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A brief look at sexual anorexia

Today’s blog takes a brief look at ‘sexual anorexia’ that according to Dr. Douglas Weiss in his 1998 book Sexual Anorexia, Beyond Sexual, Emotional and Spiritual Withholding, typically refers to “the active, almost compulsive withholding of emotional, spiritual and sexual intimacy from the primary partner”. The 12-Step group Sex and Love Addicts Anonymous offers this definition and analogy: 

“As an eating disorder, anorexia is defined as the compulsive avoidance of food. In the area of sex and love, anorexia has a similar definition: Anorexia is the compulsive avoidance of giving or receiving social, sexual, or emotional nourishment”.

A paper by Dr. Randy Hardman and Dr. David Gardner in a 1986 issue of the Journal of Sex Education and Therapy compared anorexia nervosa and sexual anorexia. They highlighted the four most significant characteristic similarities of these self-perpetuating disorders from both an intrapsychic and interpersonal level. These were (i) control (i.e., overt personal control and covert relationship power), (ii) fear (i.e., fear of losing control and fear of personal sexuality), (iii) anger (i.e., passive and active expressions of anger based on devaluation), and (iv) justification (i.e., an elaborate system of denial, delusion, and misperception).

Along with Dr. Weiss, most of the key writings on the topic have been written by Dr. Patrick Carnes (the author of many articles and books on sex addiction). Dr. Carnes defines sexual anorexia as: “an obsessive state in which the physical, mental and emotional task of avoiding sex dominates one’s life. Like self-starvation with food, deprivation with sex can make one feel powerful and defended against all hurts.” In a 1998 paper in the journal Sexual Addiction and Compulsivity, he also notes that: “the term “sexual anorexia” has been used to describe sexual aversion disorder [in the Diagnostic and Statistical Manual of Mental Disorders], a state in which the patient has a profound disgust and horror at anything sexual in themselves and others”. According to the Wikipedia entry on sexual anorexia, the term ‘sexual anorexia’ has been around for over 35 years, and the first use it the term is generally attributed to psychologist Nathan Hare, a psychologist who coined the term in his 1975 PhD thesis. (However, I have failed to track this down, and none of the academic papers I have read on sexual anorexia ever mention Hare).

Dr. Carnes claims to have identified three causative factors in the formation of sexual anorexia. These are (i) a probable history of sexual exploitation or severely traumatic sexual rejection, (ii) family history of extremes in thought or behavior (often very repressive/religious or it’s polar opposite of “anything-goes" permissiveness), and (iii) cultural, social or religious influences that view sex negatively and supports sexual oppression and repression. Dr. Weiss adds that there are three key criteria in the formation of anorexia: (i) sexual abuse, (ii) attachment disorder with the opposite sex parent and (iii) sex addiction

In his 1997 book Sexual Anorexia: Overcoming Sexual Self-Hatred, Dr. Carnes views the symptom cluster of the sexual anorexic as primarily sexual and includes: (i) a dread of sexual pleasure, (ii) a morbid and persistent fear of sexual contact, (iii) obsession and hyper-vigilance around sexual matters, (iv) avoidance of anything connected with sex, (v) preoccupation with others being sexual, (vi) distortions of body appearance, (vii) extreme loathing of body functions, (viii) obsessional self-doubt about sexual adequacy, (ix) rigid, judgmental attitudes about sexual behaviour, (x) excessive fear and preoccupation with sexually transmitted diseases, (xi) obsessive concern or worry about the sexual intentions of others, (xii) shame and self-loathing over sexual experiences, (xiii) depression about sexual adequacy and functioning, (xiv) intimacy avoidance because of sexual fear, and (xv) self-destructive behavior to limit, stop, or avoid sex.

The 1998 paper published in the journal Sexual Addiction and Compulsivity by Dr. Carnes is one of the very few in the literature to collect empirical data. The data were collected from 144 patients at his treatment clinic that were diagnosed with sexual anorexia. Of these, 41 percent were male and 59 percent female aged between 19 and 58 years (all of whom were Caucasian). The main findings were that:

• 67 percent reported a history of sexual abuse

• 41 percent reported a history of physical abuse

• 86 percent reported a history of emotional abuse

• 65 percent reported members of the immediate family as some type of addict

• 40 percent reported having a sex addict in the immediate family

• 60 percent described their family as “rigid”

• 67 percent described their family as “disengaged”

Carnes also reported that over two-thirds of the sexually anorexic population claimed to have other compulsive and/or addictive problems including alcoholism (33 percent), substance abuse (25 percent), compulsive eating (25 percent), caffeine abuse (26 percent), nicotine addiction (23 percent), compulsive spending (22 percent), and/or bulimia/anorexia with food (19 percent).

Of most interest was the fact that Carnes compared his group of sexual anorexics with a group of sex addicts (also from his treatment centre). Carnes concluded that:

“By contrasting that profile with data from sex addicts who were in the same patient pool, some important contrasts can be made. The data for sex addicts and sexual anorexics were very parallel in terms of family system, abuse history, and related patterns of addiction, compulsion, and deprivation. Even the criteria for sex addiction and sexual anorexia have important parallels in terms of powerlessness, obsession, consequences, and distress…Such comparisons tend to confirm the proposition that extreme sexual disorders stem from many of the same factors and are variations of the same illness. Of equal importance is the possibility that extreme behaviors in various disorders (food, chemical, sexual, financial) whether in excess or in deprivation are for many patients interchangeable parts representing much deeper patterns of distress”

Finally, if you would like to know if you are sexually anorexic, you can take this simple test that I found at the Freedom In Grace website (and appears to be based on the world of Weiss and Carnes). If you endorse five or more of the following nine statements “you or your partner are currently struggling with sexual anorexia”.

• Withholding love from partner

• Withholding praise or appreciation from partner

• Controlling by silence or anger

• Ongoing or ungrounded criticism causing isolation

• Withholding sex from your partner

• Unwillingness or inability to discuss feelings with partner

• Staying so busy that they have no relational time for the partner

• Making the problems or issues about your partner instead of owning their own issues

• Controlling or shaming partner with money issues

References and further reading

Carnes, P. (1997). Sexual Anorexia: Overcoming Sexual Self-Hatred. Center City, MN: Hazelden.

Carnes, P. (1998). The case for sexual anorexia: An interim report on 144 patients with sexual disorders. Sexual Addiction and Compulsivity, 5, 293–309.

Hardman, R.K. & Gardner, D.J. (1986). Sexual anorexia: A look at inhibited sexual desire. Journal of Sex Education and Therapy, 12, 55-59.

Nelson, Laura (2003). Sexual addiction versus sexual anorexia and the church’s impact. Sexual Addiction and Compulsivity, 10, 179–191.

Sex and Love Addicts Anonymous (undated). Sexual anorexia. Located at: http://www.slaauk.org/files/anorexia.pdf

Weiss, D. (1998). Sexual Anorexia, Beyond Sexual, Emotional and Spiritual Withholding. Fort Worth, TX: Discovery

Weiss, D. (2005). Sexual anorexia: A new paradigm for hyposexual desire disorder. Located at: http://www.sexaddict.com/eBooks/SAeBk.pdf

Wikipedia (2012). Sexual anorexia. Located at: http://en.wikipedia.org/wiki/Sexual_anorexia

Dr. Mark Griffiths is a Chartered Psychologist and Director of the International Gaming Research Unit in the Psychology Division at Nottingham Trent University (UK).

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