Eating Disorders and Sexuality
A Mirasol Panel Discussion
Estimates vary widely, but experts agree that there is a very high correlation between eating disorders and sexual abuse. So how do we begin to repair those damaged relationships, especially when clients may relate to sex the way they relate to food, engaging in behaviors that range from restriction to over-indulgence? It was a challenging topic for a panel discussion with therapists from Mirasol's adult and teen residential eating disorder treatment programs. As always, it reminded us of the many ways that our relationships with food both reflect and affect our interpersonal relationships.
- Diane Ryan, Executive Director
- Maeve Shaughnessy, Clinical Director, Adult Program
- Ann Twilley, Trauma Therapist
- Katie Klein, Clinical Director, Partial Hospitalization Program
- Jamelynn Evans, Primary Therapist
- Anne Ganje, Dietitian
- Kira Vredenburg, Primary Therapist
- Rachel Nelson, Art Therapist
Download Audio: M4A
Early relationships are the biggest determinant of the kind of relationships we have later in life ... And if those early relationships aren't established, especially in those first eight years of life, then people are going to struggle.
Ann T: "Early relationships are the biggest determinant of the kind of relationships we have later in life, whether that be romantic relationships, or platonic relationships. And so if those early relationships aren't established, especially in those first eight years of life, then people are going to struggle. If they do not get those relationships repaired, there are going to be challenges in how they develop connections with other people."
Diane R: "Certainly this is an area that's fraught with dysfunction. There was a big study done in the International Journal of Eating Disorders that reported that the vast majority — 70-something percent — of individuals with eating disorders struggle with various aspects of sexuality, whether it's loss of libido which is highly associated with low BMI. It's really a function of the whole pattern of relationship challengers that are created by attachment issues and that play out as time moves forward."
Ann T: "We consider attachment ruptures to be trauma, and eating disorders and trauma have a close relationship. I would say we see a 90% relationship between eating disorders and some type of sexual abuse. Research shows that with bulimia, there's a higher correlation with sexual abuse versus anorexia. I'm not convinced that's actually the case. With anorexia, there seems to be a higher level of dissociation, and it makes me wonder if they're just not able to get in touch with other things that have happened in their lives."
Katie K: "Especially with anorexia and restricting, it suppresses the sex hormones — estrogen and testosterone — so the libido is diminished, and they're in touch less with their bodies and with pleasure, and with having sexual relationships."
Diane R: "We have three separate components that play out. There's the physiological component — the hormonal part — and just the lack of physical wellness that shows up in sexual relationships, plus you have all the body image distortions and body dissatisfaction that are prominent in sexual relationships. And then you also have all the co-occurring conditions. I don't know that I've ever seen anybody who had an eating disorder and who didn't have something in addition to that. So the trauma piece is certainly paramount when you're talking about sexual relationships, but we're also talking about depression, social anxiety, sexual anxiety ..."
Katie K: "And also, some of our clients deny themselves any kind of pleasure. Asceticism is huge with our clients, and so the mere idea of having a sexual encounter and maybe even experiencing pleasure — they deny themselves that."
Moderator: "You touched on something a minute ago, which is that it seems that maybe sexual dysfunction related to an eating disorder can manifest itself differently in an anorexic versus a bulimic."
With bulimics, the typical profile is that they're more impulsive, whether it's substance abuse, sex, love addiction, shopping, gambling .... Whereas for anorexics, the typical profile is that they restrict is all senses — food, and also restrict relationships.
Katie K: "Yes, with bulimics, the typical profile is that they're more impulsive, whether it's substance abuse, sex, love addiction, shopping, gambling .... That tends to fit the profile of something who is struggling with bulimia. And so sometimes they tend to act out sexually as part of their co-occurring issues with their eating disorder. Whereas for anorexics, the typical profile is that they restrict is all senses — they restrict food, and also restrict relationships."
Diane R: "Harm avoidance becomes a really key component in the difference between anorexia and bulimia. The anorexic tends to that more restrictive, harm-avoidant profile that really plays out in terms of avoiding sexual relationships or intimate relationships."
Moderator: "In years past, Mirasol did not accept males, and was considered pretty much a women's program. And I know one of the concerns was that because there was such a high incidence of a history of sexual abuse, that it would be problematic for female clients who had experienced that to be around men. How have we resolved that, and how do we handle it when somebody has been abused, and all of a sudden here they are in this very intimate environment with a member of the opposite sex?"
Ann T: "In a residential community, it's about safety before anything else, and I think Mirasol does an amazing job of keeping their clients safe. The other side of that is, you cannot protect everybody all the time. And I think for me, I like have male staff here because I think it's really important for our clients to have experiences that can trigger them in a way that can bring up those issues. This is stuff for us to really attend to, and it's really important. If we shelter them completely, I think it's a problem."
Diane R: "I always enjoy it when boys come to the teen program because I find they're a little bit stabilizing. It modifies the behavior of some of the clients. Plus it adds another component, and another perspective, and I think that anything that adds to a broader perspective and a different understanding of who we are is always helpful."
I think that for the women I work with, objectifying themselves for men plays a role in their eating disorders. So by being [with males] in PHP, IOP or with the teens, they are able to have those healthy relationships with men where they learn not to act out and ... how to respect one another.
Kira V: "I think that for the women I work with, the piece of objectifying themselves for men plays a role in their eating disorders. So by being [with males] in PHP, IOP or with the teens, they are able to have those healthy relationships with men where they learn not to act out, and how to have a platonic relationship and learn how to respect one another."
Rachel N: "[In art therapy], one of the first things I ask them to do is to tease apart what is "me" and what is "the eating disorder", and after that, to do the "authentic self" doll. And people struggle so much with the authentic self doll. Some people just have no clue who they are authentically. I have had clients who have done that project two or three times, and it always changes depending on where they are in their treatment. I think part of what they're working on here is who they are. They have been disconnected for so long that sometimes it's kind of surprising what comes up."
Anne G: "It's always a metaphor for me, what I see in their relationship and interaction with food, viewing it as either something that's very scary, or something that's binge-worthy. It's a metaphor for where they're at with sexuality. And when someone comes in who is a very traditional anorexic, I can see this fear of having food in their body. That disconnect is so huge! And someone who is bingeing is not necessarily bingeing on sex, but they are filling that void — that sexual, intimate void — with food, and reaching for something that is very visceral, very physical, that you can hold onto to fill that need in place of sexual intimacy and touch. As clients progress and become more connected in their relationships with food, that sexual piece evolves, and it works out in therapy. When clients start talking about how they are beginning to able to taste and enjoy the taste, or texture or sight of food, I hear from their primary therapist that they're also doing some other work."
It's a rebirth, it's an awakening, that's how I see it. You're just learning about yourself. It's like learning to walk again.
Rachel N: "It's a rebirth, it's an awakening, that's how I see it. You're just learning about yourself. It's like learning to walk again. And so sometimes it's awkward, but I think it allows you to open up to support, so you can feel safe and set yourself up for not needing residential treatment for the rest of your life, but having that type of support moving forward, so that you can continue."