Understanding Sexual Anorexia

This article is more than 9 years old.

Recently, a close friend of mine had to cut short our visit so he could get to his weekly Sex and Love Addicts Anonymous meeting.

This friend, I'll call him Kevin, is a highly successful, functional person and a prominent community leader. He has close friends, family and a long-term romantic relationship. But he is, quite often, repulsed and terrified by sex. Let me clarify: On and off over decades, he's been terrified of sex with anyone he feels emotionally connected to or loves.

He described to me the intense panic when his live-in girlfriend (now wife) would initiate even moderate sexual overtures, saying that sometimes if she started kissing him or touched him in certain ways, he felt as if he were being physically attacked, and would experience shortness of breath, cringing and terror. When he felt that intense sexual aversion, he'd shut down, or run from any type of close physical connection.

However, when it came to emotionally disconnected sexual or erotic adventures, he was pretty much up for anything, frequenting strip clubs, hooking up with strangers (married, unstable women, for instance) or pining after completely unattainable and inappropriate prospects.

Now that he's going to 12-step meetings he identifies his condition this way: He is both a sexual addict and a sexual anorexic, which has been described as "an obsessive state in which the physical, mental, and emotional task of avoiding sex dominates one's life." Kevin explained that he'd either "act out" (through his obsession with and compulsion toward inappropriate sex) or "act in" (repelled by intimate, emotionally-laden sex, he'd steer clear of it altogether much as an anorexic self-starves to try to control intense, chaotic, shameful feelings.)

He offered this food analogy: "It's like I'm craving cotton candy day after day, but when there's a healthy, well-rounded meal, I won't eat it, I'm repulsed."

[module align="right" width="half" type="pull-quote"]He offered this food analogy: "It's like I'm craving cotton candy day after day, but when there's a healthy, well-rounded meal, I won't eat it, I'm repulsed."[/module]

I'd never heard the term "sexual anorexia" but as soon as Kevin raised it and described it as one extreme dimension of his overall sexual addiction, I began to see it all over the place. Newsweek's Dec. 5 cover story, for instance, warns of "The Sex Addiction Epidemic."

Sex addiction is also the focus of the new Steve McQueen film, Shame, about a young, attractive New Yorker's unrelenting addiction to anonymous, emotionally dead and seemingly pleasureless sex all over Manhattan — on the N train, in his Chelsea apartment, with prostitutes, whatever.

(Ed Koch wasn't crazy about the film. In a Dec. 5 review, he wrote: '“Shame” is an interesting picture but not one that I enjoyed. It is too clinical and without emotion in its relations.' Note to Ed: That's the point.)

The food analogy is an apt one here too, as McQueen describes the movie's protagonist in an interview in New York Magazine:

Brandon in Shame is someone who doesn’t eat — I think we see him eat once in the movie, and it’s just Chinese food while he’s surfing through Internet porn. It’s purely fuel, and he doesn’t get any enjoyment from it. His senses aren’t alive and awakened...and the same can be said for his sex life. He has the urge and compulsion to get involved with people, but without any emotional content, and without any sort of real pleasure being taken from it, you know?

(Kevin, by the way, said he can't bring himself to see the film — just watching the trailer made him "envious" and wanting to "act out. "I could feel the trailer stimulating that part of the brain I don't want to have stimulated," he said.)

Sex Addiction Deconstructed


Addiction, including sex addiction, has plagued humanity through history, of course. But perceptions of it have evolved, from viewing it as a personal act of transgression and social failure to a disease and more recently a specific disorder of the brain. (Though even that remains controversial.)

In 1983, the influential psychologist and expert on sexual addiction Patrick Carnes, Ph.D wrote the groundbreaking book, "Out of the Shadows: Understanding Sexual Addiction," which examined the condition and placed it in context. Carnes' 1997 book, "Sexual Anorexia: Overcoming Sexual Self-Hatred" was the first in-depth exploration of the phenomenon (he coined the term) and its complexities, and he also offers stories of patients who recovered. Carnes is now executive director of the Gentle Path program at Pine Grove Behavioral Center in Hattiesburg, Mississippi.

"The reality is that our number one public health problem is addiction," Carnes said in an interview. "But when it comes to sexual is so hard to talk about in our culture."

The prevalence of sexual addiction in the U.S. has most often been cited as 3-6% of the population. Carnes' office told me there are no prevalence studies on sexual anorexia as far as they know.

Sex, Food And Shame

Carnes describes the parallels between sex and food, and how anorexia can play out in either realm. Both sex and food are part of our wiring for survival, and both have sensual qualities, he says. "Like in eating, you have people in self-starvation and they also binge and purge. It's the same in sexual starvation, which can be followed by a cycle of binge and purge...there's a connection between the two extremes."

