National Association of Anorexia Nervosa and Associated Disorders (ANAD)
One thing that I notice about myself is that I have an aversion to sex. This can’t be from the anorexia, can it?
This may surprise you, but yes, it can. Remember Ancel Keys and his classic semi-starvation study? Some of the outcomes noted in this study were the changes that took place in social relationships and sexual desire. With increased calorie restriction and duration of weight-loss, participants became progressively more withdrawn, social contacts with the opposite sex diminished sharply, and interpersonal relationships took on a strained tone. According to accounts, the sexual interests of the volunteers dramatically decreased.
Sexual impulses, fantasies, and masturbation either ceased or dramatically diminished. This finding is particularly salient to your question. In fact, it has been suggested that for some adults who have sexual conflicts, dieting and severe food restriction may actually be an attempt to curtail sexual concerns and discomfort. According to the Handbook of Treatment for Eating Disorders, some adolescent patients may engage in restrictive dieting in the hope of delaying sexual maturity, reducing the appearance of secondary sex characteristics, and diminishing sexual concerns at a time when they feel unprepared to embrace their own sexuality. The presumption is that sexual intimacy can be avoided by making the body less aesthetically appealing and diminishing the appearance of an “adult sexual being.”
Heightened body consciousness and body image issues may likewise contribute to increased sexual aversion among eating disorder patients. For patients who experience body image distortion, it can be difficult enough to view their own naked bodies; to be naked with another is unthinkable.
In Gaining: The Truth about Life after Eating Disorders, author Aimee Liu, herself a former anorexia patient, states: “among people with eating disorders, the realm of sexuality is particularly fraught.” Liu cites two scientific studies that demonstrate that eating disorder patients have lower than normal sexual arousal, desire, and orgasmic functioning, along with increased “sexual discord.” Issues of trust, vulnerability, shame, and intimacy are significantly heightened in a sexual relationship or encounter—issues that can be particularly uncomfortable for anorexia patients. As Liu confirms, whether a precursor or an effect of the illness, sexual intimacy is one area of social and emotional functioning that may be dramatically impacted by anorexia nervosa.
My daughter has been recovered for a couple of years and is doing well. I am concerned because she has made friends with a couple girls who look really underweight and unhealthy. Should I worry that her friendships could lead to a relapse?
This can be a difficult question to answer. On the one hand, peer weight-loss behaviors and dietary restriction among close friends have been shown to influence adolescent attitudes about food and weight. If a teen wants to feel “part of the crowd” or be accepted by a group of peers who emphasize thinness, it can be difficult to go against the tide of peer attitudes.
Social peers who engage in eating disorder behaviors such as calorie restriction and purging can be a source of vulnerability for someone at risk. On the other hand, research
also shows that supportive friendships can both protect teens from developing an eating disorder and may help in recovery from an existing eating disorder.
You may want to speak with your daughter in a gentle, nonthreatening way that does not accuse her friends, but instead encourages open and honest communication. You will want to know if your daughter notices any high-risk behaviors or harmful attitudes toward food, weight, and body shape in her friends. Ask her if their behaviors have been discussed among the group. Perhaps her friends are in treatment themselves; if so they may be a source of support for your daughter and friends with whom she feels comfortable sharing her own experiences of recovery. If they are not in treatment, or if they appear to be encouraging eating disordered behavior, you may want to consider limiting the amount of contact she has with them. However, you should approach this matter very carefully with your daughter, as a teen’s friendships can be an extremely important and influential source of support. Be careful to not attack her friends, judge them, or put them down in any way.
Instead, communicate your reasons for concern. Also, consider speaking with her in private, not when her friends are present. You will want to ensure there are other avenues
for support in your child’s life to prevent feelings of isolation, peer rejection, and resentment, all of which can trigger eating disorder symptoms. It may be helpful to suggest that your daughter discuss this matter with her treatment team for additional support. Lastly, you may want to communicate to your daughter that you will remain open to discussing this matter with her periodically; amending the need for limited contact with this group should the situation change.
