The term sexual anorexia is one (amongst many) that causes a fair bit of conflicting discussion in the addiction treatment and therapy field. For some the term trivialises the more serious eating disorder conditions by seeking to give credibility to a behavioural pattern that is not pathological. For others the two conditions share similar characteristics such as control, fear, anger, and justification. The term was first adopted by Dr Patrick Carnes, a visionary in sexual addiction treatment for some or a sexologist that perpetuates the myth of the disease model for others, who published many ground breaking books including Out of the Shadows and Sexual Anorexia. Julia Hare also used the term in the book The Sexual and Political Anorexia of the Black Woman in June 2008.
In common with the term ‘sex addict’ a sexual anorexic is a term that is not, however, formally recognised in the psychiatric setting. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the so-called clinical diagnostic bible used by mental health professionals and published by the American Psychological Association (APA), does not recognise the condition as a panel of psychiatrists have not yet come to decisive decision making around clusters of behaviour. The DSM can have its uses as it allows for specific diagnostic criteria for a range of mental health disorders, in addition to providing a series of codes that help practitioners to arrive at summaries around complex conditions for insurance companies as well as offering other applications that facilitate quick referencing. Whilst these standardising approaches can be useful there are risks that clinicians might pathologise alternative behaviour or over-diagnose presenting issues. Similarly, the panels of psychiatrists that come to decisions about what may be deemed a mental health condition will reflect societal norms and values. It is important to remember that homosexuality, for instance, was classified as “sexual orientation disturbance” in the third iteration of the manual so the risks of stigmatising behaviour when seeking to classify conditions are high.
In assessing sexual anorexia it is worth thinking of comparisons about actual psychiatric conditions. Hypoactive sexual desire disorder (HSDD) is considered a sexual dysfunction by the DSM, whereby a person has no interest in engaging in sexual intercourse and sexual play. This diagnosis, which also has its fierce critics (chiefly that lack of sexual desire may not be maladaptive), is characterised as a lack or absence of sexual fantasies and desire for sexual activity. An appropriately qualified clinician will seek to ascertain whether it is causing marked distress or interpersonal difficulties and is not better accounted for by another mental disorder (such as depression, for example), by a drug, or by some other medical condition. HSDD can be general (a general lack of sexual desire) or situational (still has sexual desire, but lacks sexual desire for current partner), and it can be acquired (HSDD started, for example, after a period of normal sexual functioning) or lifelong (the person has always had no/low sexual desire.). In the DSM-5 classification, HSDD was split into male hypoactive sexual desire disorder and female sexual interest/arousal disorder. Sexual anorexia can be different in that a person can engage in a vivid sexual fantasy life in spite of staying away from physical sex. They can have a creative fantasy life, engage in other sexual play and are often dual addicted (alcohol, drugs and gambling being examples). A sexual anorexic may exhibit symptoms of a social phobia or feel so emotionally vulnerable that the risk of rejection or criticism from a possible partner entails greater fear than the prospect of being isolated.
A period of enforced social isolation can be extremely challenging especially since self protection schemes and avoidance strategies may be reinforced and hardwired leading to deeper introspection and anxiety. A sexual anorexic may experience an internal emotional imploding in the absence of a strong social support structure and a declining self-care regime. The absence of external routines and distractions can be felt acutely. For more on this see my article on sexual anorexia during a period of social isolation.
Noel Bell is a UKCP accredited psychotherapist and can be contacted on 07852407140 or noel@noelbell.net
