Sexual Anorexia in Marriage

By

Praveen K Rudra.

Submitted
to

Prof. Dan Keefer

Lancaster Bible College

In Partial Fulfillment of the Requirements for

CPS 527: Human Sexuality

Fall 2014

Chapter 1
Sexual Anorexia in Marriage
Introduction
As we turn our newspapers or switch on to our news channels we hear daily about cases
of people suffering with sexual addictions or sexually depended behavior who cannot resist to
sexually abuse others irrespective of their age, gender and we start wishing what if the world had
people who are opposite to sexual addicted i.e. being sexually aversive or sexually anorexic and
to our surprise the world does have people who are Sexually Anorexic but not much focus is
given to people who are suffering with this type of behavior and the struggles that they go
through.
So what is sexual Anorexia, we have always heard about Anorexia is something affiliated
to Eating Disorder, in this research paper we would be looking at the other side of anorexia
which is related to Sexual Disorder. Those two areas are quite distinct to be related to each
other, but the definition of anorexia still remains the same. Anorexia which is derived from a
Greek word Orexis meaning Appetite while An-Orexis meaning Without Appetite.
While Sexual Anorexia is defined as a Pathological Loss of appetite for romantic-sexual
interaction, which means having little or no desire for sexual contact. People suffering with this
behavior usually tend to be suffering with intimacy issues; i.e. they dont mind being sexual with
strangers or even having a one-night stand, but the fear of being intimate or showing love and
affection to their partners dreads them the most, due to which they get to a deliberate sexual
avoidant behaviors with their partners leading to disturbances in their personal life. There isnt
any solid evidence or research to back the specific reasons in explaining why this behavioral

pattern occurs in a sexual anorexic, but According to Alexandra Katehakis Founder and Clinical
Director of the Center for Healthy Sex says that for the anorexic, the possible rejection he or she
might encounter from another human being is just too threatening (Katehakis, A.2014). So the
fear of rejection forces them in being isolated from others and society and to avoid any
developing relationships. While Alexandra Katehak also suggests that this behavior might be the
result of sexual abuse, body dyspareunia, highly repressive upbringing, rigidity, judgment and
shame in the life of sexual anorexic (Katehakis, A.2014)
Issues to be addressed
Definitions explains that being sexual anorexic not just affect the spiritual aspects of their
personal life leading them to a depression, hopelessness, devastated self-esteem as well as in
sometimes becoming sexually anorexic themselves. This paper addresses the some of the issues
relating to the primary causes, in addition to some of the symptoms of becoming sexual anorexic
and consequences on how being anorexic affects their partner in their relationship. Thereby
emphasizing at the different diagnostic aspects from medical as well as therapeutic perspective
which can help the anorexic patient to overcome this struggle.
Definition of Terms
Sexual Anorexia Sexual anorexia is an obsessive state in which the physical, mental,
and emotional task of avoiding sex dominates ones life. Like self-starvation with food or
compulsive dieting or hoarding with money, deprivation with sex can make one feel powerful
and defended against all hurts.
Sexual Aversion Disorder Severe anxiety or disgust at the thought of sexual activity

Sexual interest/Desire Dysfunction Diminished or absent feelings of sexual interest or

desire, absent sexual thoughts or fantasies and a lack of responsive desire (Lewis, R. 2006)
Sexual Abuse Any interaction between a child and an adult (or another child) in which
the Child is used for the sexual stimulation of the perpetrator or an observer.
Emotional Abuse Any act including confinement, isolation, verbal assault, humiliation,
intimidation, infantilization, or any other treatment which may diminish the sense of identity,
dignity, and self-worth."
Research Goal and Focus
This paper analyzes the reasons behind someone becoming sexually anorexic. While also
understanding and examining the impact of anorexia in the life of their partners and what goes
through them knowing about their partner as sexually Anorexic. Furthermore shedding light at
the others aspects on how to have a non-sexual affection, which can act as cure for the emotional
and psychological scars which were experienced during those past years of their marriage.

Chapter 2
History of Sexual Anorexia
There was many cases reportedly suffering with lack of sexual desire or intimacy in
relationship with their partners before. But in the early versions of DSM only two sexual
dysfunction were listed those were Frigidity for women and Impotence for men. However
during 1970 Masters & Johnson published a book called Human Sexual Inadequacy where
in they talked about other sexual dysfunction which basically included dysfunction related to
genitals. As during this era sexual dysfunction was considered to be something more related to
physical dysfunctions of a human body rather than the emotional and psychological side of a
person. Although during 1975 psychologist Nathan Hare used the concept of Sexual Anorexia in
his dissertation for Ph.D. Later it was Sylvian Kaplan while he was the member of DSM III in
year the 1980 made a proposal to the American Psychological Association (APA) task force for
Inhibited Sexual Disorders for DSM III. Later in the year 1987 it was revised by sub-dividing the
disorder into 2 categories namely Hypoactive Sexual Desire Disorder and Sexual Aversion
Disorder. Under Sexual Aversion Disorder comes Sexual Anorexia which is a Subtype according
to DSM IV, while in DSM V Sexual aversion disorder has been removed because of its rare use
and lack of research to Support it (4th ed., American Psychiatric Association, 1994).
During the year 1975 psychologists Dr. Patrick Carnes who was the pioneer in the study
relating to sexual behaviors did a study on sexual anorexic and in the year 1997 published a book
called Sexual Anorexia. While Dr. Douglas Weiss a psychologist published a book Sexual
Anorexia, Beyond Sexual, Emotional and Spiritual Withholding. These were the most
prominent ones to do research in this field, followed by many other psychologists recently.