I think I may have an eating disorder, but I’m not ready to get help for it. I don’t want my family to be concerned, so I’m hiding my weight loss from them. I also usually eat alone and hide how much I exercise from them. I don’t know how much longer I can keep this up. What should I do?
Hiding behaviors associated with anorexia is quite common. It is not unusual for someone with anorexia to live certain aspects of their lives in secret, eating alone, weighing them when no one is looking, purging in secret. Individuals may also lie to loved ones about their behavior (e.g., “I’m just not hungry because I ate a big lunch,” or, “This outfit just makes me look thin.”); however, the reality is that lying about your illness and hiding your eating disorder is only cheating yourself.
One reason you may feel “protective” of your eating disorder is that unlike with other mental illnesses, such as depression or anxiety, the symptoms of anorexia are “ego-syntonic,” a technical term that means the behaviors and feelings associated with anorexia are often welcome and acceptable to patients, rather than distressing and uncomfortable. Indeed, many anorexia patients reportedly experience certain “benefits” from their illness. A 2002 issue of the European Eating Disorders Review recorded some of these perceived benefits, as expressed by patients in recovery.
Responses included:
• “Anorexia gives me a sense of control.”
• “Anorexia is my way of avoiding serious problems.”
• “Anorexia is my way of escaping thoughts about myself that I do not like.”
• “Anorexia distracts me from my painful emotions.”
• “Anorexia allows me to avoid my fears about sex and sexuality.”
• “Anorexia makes me feel unique and special.”
Feelings such as these serve to reinforce anorexic behaviors and cause patients to feel stuck. They may know anorexia is not good for them, but they do not know what else to do.
The writers of Anorexia Nervosa: A Guide to Recovery put it this way: “Anorexia is a paradox, because while it is slowly killing you, it is also serving you in some way. It is natural to fear the uncertainty of what life would be like without it.”
Eating disorders are dangerously insidious. Although you may not feel ready to tell your family, please consider telling someone.
Your doctor, therapist, teacher, school nurse, a trusted friend (another person who is not struggling with an eating disorder themselves). If you are able to tell even one trusted person who is concerned for your health and safety, you can reduce the sense of living in secret and isolation-and you may then feel more ready to receive help. It is far better to take steps to arm yourself against the devastating consequences of this illness than to let it have the upper hand. Please, don’t be silent any longer. Tell a trusted loved one what you are going through.
For over a decade, I believed that I hid my eating disorder from family and friends. Most people close to you actually know more than you think about what is going on, but they don’t know what to do or how to help, which is even more stressful for them. There was a lot of denial involved for me. I believed I knew what I was doing and that I knew better than friends, family, coaches, and doctors. I had national records in races to confirm this in my mind.
As the disease progressed, I could feel and sense the dangers, yet the fear of losing control and the fear of gaining weight were as strong (often stronger) than the fear of dying. The longer I stayed in the disorder, the harder it was to get out. Ironically, the more I wanted to feel in control by staying in the anorexia, the more the anorexia controlled me. When I finally did try to get help, I discovered that no one could “control me” out of the disorder. No one can ever force you in the long run to eat and gain weight. I would always have the choice to stay in the eating disorder and allow it to control me and even kill me. Recovery was much different than I expected. In recovery I truly did learn how to take control of my own life, and the world then seemed to open up to me in ways I never imagined.
Sarah shares:
For a long time I tried to hide my strange behaviors from friends and family. I told everyone at school that I had an overactive thyroid gland and that I just ran for fun. But despite my attempts to be sly, I don’t think anyone was fooled by my act. I let my eating disorder get to the point where there was no more hiding it, and even then, letting go of anorexia was one of the scariest things imaginable.
An eating disorder is not just a made-up sickness that you can cure
on your own, and as terrifying as it might seem to let go of your eating disorder and live a normal life, it is SO much scarier to let it get the best of you. My parents had to literally drag me to the door of my treatment center, and though I never thought I would say it, going to treatment was the best thing that has ever happened to me.
It is not unusual for someone with anorexia to live certain aspects of their lives in secret.
