antidepressant drugs.

The actress Jane Horrocks admitted in 1999 that she suffered from obsessive compulsive disorder which affected her swallowing, leaving her with an aching jaw from the incessantly repeated action. Later she became obsessed with counting how many times she blinked. She said the condition improved after she became a mother.

Tim Kendall, a Sheffield-based consultant psychiatrist and joint director of the National Collaborating Centre for Mental Health, said:"One survey showed it took up to 17 years from the time of onset of the illness to the sufferer receiving the correct treatment ... A lot of people's lives are wrecked."

On BDD, he added: "Cosmetic surgeons ought to be thinking, when someone comes and says the bridge of their nose is too wide, why are they coming for treatment? Sometimes there is an obvious problem with their face but [in other cases] I think they should ask the question."

David Veale, consultant psychiatrist at the Maudsley Hospital in London and an expert in BDD said: "The problem is mainly centred round the face. People magnify their defects - they tend to see themselves as a walking nose. We see a lot of people who have been for cosmetic surgery and remain dissatisfied - or the problem moves on to another area."

Isobel Heyman, a consultant child and adolescent psychiatrist at the Maudsley, said children as young as six were affected by obsessive compulsive disorder and it could last into old age. "It can destroy young lives. I see many children who spend six to seven hours a day washing. They can't go to school and they can't see friends, they feel incredibly embarrassed and ashamed."

Gillian Knight, 43, an OCD sufferer, said the main hurdle was getting the right diagnosis and treatment. "It started when I was 13, I would have intrusive thoughts that I might accidentally harm somebody or have an accident. To get rid of the thoughts I had to check everything was safe. I spent hours trying to get out of the bathroom by making the bath mat flat so no one could trip over it. At first the checking relieves the anxiety but then you have more and more thoughts and you can't get out of it."

Ms Knight, from north London, works as the research manager at the Institute of Chartered Accountants. She was 26 before she got effective treatment with antidepressants and, later, cognitive behaviour therapy . "The therapy really helped - it had a lasting impact," she said. "The intrusive thoughts don't entirely go away but they don't bother me. I lead a normal life."

OCD Action can be contacted by telephone on 0207 226 4000 or at

How do you know if you have the syndromes?

Possible symptoms of obsessive compulsive disorder include:

* Washing or cleaning a lot

* Checking things a lot

* Thoughts that bother you that you would like to get rid of but can't

* Daily activities taking a long time to finish

* Being concerned to put things in a special order or being upset by mess

Possible symptoms of body dysmorphic disorder:

* Worrying about the way you look and wishing you could think about it less

* Having specific concerns about your appearance and spending more than an hour a day with them on your mind

* Worries making it hard to do your work or be with your friends