It was three years before Kelly Boone saw her daughter’s face free from a thick layer of make-up.

Avella was 11 years old when she first began exhibiting symptoms of severe body dysmorphic disorder (BDD) – even going as far as to consult a cosmetic surgeon and begging for rhinoplasty.

At the most severe, it left her housebound and she would cover her head with a towel just to go to the toilet, refusing to let her family see her without the thick layers of foundation.

On one “devastating” occasion, her father Patrick opened a package that had arrived for Avella – it contained injections and filler bought off a dodgy website.

It was not the first time Avella had tried “self-surgery”.

“She didn’t actually use any of the things she bought – by luck,” Kelly, from south Devon, said.

“It was crippling. She was a recluse, just living in her room.

“I was sliding trays of food across her bedroom floor with her in a darkened room at one point.”

As Avella, now 17, makes steps towards recovery, Kelly fears the cost of living crisis will make things harder.

Two showers a day

Although Avella no longer wears layers of make-up she has a strict hygiene routine – including two showers a day – to help her cope with her body dysmorphia.

Amid the soaring cost of energy, bills and inflation, there are concerns it could become harder for the family.

The family’s monthly gas bill has risen from £400 to more than £500. But for Kelly, the price is non-negotiable.

“She’s starting to recover and the gains we’ve made, we can’t negotiate on that,” Kelly told Sky News.

“It’s quite ritualistic and quite necessary to her, and we can’t make any concessions on those, whilst they might be a luxury to some people.

“So we cannot cut down our water bill, the cost of gas – these things are non-negotiable, so our bills are extortionate.”

Avella also cannot get public transport. “She cannot sit face to face with someone,” her mother said – so instead they have to drive her to therapy appointments, and previously to college.

“I can’t believe how quickly my tank gets down to zero,” said Kelly. “It’s very expensive.”

Read more on the cost of living crisis

‘Her recovery has to be at her pace – not at my energy bill convenience’

Kelly said seeing Avella suffer is “excruciating”.

“I would do anything to swap places with her,” she said.

“It’s been really difficult and gut-wrenching, but we’ve also had some really high moments.

“Like the day she decided to wipe her make-up off and come down and show us.

“It was the first time in three years we had seen her without any make-up on.”

As the family takes each day “hour by hour”, none of them want to see Avella slide back to where she was before.

The mother of three said: “Any requested change to her routine, other than what she does for herself of her own choosing would cause immediate anxiety and distress.

“This can snowball to affect other aspects of how she perceives herself. Her recovery has to be at her own pace not at my convenience due to rising energy bill concerns.”

One in three fear for their children

Kelly is not alone, as new research shows a third of parents think the cost of living crisis will significantly affect their children’s mental health.

These children, who have spent their formative teenage years living through the COVID pandemic, face coming of age in a cost of living crisis.

A poll of 2,150 UK parents – by Savanta ComRes and commissioned by the King’s Maudsley Partnership – found a third of parents (33%) feel their child is currently experiencing mental health difficulties.

This rises to 43% of parents with children ages between 16 and 17.

The most common symptom, or behaviour, noticed by parents is anxiety (68%), which is cited by nearly twice as many parents as the next most common response – which is depression or low mood episodes in their children (37%).

Read more: The real cost of being born premature

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‘Grossly underfunded’

Kelly, like many parents, experienced delay after delay in getting treatment for Avella.

Bruce Clark, a consultant child and adolescent psychiatrist and specialist in OCD, BDD and related disorders, said he had seen a “huge rise in mental health presentations to services, both in referrals to generic services” as well as emergency crisis referrals since the pandemic.

The clinical director of Child and Adolescent Mental Health Service, who works at the South London and Maudsley Mental Health Trust said while there are charities that help fill some of the gaps, the sector – particularly around research – is “grossly underfunded”.

The London trust is on the brink of opening a new pioneering mental health centre for children and young people, the Pears Maudsley Centre. Part of the new centre will involve a clinical hub, with research vital to improving support for young people.

“There was always an aspiration to deliver for 35% of the mental health needs in the community,” Dr Clark said.

“Well, we want to do more than 35%. I’d like to find ourselves in a situation with the right clinical research background to deliver as close to 100%.

“You’d never find that acceptable to say we’ll treat 35% of the cancer morbidity in our society, so it would be brilliant if we could not have that limited aspiration for children’s mental health.”