People with sexual anorexia, he said, can endure a decade of acting out and then a decade of no sex at all, or a person can have no sex with a spouse and act out with lots of anonymous sex outside the marriage.

And it all comes back to shame, feelings of "defectiveness of the self," a terror about your own sexuality, Carnes said. "You try to reach an unreachable barrier — like a superhuman diet with such restricted calories you can't manage — and then you binge and feel shame."

This type of behavior used to be judged as a moral failure and characterized as promiscuous, says Suki Hanfling, a clinical social worker, therapist and director of The Institute for Sexuality & Intimacy in Waltham, Mass. "Women might have been called 'whores' and men were labeled 'Don Juan's' or 'dirty old men,'" she said.

Now, with a greater understanding of sexual compulsion and addiction and how the condition changes the brain, treatment is much more targeted and successful, she says.

Becoming "Endemic"

Still, the related conditions of sex addiction and anorexia are really just beginning to enter the mainstream, she said. For more than 10 years, Hanfling ran the Human Sexuality program at McLean Hospital in Belmont, Mass. She says during that time, she rarely got a call about sexual addiction or, at the other end of the spectrum, sexual anorexia. Only in the last six to seven years, after launching her private practice, has the condition — which she describes as an inability to combine sex and emotional intimacy — "become endemic."

The Internet, of course, has only accelerated and deepened the problem.

My friend Kevin says in his 12-step SLAA groups, men talk about having been drawn inexorably toward pornography for many years. But with the proliferation of the Internet, he says, they describe a heightened level of intoxication: It's like the arrival of crack cocaine, easily accessible, cheap and with a much more powerful kick.

Derek Polonsky, a Brookline, Mass. psychiatrist specializing in couples and sex therapy, told me that such easy access has so compounded the problem that he now treats young, adolescent boys who are so addicted to Internet porn that they have trouble forming sexual relationships with real people.

Kevin says his own problems, however, revolve around intrigue with or fantasies about actual human beings rather than virtual, online pornography.

He describes a woman he met at a meeting whose story resonated with him deeply. Her job requires performing in front of a crowd, and she recalled being on stage and looking out at the audience thinking, 'I could take home any man here." After her shows, she'd hang out at the bar "and take some schmuck home to bed,' Kevin says. "That's exactly the feeling I had when I gave public speeches," he says. "I'd stand in front of a room and think about who I could flirt with from the stage, and take home anyone."

Kevin's been in and out of various types of therapy for decades, and one psychologist told him his symptoms are consistent with some kind of earlier abuse, but he says if that did happen, he has zero memory of it.

Doctors, Lawyers, Sex Addicts

The 12-step meetings have been enormously helpful, he says, and he hasn't acted out for some time. "That's the benefit of the group," he says. "You can go in there and say, 'I'm not the only one who's had this sensation. There are really accomplished, successful people at the meetings — lawyers, doctors — they're highly functional. Before I went to a 12-step group, I thought, 'This is going to be a bunch of perverts and losers,' but actually, it's people who are a lot like me." He's recently become friendly with a highly respected doctor who gets off work and drives around low-income parts of town and picks up prostitutes.

Still, even with more support groups, greater awareness and better treatment, Suki Hanfling says living with sexual anorexia remains "a very lonely place to be."

Readers, if any of this resonates with you, see this concise rundown of sexual anorexia from the International Institute for Trauma & Addiction Professionals (which Carnes founded):

...while the food anorexic is obsessed with the self-denial of physical nourishment, the sexual anorexic focuses his or her anxiety on sex. As a result, the sexual anorexic will typically experience the following:

--A dread of sexual pleasure
--A morbid and persistent fear of sexual contact
--Obsession and hyper vigilance around sexual matters
--Avoidance of anything connected with sex
--Preoccupation with others being sexual
--Distortions of body appearance
--Extreme loathing of body functions
--Obsessive self-doubt about sexual adequacy
--Rigid, judgmental attitudes about sex
--Excessive fear and preoccupation with sexual diseases
--Obsessive concern or worry about the sexual activity of others
--Shame and self-loathing over sexual experiences
--Depression about sexual adequacy and functioning
--Self-destructive behavior to limit, stop, or avoid sex

Both men and women can suffer from sexual anorexia. Their personal histories often include sexual exploitation, some form of severely traumatic sexual rejection or both. It is also possible that a person can be both sexually addicted and sexually anorexic, acting out sexually in meaningless relationships, and paralyzed sexually with intimate relationships.

This program aired on December 9, 2011. The audio for this program is not available.

Rachel Zimmerman Twitter Health Reporter
Rachel Zimmerman previously reported on health and the intersection of health and business for Bostonomix.