The rise of sexual anorexia

Sexual anorexia, which is a set of attitudes and behaviours to sex very much like a food anorexic’s attitudes and behaviours towards food, is on the rise. They are separate conditions but there is some overlap as people with food disorders also often have issues with intimacy and building relationships.  In both cases, people are trying to control their environment and manage their unbearable feelings.

As a clinician who has also suffered with this condition, I am seeing more people with these issues.  Sexual anorexia affects both men and women, it is linked to the spectrum of ‘addiction’ which affects between 10-17% of the population. Sexual trauma happens to all ages, genders, classes, races, abilities.

In my experience the first step to dealing with this is to recognise that it is a problem that has devastating consequences. That it is the cause of problems not the way to manage them. Getting through the denial of someone to get them to accept this is a problem is often the first and maybe most important step in developing the solution.

Anxiety, fear, avoidance, shame around sexual intimacy are typically the symptoms of a sexual anorexic. It’s the intimacy that cause the anorexic reaction, or rather the fear of having intimacy abused again. It is not the same as choosing to be asexual or chaste, which is a positive decision. People with sexual anorexia usually have co-morbidities like addiction to drugs and or alcohol.

You can, in eating disorders, see other food based pathological behaviours that are linked and exist along a connected field. Along the eating disorder spectrum, we see anorexia (restricting), bulimia (binge-purging) and over eating. Similarly, in disordered sexual behaviours anorexia (avoidance of sexual intimacy), bulimia (extreme sexual acting out followed by shame, withdrawal and avoidance and over eating (the usual image from films etc of the ‘sex addict’,) all exist in relationship to each other along the love and sex spectrum of addictive sexual behaviours

If there is latency in the family lines around addiction in an individual who experiences sexual trauma then sexual anorexia may form as the expression of that trauma. As with eating disorders an individual may range along the whole spectrum of disordered sexual behaviours.

One thing that helps with diagnosis is the comorbidity of other ‘addictive’ behaviours, for example using drugs and alcohol to try to manage the overwhelming fear of intimacy. Like sexual aversion disorder all these sex and love addiction problems are connected to anxiety reactions. But unlike it they also have an addictive life of their own and require help often beyond anxiety treatment such as CBT or medication.

All these sex and love addictions are linked in that the core of them is an anorexic relationship to intimacy. All the behaviours are aimed to avoid allowing intimacy to form. So often the sexual acting out component is with people with whom no relationship forms such as chemsex, prostitutes, sex parties and clubs.

Sexual anorexia is not yet a diagnostic category, but the closest diagnosis in that literature (DSM, ICD etc) is sexual aversion disorder; an anxiety-based disorder. Sexual anorexia was coined as a term by Dr Patrick Carnes in 1997 when he published a book of that title.

Sexual anorexia often forms as a response to trauma in sexual development. Trauma is an epigenetic process, in that it can change how aspects of our genes work and it is heritable. It is implicated deeply in the formation and triggering of addiction along family lines. In this way addiction is both inherited and a response to environmental influences. The idea of addiction latency, it can be switched on.

The combination of issues and problems associated with sexual anorexia are potentially catastrophic. At the core of it is an avoidance of human intimacy and that has devastating effects on social animals, on any human. At the core of being in the world is the ability to form functional human relationships: in the home, at school, at work. Anorexic avoidance of this creates negative impacts globally in an individual’s life. The main areas of potential damage are: interpersonal relations globally; trauma; social relations – work, school etc; drug abuse; compulsive and dangerous behaviours; physical health; mental health, self-injurious behaviours.

I believe that treatment must be triaged and planned and long term. The combination for each individual will change but will consist of these interlocking areas. Bio-medical, dealing with the physical health and mental health consequences medically. Psychotherapeutic; looking at therapies to help reduce trauma, enhance relationship skills, improve management of anxiety and depression. Psycho-social and psycho-educational: using peer to peer support groups, developing community connections and social support, learning about the condition and its solutions. Systemic: in mental health systemic refers to families and groups and how to bring about change there that facilitates recovery from chronic and long-term conditions.