Patricia"s approach was to co-operate with Samantha"s demands. She reassured Samantha 20, 30, 50 times a day when asked, “How do I look?” She spent £200 on hair extensions (which Samantha ripped out three days later). She put up with Samantha"s anger. (“I"d shout at Mum, “Why have you made me like this?” And I"d push her.”) And she humoured Samantha"s alarming dependence on a Superman T-shirt from H&M because by 2009 Samantha was having “good face days” and “bad face days”. The Superman T-shirt was key to a good face day. But not a guarantee. “A good face day could morph into a bad face,” her mother says. “We would leave the house to go to the [day] unit and halfway there she would say, “Oh no, bad face is here,” because she"d looked in the mirror, and then we"d have to come home.”

“I was going in [to work] and seeing teenagers all the time and thinking, why can"t she be like them?” Gareth admits. His role was to support Patricia. “But you get to the point where you don"t want to talk about it any more,” he says.

Experts acknowledge that BDD is extremely difficult to treat. “It is quite complex and the risk of suicide makes it even more difficult to manage,” Dr Mataix-Cols says. However, over the past 10 years two forms of treatment have proved effective: a combination of cognitive behavioural therapy (CBT) and antidepressants, which act on the brain chemical serotonin and are thought to have an “anti-obsessional” effect. But the challenge is identifying BDD and treating it correctly. “Of course CBT is widely available, but what is not available is highly specialist CBT for BDD in young people. What we are doing is adapting traditional CBT techniques to this particular problem and this particular age group. This is novel and unique to the Maudsley,” Dr Mataix-Cols says.

In June 2009 Patricia went online and typed in “BBD” and “teenagers”. “I was desperate. My child was at the highest CAMHS level in Wales and not getting any better,” she says. Over 16 months, Samantha had been seen by two consultant psychiatrists, two family therapists, two clinical psychologists, two occupational therapists, outreach workers, home tutors and an educational psychologist. “I said to one of the psychiatrists, “What does it take to help my child?”” Based on what she discovered online, she asked Samantha"s consultant to refer her to the Michael Rutter Clinic at the Maudsley.

On July 30 2009 the family set off for London. “I was thinking, “My God, what if it"s my fault? What if it"s nothing?”” Patricia says. “Samantha was put in a room at the Maudsley and there was this enormous team of people and I was praying - I"m not religious, but I was praying, please God, see what is going on - I really felt this was the last chance to save her life.”

Using a scale of 0 to 40, Samantha"s BDD was marked at 35: severe. “One of the reasons given for this was the lack of focused CBT,” Patricia says. “The validation was unbelievable. We were being told, this is not your fault. This is as real an illness as any physical illness. But then they said, “There"s no funding, we can"t treat her.” The solution was there and then it was snatched away.”

Samantha"s funding (from her primary care trust) covered only three hours of treatment (the assessment and one session). Funding for specialist treatment outside Wales requires approval from Health Commission Wales. “I have no idea why this was not suggested sooner,” Patricia says. “I did not even know it existed or was an option until I started getting a bit bolshie.”

If Samantha had lived in England or Scotland, the treatment would have been funded by the National Commissioning Group. Samantha"s bad luck, as her parents saw it, was to come from Wales. On October 2 2009 Patricia attended a surgery of her local Welsh Assembly member and asked for help in securing funding. Dr Isobel Heyman, a consultant child psychiatrist in the Child and Adolescent Department of the Maudsley, wrote to Health Commission Wales, recommending that Samantha received treatment. As did Samantha"s consultant.

Two weeks later the funding was approved: for treatment only, not travel (which was to cost the family more than £1,000 by train). On October 15 2009 Samantha started the first of 14 sessions. Treatment included learning the difference between normal and excessive appearance concerns, drawing up an “individualised treatment plan” (with Samantha and her parents) and “exposure therapy”. For this, Samantha was asked to compile a list of anxiety-provoking scenarios and measure each for distress on a scale of 0-100. She came up with 150. For example, not wearing her Superman T-shirt all weekend: 80. Not having enough time to put in

her hair extensions before going out: 90. Not looking in a mirror all day: 100. “We start with the very easy ones and work up, encouraging the patient to face the situation rather than avoiding it, until that anxiety subsides,” Dr Mataix-Cols says. “People with anxieties feel they will be anxious for ever and that the anxiety will grow exponentially, but in fact what happens is, once they face the feared situation, the anxiety drops with time and it becomes easier.”

“It wasn"t rocket science,” Patricia observes. “When he told us, it was like having admission to a secret club. This doesn"t belong only in a specialist hospital in London. It can be replicated anywhere in Britain. Samantha now has a future thanks to CBT.” Dr Mataix-Cols agrees. Last November the Maudsley set up a trial to test the efficacy of BDD-tailored CBT and once completed the aim is to help roll out a programme for young people to be treated swiftly and effectively in their local area. (So far the team has recruited 12 children for the trial; it needs 30.)

In January 2010, at the end of treatment, Samantha"s BDD score had dropped from 35 to 19. For the next six months her parents continued the programme and by June 2010 it was down to eight. Two years on, Samantha has six GCSEs and is training to be an accountant (she wants to specialise in forensic accounting). “She is happy and confident, living her life and having a great time of it,” her mother says. “I"m making up for lost time,” Samantha adds. She is still on a very small dose of antidepressants and sees a consultant psychiatrist every three months.

BDD still lurks under the surface, she admits, but she is now able to “reel in the emotions”. At one point during our interview, I tell Samantha she looks lovely. And the girl who could not accept compliments for two years; the girl who would not allow herself to be seen because even thinking about going out on a bad face day scored an anxiety level of “100 billion”, looks me in the eye. “Thank you,” she says. And smiles.

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Telegraph Media Group