“Let’s talk about Sex, E.D.”
In everything from sultry chocolate advertisements to the myths of aphrodisiacs, food and sex have been intimately linked together throughout much of history. Various food items have historically been used to enhance the sexual experience, whether for their reputation of increasing libido or by actual incorporation into sexual encounters, and others are described using terms associated with the actual act of sex. In his assessment of the hierarchy of human needs, Abraham Maslow identified food and sexual instinct as two of the most basic human requirements, essential for physiological functioning (1). As such, food and sex provide earthy, physical experiences, engaging the body through pleasure and sensuality.
For those struggling with an eating disorder, however, the relationship with both of these subjects becomes strained. A person’s sexuality is closely connected with his or her physicality, self-esteem, and body satisfaction, all of which become distorted and fall prey to the tyranny of the eating disorder. As eating disorder sufferers become familiar with using food to deny, control, or over-indulge one of humankind’s most primal instincts, their relationship with the other suffers as well.
The presence of an eating disorder largely impacts a person’s sexuality, and sexual dysfunction is common for all manifestations of an eating disorder (2). Low body weight is associated with loss of libido and complications with testosterone production, as well as physiological impairment of the functioning of the sex organs (3). Beyond physiological complications, moreover, many core elements of eating disorders, such as shame, body dissatisfaction, and distorted body image can inhibit healthy sexual functioning. Women with eating disorders display more negative attitudes toward sex, increased sexual anxiety, and less sexual satisfaction, while men with eating disorders display significant sexual anxiety that is even greater than their female counterparts (5). While those struggling with anorexia nervosa may demonstrate a restrictive view of sexuality and relationships, sufferers of bulimia nervosa may use sex to gain approval and meet the demands of their romantic partner. Personality traits associated with eating disorders may also correlate to sexual functioning (4). Individuals with constricted emotionality seem to exhibit restrictive sexuality and those with significant emotional dysregulation tend to exhibit more impulsive and self-destructive sexual choices, displaying a type of mirroring between the way an eating disorder sufferer engages in eating disorder behaviors and interacts sexually (6).
Many patients in eating disorder treatment will speak to the ways in which their illnesses have affected their sexual relationships, reporting an inability to truly connect with partners during the worst phases of the disorder. Intimate partners of those struggling with an eating disorder may notice that it has compromised their sexual relationship, and experience feeling of hurt, anger, and frustration.
Eating Disorders and Sexuality Treatment
Despite the plethora of sexual complications and dysfunctions caused by the presence of an eating disorder, sexuality is rarely discussed as an important element of eating disorder treatment outside the parameters of sexual trauma and abuse (7). Unsurprisingly then, research also indicates that negative attitudes toward sex linger long after treatment (8). Although increase in libido may accompany weight restoration and cessation of eating disorder behaviors, shame, body dissatisfaction, and negative attitudes toward sex can cause complications in sexual functioning and relationships even after an individual has been in recovery (9). Sexuality is closely linked to self-esteem and body image, both of which are issues that may linger on even after the physical and behavioral manifestations of the eating disorder have dissipated.
As such, it is essential that we begin a conversation around eating disorders and sexuality. One the most powerful components of eating disorder treatment is discovering each individual’s true and authentic identity outside of and absent from the eating disorder. Although sexuality is one of the most basic, inherent aspects of who we are as people and an important element of intimate relationships, it is also one of the most shame and expectation – laden topics in our current culture, making it difficult to discover one’s authentic, sexual self separate from others’ pressures and expectations. It is only when we give ourselves permission to explore and discover ourselves as sexual people (including values, capacity for emotional intimacy, orientation, boundaries, and sensuality) that we can authentically live out our true selves and engage in intimate relationships with others.
Every time I begin a new sexuality group, I ask the participants to bring in their “curious minds” in order to promote mutual respect and a safe atmosphere free of judgment. At any point when multiple people sit in the same room, there will be a variety of values, opinions, and experiences represented in relation to sexuality, and it is important to acknowledge the appropriateness of these differences as elements that allow each person to truly inhabit and express their unique, authentic self. In my experience, however, few people struggling with an eating disorder have ever intentionally created space to think about and question the values and boundaries they hold around the topic of sexuality, and it is often only after a value has been compromised or a boundary has been crossed that their existence is even acknowledged. Being curious and open to learning about others’ experiences and beliefs around the topic of sexuality, as well as one’s own, allows for each person to discover what feels comfortable and appropriate for him or her personally.
For those of you who may be struggling with an eating disorder or supporting a loved one with an eating disorder, I will also ask you to bring your “curious mind” with you as we begin this conversation about eating disorders and sexuality. From a position of respect and open interest, begin asking yourself what personally works for you in relation to sexuality. Ask questions like:
- “How might my eating disorder be impacting my values around sexuality?”
- “What are my values around sexuality?”
- “Under what conditions will I choose to be sexual and what boundaries do I hold?” and
- “What shame may I be holding that keeps me from being fully intimate with another person?”
In the same way our bodies physiologically need the nutrition and sustenance of food to survive, they also possess a physiological drive for sex that provides the opportunity to connect with others in a vulnerable, emotional way, and it is time for this illness to stop robbing its sufferers of both. We need to start discussing sexuality as part of eating disorder treatment, so that each eating disorder survivor may truly live from all aspects of his or her beautiful and unique Authentic Self.
About The Author:
Zach Verwey, MA works as a therapist at the Eating Disorder Center of Denver, and currently facilitates EDCD’s sexuality treatment group. Zach holds a Master’s degree in Clinical Mental Health Counseling from a CACREP accredited program where he specifically focused his professional training on eating disorders and human sexuality.
1. Maslow, A.H. (1943). “A theory of human motivation.” Psychological Review, 50 (4) 370–396. Retrieved from psychclassics.yorku.ca.
2. Pinheiro, A.P., et al. (2010). “Sexual Functioning in Women with Eating Disorders.” International Journal of Eating Disorders, 43(2): 123-129. Doi:10.1002/eat.2067
3. Pinheiro, A.P., et al. (2010). pp: 123; “Research on Males and Eating Disorders.” NEDA Website. Retrieved from www.nationaleatingdisorders.org/research-males-and-eating-disorders
4. Pinheiro, A.P., et al. (2010). pp: 124.
5. Morgan, C.D., Wiederman, M.W., & Pryor, T.L. (1995) “Sexual Functioning and Attitudes of Eating Disordered Women: A Follow-Up Study.” Journal of Sex & Marital Therapy, 21(2): 67-77; “Research on Males and Eating Disorders.”
6. Pinheiro, A.P., et al. (2010). “Sexual Functioning in Women with Eating Disorders,” International Journal of Eating Disorders, 43(2): 123-129. Doi:10.1002/eat.2067
7. Pinheiro, A.P., et al. (2010). pp: 68
8. Morgan, C.D., Wiederman, M.W., & Pryor, T.L. (1995). pp. 75
9. Pinheiro, A.P., et al. (2010). pp: 124; Morgan, C.D., Wiederman, M.W., & Pryor, T.L. (1995). pp:68
Written – 2016