Virginia Ironside's Dilemmas: My lovely son has become phobic about things

Dear Virginia,

My bright and lovely son went to university on a scholarship at 18 – but left abruptly after only a month. He became phobic about things, and felt he looked ugly even though he is actually a very good-looking boy. Now he barely stirs from his room and spends all day online. I have insisted he eat with us, but that's the only time he appears. He refuses to see the doctor, and I'm at a loss as to what to do. I thought he'd grow out of it. He can't go on like this for ever, surely?

Yours sincerely, Penny

Isn't being a parent a nightmare? It's often so difficult to judge, particularly when children are in their late teens, when is the time to back off (nearly all the time) or interfere (rarely, but, in this case I feel, crucially). There they are, these great lumbering hunks with their strength, deep voices and razors in the bathroom, to all intents and purposes grown men, and yet, sometimes, inside they not only need guidance but pretty firm steering.

This is the case with your son. He's ill. In fact, at the risk of being a DIY doctor, I'd say he's got "body dysmorphic disorder". Look it up on Google and see if it fits. He has become phobic about his own appearance. To everyone else he looks perfectly normal, but when he sees himself in the mirror he sees someone with a huge forehead, bulging eyes of different sizes, squat neck – all kind of ugly quirks. No wonder he can't face going out.

As he is now 18 you can't force him to do anything, but you've managed, somehow, to "insist" he eat with you, so can't you "insist" he see the doctor? (Visit your doctor first to tell him or her of the situation and check out that they'll be sympathetic and have a plan – probably a mixture of therapy and drugs).

If your son refuses, simply tell him, decisively: "I'm your mother, and I can see you're ill. While you're in my house all I ask is that you visit the doctor. I don't ask that you follow their advice. I just ask that you visit. It would take an hour of your life. I cannot stand by and see you wrecking your life like this when you're suffering from a disorder that is not uncommon and can, in many cases, be almost completely relieved."

If he refuses, then consider threatening him with having to leave the house. It may not be possible for you to carry out this threat but it doesn't stop you making it. And, to be honest, unless you take a stand on this, you are really failing him as a parent.

I'm sure you're thinking that, given a bit of space and time, he'll get over this, but he won't. The longer he stays comfortably isolated in his room, the more difficult it will be for him to come out of this personal hell he finds himself in. And the older he gets, the less inclined he will be to listen to anything that you say.

He's a clever boy. Up to now you've obviously done everything brilliantly in bringing him up. Don't give up on parenting now, just because he seems old enough to know his own mind. He doesn't. Now's the time to go the extra mile and, by coercing him to seek help, ensure that his future is as wonderful as it looked set to be before this crisis struck.

Readers say...

Depression has a cure

These are big, flashing-red-light alarm signals you describe. Something happened during that short period at university to make him terribly depressed. He has had, however, almost a year to get over it. The fact that he hasn't suggests it was a serious blow to his equilibrium. If he won't see a doctor, you should.

Depression is a terrible thing but it can be cured with a variety of drugs that are available now. Show him this letter if all else fails.

Helen Braithwaite

London NW3

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Send him out to work

Boys mature at a slower rate than girls and consequently they are unsure of themselves; the confidence of an 18-year-old boy is easily shattered. Something must have happened at university to cause your son to hate himself. The only solution is to restore his confidence. Tell him that most girls prefer intelligent (your son must be, having gained a scholarship), ugly boys to thick, good-looking ones.

Make him go out and get a job and, failing that, tell him he must do some charity work. Once he has witnessed the real world he will realise the mistake he made in leaving university. In any event, a year on and with the experience gained, you won't recognise your son as he is now, so don't despair.

Malcolm Howard

Banstead, Surrey

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He is a typical teenager

I really don't think that there is anything sinister going on here. He is just taking his "Kevinness" to its full extent. How I wish I had won a scholarship to university at 18. However, this route is not right for everyone and it's never too late to reconsider at a later date.

It seems to me that he is a typical teenager who has been mollycoddled for too long. He was a big fish in a small pond and didn't like being a small fish in a big pond. Every mother thinks her offspring is good-looking, but 99 per cent of teenagers, and adults for that matter, are not happy with what they see in the mirror. We have the media to blame for this.

The internet has changed the way we live; young people have been brought up with it and often know no other means of communication. He is obviously a very intelligent boy, so hopefully his surfing passion is sometimes being used to a useful purpose.

You must make him realise that the gravy train has come into the station. If he continues behaving in this manner then he must start to contribute. Internet access, mobile phones, food, heat and clothing – all have to be paid for. Work out what he costs you and think of ways he can help ease your finances whilst he decides what course is right for him.

Get him doing the shopping, washing the car, walking the dog, washing up, changing his sheets or anything else which you think is reasonable. I think you will find that he will soon start to grow up realising the sacrifices you have been willing to make for him, and hopefully consider that university isn't such a bad idea after all.

Anita Ashford

Norwich

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Get him to see a doctor

I don't want to sound alarmist, but it is crucial your son see his doctor, even under duress. I am by no means saying that he is developing a serious mental illness but it's incredibly important to rule it out, particularly if you feel his behaviour has become suddenly and markedly different. Most mental illness occurs in late adolescence and is triggered by an emotional upheaval, such as leaving for university.

The odds are that his confidence has been knocked by not flourishing at university as he'd hoped he might, but it really is so very important to rule out the early stages of more serious mental illness. If this should prove to be the case, the earlier the diagnosis the better the prognosis.

Sam Whyte, by email