‘My 16-year-old son doesn’t like the way he looks. He seems to be struggling with puberty’

Question

My 16-year-old son doesn’t like the way he looks. He won’t have his hair cut as he is trying to cover his face with his hair. This is causing students in his class to make nasty comments about his appearance. On occasion he is refusing to go to school because he doesn’t want anyone to see him.

He is very anxious and avoids social situations. He doesn’t socialise outside school, but talks to friends online. He has now said he doesn’t like his friends and doesn’t want to hang out with them at school any more or speak online. He won’t say why.

I have tried to explain that it doesn’t matter what people look like and he shouldn’t care what people think. Also, I have talked to him about building resilience. He seems to be struggling with puberty and how his body is changing and also his features. This is really impacting his life now and affecting his school work. I read online about ‘body dysmorphia disorder’ and wondered if this is what is affecting him.

We are not sure how to help him and would appreciate your advice.

‘My 16-year-old son doesn’t like the way he looks. He seems to be struggling with puberty’

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Answer

Lots of teenagers worry about their appearance or are unhappy about certain parts of their body. When these feelings and thoughts become excessive so that they start negatively affecting their quality of life, then the teenager may have a condition called body dysmorphic disorder. This can start off mild and then become more serious as the negative thoughts become habitual, and the teenager can spend large amounts of time ruminating and obsessing about their appearance. This can lead to low self-esteem and avoiding going out to meet people socially.

As you have discovered, simply reassuring your teenager that they look fine or that they should not worry about what other people think usually does not reduce their obsessions – they may know this rationally but are finding it too hard to control their negative thoughts.

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Listening to your son

Try to encourage your son to talk about what is going on for him. Ask him to describe his thoughts and feelings in detail. For example, encourage him to talk about how he feels going out and how he thinks growing his hair might help him. As you listen try to communicate compassion and understanding: “Lots of people ruminate about their appearance – it can be really hard to change this.” Initially you are not trying to “judge” or “challenge” what he is saying, you are simply trying to help him talk and vent his feelings – this will help him feel better and not alone.

Helping your son talk

Of course, lots of teenagers find it hard to open up about something as personal as their body image, and asking too many direct questions can feel like a pressure and make them close down. In this instance it can work to take a step back and communicate a message that you are there for them when they are ready to talk. You can also make sure to be available at the times your teen is more likely to talk (such as travelling one to one to activities or late at night when they are more open). You can also create daily “opportunities for conversation” such as arranging a trip when you can be one to one and relaxed together.

Naming what is going on

Naming his condition as something external to him could be helpful. You can start this conversation by talking informally about BDD – “it sounds like you might be suffering from body dysmorphia disorder; this can happen to lots of teenagers”. Then you can encourage him to seek a diagnosis and further help (see below). A diagnosis of BDD could help him view his condition more objectively and help him to realise that he is not alone – that lots of teenagers feel this way.

It also means that you both can research the condition online. Check out together some of the reputable medical websites, which describe BDD and related conditions as well as treatments and support groups that he might be interested in attending.

Getting help

You can seek formal assessment and support by going to your GP to get a referral to your local Child and Adolescent Mental Health Service (CAMHS).

The recommended treatments for BDD include:

Supportive counselling to help him talk through his feelings
Cognitive behavioural therapy (CBT) to help him change his negative thoughts and ruminations
Family therapy to help you support him and
medication, notably SSRIs, which are a type of antidepressant that have been shown to have a positive impact.

Finally, overcoming BDD and body image concerns can take some time. It is important to help him live his life well despite his ruminations.

Continue to support him to get involved in his passions and fun activities and to support him to reach out and make friendships whether online or face to face.