Sexual Anorexia
Sexual Anorexia which is a considerably a new term in the field of Sexual Addiction is
defined by Dr. Patrick Carnes as Obsessive State in which the physical, mental and emotional
task of avoiding sex dominates ones life (Carnes, 1997). Which means People suffering with
sexual anorexia suffer with an obsession of engrossing themselves in thoughts of avoiding any
sexual contacts with their partners, this obsession takes over their physical strength by making
them less effective in things which they are supposed to put in their efforts at, thereby reducing
their productivity in their work place or the other areas of their life, and emotionally living with
fear of having any physical contact with their partners further it affects them mentally with the
thoughts of how to avoid any sexual moves from their partners. On the whole, it paralyzes their
life to an extent. While Dr. Douglas Weiss definition of sexual anorexia also includes the most
important area of human life which is that Spirituals side and he defines sexual anorexia as, The
active, almost compulsive withholding of emotional, spiritual and sexual intimacy from the
primary partner (Carnes, 1997).

Understanding Sexual Anorexia in the light of Sexual Addiction:

Dr. Patrick Carnes in his book Sexual Anorexia: Overcoming Sexual SelfHatred collates sexual anorexia with a negative of a black and white photograph, where in all
the shades of black and white are seen reversed (Carnes, 1997). As he uses this illustration he
wants us to understand that the addiction and anorexia are same shades of an obsession. The
Sexual curve which helps us to visualize the degree of sexual experience and also to understand
the difference between the anorexia and addiction is show below.

Sexual Anorexia
Sexual Addiction

Less
Hypoactive Sexual Desire

More
Hyperactive Sexual Desire

Sexual Curve is divided into two areas; most of people tend towards more or less part of
the curve. Some of them fall to the right of the curve which means their sex life is extreme
fulfilling, while some people fall at the extreme right of the curve, these are the people, who have
difficulty in stopping their sexual behaviors and they act out on their behaviors; these are called
as Sex Addicts , While people Consider Sexual addicts are people who lack moral weakness or
Character, but according to Dr. Carnes like all the addicts even an sexual addicts , they have
addiction that is about attempting to manage emotional pain (Carnes, 1997). In the same way
some of the people fall at the left side of the curve, which means they didnt have much
opportunity due to a restrictive sexual behaviors, or experiences, medical conditions or
addictions which can lead to lack of this sexual drive. The fourth and last category of people fall
to the extreme left of the curve, these are the people who are terrified of their sexuality as well as
hatred towards sexual feelings and sex becomes their enemy, these people are termed as Sexual
Anorexics.
Characteristics of Sexual Anorexia
Dr. Patrick Carnes believed that sexual anorexia is not just a problem involving absence of
arousal or desire but it was an obsessive hatred and fear of sex (Carnes, 1997). To understand
these patterns of an Anorexic client Patrick Carnes did an Intensive study on understanding the
7

behaviors of these clients, after considering several criterias and interviewing many patients, he
came up with different characteristics which can help a clinician to understand anorexic client in
a better way (Carnes, 1997). Those characteristics are as follows:
1. A pattern of resistance to anything sexual
2. Continuing that pattern of avoidance, even though they may know its self-destructive
(i.e.: harm a marriage, prevent relationships)
3. Going to great lengths to avoid sexual contact or attention
4. Rigid or judgmental attitudes toward sexualitytheir own, and others
5. Resistance and avoidance of deeper, more painful life issues
6. Extreme shame and self-loathing about their bodies, sexual attributes and experiences
7. Obsessing about sex and how to avoid it, to a point where it interferes with normal living
8. Possible episodes of sexual bingeing or periods of sexual compulsivity.
Criteria for Sexual Anorexia
While there isnt much research in this areas of Sexual anorexia it has been categorized
under Sexual Aversion Disorder in Diagnostic and Statistical Manuel IV (1994) with a DSM
code of 302.79 (4th ed., American Psychiatric Association, 1994). For a while Sexual anorexic
was used to define as a type of aversion to any sexual moves from their partners. But looking at
the struggles of an anorexic patient its far more than aversion, it includes stages of anxiety,
suicidal tendencies as well as isolation from the society, which impacts to an extent to which it
impairs their basic social functions. According to Diagnostic and Statistical Manual- IV,
Following is the criteria for Sexual Aversion Disorder.
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A. Persistent or recurrent extreme aversion to, and avoidance of, all (or almost all) genital
Contact with a sexual partner.
B. The disturbance causes marked distress or interpersonal difficulty.
C. The sexual dysfunction is not better accounted for by another Axis I disorder (except
Another Sexual Dysfunction).
The above criteria is also used for describing the Sexual Anorexia not fully but partially
because of lack of literature defining criteria as well as most of the characteristics are commonly
observed but there isnt much research which support these characteristics to be sexually
anorexia (Carnes, 1997). Some of these characteristics usually includes a combination of sexual
aversion combined with addictive behaviors and the person keeps switching between these
behaviors in a pattern which makes it hard for a clinicians to understand and pin-point at the
issue. For example a person suffering with sexual anorexic, who has history of sexual abuse and
trauma, not just have the problem of aversion but also the fear and disgust about any sexual
contact with their partner at the same time sexually risky behaviors outside of her marriage,
thereby the client keeps switching between those behaviors. Because of switching in behavior
pattern as well as lack of research in this area sexual aversion disorder has been removed from
the Diagnostic and Statistical Manuel- V from distinct disorder and now it has been coded under
Other Specified Sexual Dysfunction.
Causes for Sexual Anorexia
Addiction is one of the way through which people try to overcome their emotional pain,
as they have this mis-belief in assuming that getting into addictions suppresses and heals their
wounds, but they fail to understand that those wounds become more deeper as they get into
9

