Thursday 18 December 2014

David Coleman: My 17-stone son won't get off the sofa and has been diagnosed with social anxiety

Published 15/08/2011 | 05:00

I am a divorced mother of three boys. Their dad and I split up 10 years ago when my eldest boy was seven; he is now 17. For the past few years my son has become very withdrawn and never budges from the house.



The newest problem is he is overweight (over 17 stone) and does not do any exercise. His diet is terrible and he is at risk of diabetes due to a very raised sugar level.

Last year he had been crying and not going to school. I brought him to the GP and he was referred for psychiatric assessment. They diagnosed depression. He has been attending a psychologist and psychiatrist for the past 10 months and has been put on Prozac. He now does not have the depression side of things, thank God, but they also diagnosed that he has social anxiety.

Because of his weight he had an appointment with the GP last Friday and was told to commence a new diet regime and one hour of exercise per day. He refuses to get off the sofa. I am at the end of my tether. He just will not get up to do anything. He sits and plays his guitar, plays PlayStation or hangs out online.

What is the next step? I can't physically pull him off the chair. The thing is he is such a lovely, kind, honest young fella. Please help.

David replies:

When I first read through your query I was struck with a sensation of stuck-ness. Your son seems very stuck and his development is not progressing.

I can really empathise with his sadness and distress about whatever was going on in school. I wonder if he was being picked on or excluded in some way. I can really empathise too with his possible upset about his dad not living with him any more and I could imagine that it might be hard for him to have divorced parents.

While reading that he has been attending a psychologist and a psychiatrist for the last 10 months I wondered why things have not been improving for him. You say that he has had some alleviation of his depression with the medication that he has been on, but I don't get a strong sense that he has been receiving regular therapy over the last year.

I do believe that he needs some focused therapeutic support to help him progress and to continue to develop. Psychological treatment for social anxiety can be really effective. Therapy can also work very well with reactive depression (which it sounds like he had in response to something that was going on in school).

I suggest that you go and talk to the psychologist and psychiatrist and find out what their specific treatment plans and treatment goals are for your son.

Part of his therapy should be trying to help him to see a future for himself, one that he can realistically aim for. Having some goals in life would help him to identify and harness his internal motivation to deal with his weight and overcome his social anxieties.

You don't mention any men who might be influential in his life. It would be helpful to find a really positive male role model for him. Wouldn't it be a real boost for your son (and support for you too) to find someone who could inspire him to reach for his potential?

Even if you can't identify someone right away, do keep in mind that you both might benefit from having friends and family involved to support you to shift the dynamic of how he lives his life currently.

From what you describe it seems really clear to me that your son is not acting like an independent, responsible 17-year-old. In this situation, therefore, I don't think you can treat him like one. He needs very specific guidance and direction and he still needs lots of limits to keep him on track.

It seems that he is behaving in a very immature way and so he needs you to continue to help him manage his behaviour, until he can take more responsibility for it himself.

In a practical sense you must continue to determine what he is and is not allowed to do. This means that you need to stop making it easy for him to opt out of the real world.

You also need to stop facilitating him living in a computerised fantasy world.

You are correct to spot that you can't pull him out of the chair, but you can restrict his use of the PlayStation, TV and computer by controlling his access to them, or to their power leads.

I am sure if you unplug him from his computerised world that he will react angrily. This is a good thing. At least he will be noticing you and engaging with you.

You say that he has secluded himself and is withdrawn, but in fact he seems quite self-centred. At the moment he can largely ignore you (and because of his diagnosis of depression and social anxiety you may interpret this as withdrawal). If you have control of his online life then he can't and won't ignore you.

You will have to weather the storms of his unhappiness at losing access to his online life. While this may be unpleasant and distressing for you and him, it will ultimately be good for him. His health and well-being are two of his most important assets in life and by your actions you will be giving him a real opportunity to mind them both.

Opt-out

At the moment he has no motivation to address his lethargy and his withdrawal. His 'pastimes' seem more like opt-out activities and he needs to discover reasons for himself to opt-in.

Partly this can be your job, by not making his life so comfortable. Partly it is the responsibility of his therapists to help him click back into life. Partly it could be a role for an inspirational man he knows.

Ultimately, however, it is your son's responsibility to be in charge of his own life but for now he needs adult support and help to make healthier choices and choices that will give him a real future.

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