In his early 40s, William had neither dated nor had sex with a woman. His promiscuous, alcoholic mother had affairs, driving his father to suicide; had sex with one of his friends; and made sexual advances toward him as well. He isolated himself, found sex repugnant because he couldn’t trust women, and attempted suicide before seeking help.
Nancy was a 38-year-old virgin who fell in love with a gay male friend who couldn’t reciprocate her feelings. When she was a child, her alcoholic parents had violent fights and neglected her, so she turned to a neighbouring couple who looked after her—in exchange for mutual masturbation. At the age of 14, she vowed not to have sex again.
These are two examples cited in a study of a sexual disorder termed sexual anorexia (only first names were used in the study) by Patrick J. Carnes, founder of the certified sex-addiction therapist program at the International Institute for Trauma and Addiction Professionals; he’s written about addiction and recovery issues, including the 1997 book Sexual Anorexia: Overcoming Sexual Self-Hatred.
In “The Case for Sexual Anorexia: An Interim Report on 144 Patients With Sexual Disorders”, published in a 1998 issue of the journal Sexual Addiction and Compulsivity, Carnes explains that the term sexual anorexia is used to describe what the Diagnostic and Statistical Manual of Mental Disorders calls sexual aversion disorder: a condition characterized by disgust, fear, lack of desire, and avoidance of sexual situations.
Carnes describes sexual anorexia as “an obsessive state in which the thought of being sexual by oneself or with others is almost unbearable”.
He explains that at its core are an excessive hatred and fear of sex that come from the same root cause as sexual addiction: a sense of powerlessness. It’s the inverse of the behaviour of sexual addicts, who act out by engaging in compulsive sexual acts.
In the same way that people who have anorexia severely restrict food intake as a means of maintaining power or resisting external control, those with sexual anorexia deprive themselves of sexual activity and have a disproportionate fear of or anxiety about sex related to a sense of control.
Carnes also notes that people with sex addictions and those who have sexual anorexia have parallel distorted belief systems about being unlovable and self-perpetuating behaviour cycles involving shame.
Paulette Tomasson, a Vancouver-based registered clinical counsellor and sex-addiction therapist, has worked with addiction issues since 1985 and sex addiction since 2000, and addresses sexual anorexia in her practice.
On the line with the Georgia Straight, Tomasson recalled that she first learned about sexual anorexia when Carnes spoke about sex addiction at a codependency treatment program in Tennessee where she was working.
“He came in and it was just, like, ‘Oh my god.’ The light went off and it was like, ‘This is what I’ve been dealing with, but I didn’t have words for it.’ ”
Tomasson said that terms such as frigid for women and impotent for men have often been used to describe what could be sexual anorexia. The term isn’t widely recognized by psychologists, counsellors, or sexual-health researchers, and it’s even up for debate whether what it describes may actually be something else, such as low sexual desire or asexuality.
“What sexual anorexia is to me is another frame of reference to look at some of the problems that people have around their wounded sexuality,” Tomasson said. “It’s a way of responding to a wound.”
Due to the internal nature of the behaviour, sexual anorexia is often hard for others to recognize.
“The eating-disorder anorexia—you can see it,” Tomasson said. “But do you think anorexics would go for help if people weren’t at them about their weight loss? So sexual anorexia is invisible. So no one really asks the questions and rarely do people come in and say, ‘You know, I think this is what it is.’ ”
Tomasson said she’s had clients who discover they’re sexually anorexic after being engaged solely with pornography for an extended period of time.
“It’s easy for them to get involved with a nonhuman, but it’s not easy for them to get involved sexually with a human, and so they’ve got this whole intimacy disorder and then they realize that they’re shut down. They need that…stimulation of the porn, and they have all kinds of body-image things that are going on for them. They despise their bodies. They have self-loathing around their bodies.”
Carnes states in his book that the disorder usually begins with a childhood experience of abandonment or betrayal.
Tomasson said it can be traced to developmental trauma in which “expectations [are] put on the child that’s beyond their growth and development.” Examples she gave include covert sexual abuse: being exposed to sexual content or experiences without feeling emotionally or psychologically capable of dealing with them, overhearing parents fighting about sexuality, or parents sharing personal information before the child is ready for it.
As with eating disorders, the underlying issue is an excessive need for control. The behaviour is reinforced by the sense of power people derive from it.
“When someone has an intimate relationship you’re vulnerable, and so you’re exposed and you lose control,” Tomasson said. “Orgasm is the body’s loss of control. When we’re in an orgasm we have no control, and anorexics don’t like to lose control.”
This extreme self-regulation squelches not just the capacity to have sex, but enjoyment of life.
“They can’t have fun. They just shut down. They can’t open up to be vulnerable, and they can’t open up to lose control. They feel very unworthy around their sexuality, and they have shame around their sexuality and their body.”
If a sexual anorexic does have a partner, the lack of sex creates stress and strain in the relationship.
“The partner is then left thinking, ‘There’s something wrong with me. I’m not attractive.’ It really works on their sense of sexual well-being.…It just starts to erode the relationship.”
There aren’t any 12-step programs devoted to sexual anorexia or any dedicated treatment centres in B.C., but Tomasson said that sex-addiction therapists address the same core issues, namely the negative effects on the client’s life.
“It doesn’t matter what the diagnosis is. What you’re trying to do is help people get in touch with their passion.”