Hours in front of the mirror, dodging photos and camouflage. It is a daily ritual for Niek Silvan (33). He suffers from body dysmorphic disorder (BDD): a psychological disorder in which you have a distorted image of your appearance.
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Silvan says he has ‘a ridiculous amount of mirrors in the house for someone with BDD’. “I have a love-hate relationship with the mirrors,” he says. “When I look in the mirror, I see someone who is ugly. Especially my nose and my hair.”
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BDD is believed to be one of the most under-diagnosed mental disorders, according to Najla Edriouch, GZ psychologist. “Research shows that two-thirds of clients have an excessive focus on appearance and imperfections that are invisible to others,” explains Edriouch. “In about a third, the excessive focus is also on appearance, but on an imperfection that is present. Although to a (very) slight degree, almost invisible to others.”
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Skin, hair and nose
The most common focal points, according to Edriouch, are the skin, hair and nose. “Someone with BDD, who may have a mild form of acne or troubled skin, experiences this imperfection as more severe than it is,” the psychologist gives as 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 actions to hide it.”
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People with BDD spend an average of three to eight hours a day looking at or thinking about their perceived abnormality
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While the outside world probably won’t notice about his appearance, Silvan can spend hours working on his nose and his hair. Excessive focus on the (alleged) abnormality in appearance is therefore one of the criteria that psychologists and psychiatrists look at in order to make the diagnosis of BDD. “In addition, this focus must be experienced as heavy by the environment and it may be that someone with BDD can no longer function properly at school or at work,” says Edriouch. “The complaints must not be explained by another disorder, such as anorexia or bulimia.”
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Genetically more 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 that have an influence,” says Edriouch. “A person may be genetically more susceptible to developing BDD or may be more likely to develop BDD because of their temperament. Bullying, rejection or abuse can also play a role.” In addition, it is also a society in which a lot of attention is paid to appearance. For example, mainstream media and social media can contribute to aggravating or maintaining the disorder.
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Also with Silvan it is probably a combination of different factors. “Besides BDD, I have a personality disorder,” he says. “I have also been bullied in the past. I was called ‘ugly’ and after a while came to believe it. Maybe my home situation can also play a role, my parents divorced when I was 5.”
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If the treatment is carried out, the condition usually does not disappear afterwards
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Because patients see their perceived deviation as truth, they often seek help in the wrong direction. They do not go to the general practitioner or psychologist, but to a cosmetic doctor or dermatologist. “The moment a dermatologist or plastic surgeon does not want to carry out the treatment, this can lead to misunderstanding and contact is often sought with another doctor,” explains the psychologist. “If the treatment is carried out, the condition usually does not disappear. The focus on the body part can actually make it worse. That is why it is important that cosmetic, medical and psychological care providers ask the right questions, so that people receive the right help.”
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Correct diagnosis is important
This is recognizable for Silvan. His big dream is to change his appearance. “I’m afraid I’ll regret it later if I don’t do it now,” he says. “But on the other hand, I’m also afraid that it will still be the same after the procedure, as if I can’t be repaired.” Thanks to temporary medication and group therapy, the thirty-something has learned to look at himself in a different way over the past two years. ,,I don’t suddenly think of myself as handsome, but mentally I do feel much better and that also reflects in a positive sense on my appearance.”
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According to Edriouch, making the correct diagnosis is extra important, because with the right treatment the disorder can decrease or completely disappear. Then you can think of treatments such as: EMDR therapy, a combination of therapy and medication or cognitive behavioral therapy.
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Niek Silvan shares his story in his own documentary Swans Reflecting Elephants. The documentary will premiere in October at the Keep an Eye Film Academy Festival in Amsterdam and will be broadcast on AvroTros in November.
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