Sexual Anorexia

I was discussing the concept of sexual anorexia with a colleague who was treating a 37-year-old married woman. The woman came to see him for issues relating to pain medication dependence. Fortunately, my colleague is a thorough clinician and took the patient's sexual history as part of the intake interview. Through it, he found the patient completely stopped having sex over 3 years ago and became incredibly anxious when talking about it.

Posted on | Paul Hokemeyer, PhD, JD | Comments ()

I was discussing the concept of sexual anorexia with a colleague who was treating a 37-year-old married woman.  The woman came to see him for issues relating to pain medication dependence. Fortunately, my colleague is a thorough clinician and took the patient's sexual history as part of the intake interview. Through it, he found the patient completely stopped having sex over 3 years ago and became incredibly anxious when talking about it.

As a therapist who specializes in the treatment of addictive disorders, I see day in and day out how intricately connected sexual issues are to addictions. Both men and women who survive sexual abuse and trauma are at a higher risk for developing substance abuse problems than people who have not had negative sexual experiences. In addition, conflict over one's sexual identity is one of the reasons many people abuse alcohol and drugs. Essentially, when a person has a traumatic sexual past or troubling sexual present they use substances and methods to manage painful emotions.

Sexual anorexia is one of the ways people attempt to manage emotional pain. It’s a condition where a person starves their selves of sex. By closing the door on their sexual lives, these men and women feel a sense of mastery over their bodies, their lives and – most importantly – their emotions. Like other addictions, in the short run, this method of coping seems to work. Over time, however, shutting down one's sexuality extracts a dire toll. 

Four of the most common characteristics of sexual anorexia are:

  • Rigidity around sex (i.e. never having sex and/or refusing to discuss sex)
  • Fear of sex, sexuality and sexually related issues and objects (i.e. becoming anxious when the topic of sex is discussed, when other people express their sexuality, or when sexual objects such as lingerie are shown or discussed)
  • Shame and guilt around sex (i.e. feeling “damaged” because of your sexual past or current sexual desires)
  • Self-harm to avoid appearing sexual (i.e. gaining weight to avoid sexual advances from others)

Sexuality is a human drive. It serves a biological function and is one of the ways we celebrate our bodies, minds and our spirits. To deny ourselves sex is akin to denying ourselves food and air. In the long run, it’s harmful and has a punitive quality to it. The challenge, of course, is learning how to manage our uncomfortable emotions and express our sexuality in healthy and self-affirming ways.

Here, there is no one standard solution. Different approaches work for different people. The key is to create a sexual frame that is safe, contained, and objectively measured. A good example of such a frame is to come up with a strategic plan that outlines the steps one will take to engage in nurturing and safe intimate encounters. It’s also critically important to explore and understand the emotions that are beneath the behavior. Unless we are clear about what drives us, we are doomed to continue down a self-sabotaging path.  

It’s also important to remember that easy-does-it. Sexuality involves vulnerability, intimacy and trust. These qualities must be intuitively felt in ourselves and earned by others. 

Blog written by Paul Hokemeyer, PhD, JD
Paul Hokemeyer is a licensed attorney, researcher and Marriage and Family Therapist who works with individuals, couples and...