Niek (33) Physical dysmorphic disorder: ‘When I look in the mirror, I see an ugly person’ | Healthy

Photos and camouflage standing in front of the mirror for hours. For Nick Sylvan (33) this is a daily ritual. He suffers from physical dysmorphic disorder (BDD): a psychological disorder in which you have a distorted image of your appearance.

Sylvan says someone with BDD has an ridiculous amount of glasses in the house. “I have a love-hate relationship with glasses,” he says. “When I look in the mirror, I see an ugly person. Especially my nose and my hair. “

According to GZ psychologist Najla Etrioch, BDD is believed to be one of the most rare mental disorders. “Research shows that two-thirds of customers pay more attention to invisible looks and imperfections than others,” explains Etrioch. “About one-third, too much focus is on appearance, but one flaw that currently exists is (very) small but almost invisible to others.

Skin, hair and nose

According to Edriouch, the most common focal points are the skin, hair and nose. “Someone with BDD, with mild acne or troubled skin, experiences this imperfection more severely than it does,” the psychologist gives an example. “People with BDD spend an average of three to eight hours a day thinking about their perceived abnormality, looking at it or taking action to cover it up.”


People with BDD spend an average of three to eight hours a day watching or thinking about their known abnormality.

Nalja Etrioch

While the outside world may not care about his appearance, Sylvan can work many hours on his nose and hair. Focusing more on the (alleged) abnormality is one of the criteria that psychologists and psychiatrists seek to diagnose BDD. “In addition, this focus should be felt acutely by the environment, and someone with BDD can no longer function properly at school or at work,” says Etrioch. “Complaints should not be explained by another disorder, such as anorexia or bulimia.”

Genetically highly sensitive

BDD is usually caused by a combination of several factors. In most people, the symptoms appear during adolescence. “You can distinguish biological, psychological and cultural factors,” says Etrioch. “A person is more likely to be genetically predisposed to developing BDD or is more likely to develop BDD due to their attitude. Bullying, rejection, or abuse can also play a role. Can contribute to deterioration or maintenance.

And with Sylvan it could be a combination of different factors. “Besides BDD, I have a personality disorder,” he says. “I have been bullied in the past. They called me ‘ugly’ and after a while that hope came. Maybe my home environment can also play a role, my parents divorced when I was 5 years old.


If treated, the condition usually does not go away later

Nalja Etrioch

Patients often seek help in the wrong direction because they see their perceived deviation as real. They do not go to a general practitioner or psychologist, but to a cosmetologist or dermatologist. “When a dermatologist or plastic surgeon does not want to treat you, this can lead to misunderstandings and frequent contact with another doctor,” the psychologist explains. “Once the treatment is done, the condition usually does not disappear. Focusing on the body part can really make it worse. That is why it is important that cosmetic, medical and psychological care providers ask the right questions so that people get the right help.

Proper diagnosis is important

Sylvan knows this. His biggest dream is to change his appearance. “I’m afraid I’ll regret not doing it now,” he says. “But on the other hand, I’m afraid it’s still there after the procedure, and I can not fix it.” Thanks to temporary medication and group therapy, the thirty-year-old has learned to look at himself differently over the past two years. ,, I do not suddenly think myself beautiful, but mentally I feel so good, it also reflects in a positive sense in my appearance.

According to Edriouch, a proper diagnosis is important because with the right treatment the disorder will go away or disappear completely. Then you can think of therapies such as: EMDR therapy, combination of therapy and medication or cognitive behavioral therapy.

Nick Sylvan shares his story in his own documentary Swans Reflecting Elephants. The documentary will be screened at the Keep an Eye Film Academy Festival in Amsterdam in October and air on AvroTros in November.

Najla Edriouch works as a health care psychologist at a specialized mental health organization in Den Bosch. Here he treated many young men (male / female) with BDD. He also makes videos for his own channel ‘Psychologist Najla’ on YouTube.

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