addiction. In the same way it is with people suffering with Sexual Anorexia; they attempt to
overcome their emotional pain by starving themselves from sex, According to Dr. Paul
Hokemeyer By closing the door on their sexual lives, these men and women feel a sense of
mastery over their bodies, their lives and most importantly their emotions.. There are many
reasons behind behavior of a sexual anorexic patient but the most common causes are sexual
abuse and trauma. In a study conducted by Dr. Patrick Carnes in the year 1997 on 687 patients
who were admitted to facility were assessed and it was found out that 271 patients were
identified as having with sexual disorder on further assessment it was revealed that sixty-three

Were assessed to be sexually aversive and one Hundred and twenty one were sexual addict and
Twenty-one clients were assessed to be having both condition (Carnes, 1997). From the data
collected by Dr. Patrick Carnes it was found out that 86% of 61 Sexually Aversive clients had a
history of emotional abuse, while 67 % of them suffered with scars of sexual abuse as well as
having disengaged family style. Research has found out that people coming in from rigid family
styles upbringing make them grow in a fear of being intimate with their partners as well as lack
of knowledge about sex also leads them to abstain themselves from any romantic relationships.
While other causes include hormonal imbalances (testosterone, estrogen), medication use,
exhaustion as well as communication problems and power struggles with a partner or loved ones.
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Interesting fact which Dr. Carnes found out in his study was, People who were suffering with
Sexual anorexia also were suffering with other compulsive problems such as Alcoholism,
Substance abuse, compulsive eating, caffeine abuse, nicotine addiction, spending/Debiting and
Bulimia or Anorexia with Food (Carnes, 1997).
How Does Sexual Anorexia Affects Marriage
Sexual Anorexia impacts the marriage in a very profound way, it not only affects the
person suffering with sexual anorexia but it also affect their spouse at a deeper level, leading to
an unhealthy marital relationship which can give a false sense of privilege to bargain the true
intimacy with a false intimacy such as pornography, masturbation, extra-marital affairs and etc.
These behaviors will tend in destroy the marital relationship completely. But these marriages can
be saved if the spouse understand the symptoms of the other spouse in early stages; can help
them to avoid early marital friction in the marriage between the partners as well as the partner

11

can act as a support to their spouse. Some of the symptoms which are usually found in a Sexual
Anorexic partner are as follows (Carnes, 1997):

Withholding love: Partners suffering with anorexia withhold their feeling of

expressing love to their spouses, which might be through touch, getting gifts or any other ways
of showing love as they dread this might lead them to have intimacy with their partners

Withholding praise or positive attention: Anorexics dont praise their spouses, its

not because they dont know what best about their spouse, and its just the fear of becoming
close keeps them away in complementing their spouses. While some of the anorexic only choose
to complement their spouses in public.

Withholding sex: Anorexic spouse withhold sex or withhold intimacy during the

sex by fantasizing of something else or in some situation they completely avoid talking about sex
and withhold sex from their partners

Using silence or anger to control: They use silence or anger as tool to put the

other spouse at a distance which once again leads to lack of communication. Sometimes they
remains silent for weeks or months and act as strangers living in the same roof.

Consistent or unfounded criticism: Criticizing spouse in front of others, becomes

their hobby.

Unwillingness or inability to share feelings: They withhold their feelings of

happiness, sadness leading to no bonding or communication and trust in the relationship.

12

Staying busy so that no time is left for your partner: The patients suffering with

sexual anorexia stay busy in things such as television, computer, games, household work,
children and other stuff and thereby having no time for their spouse (Douglas Weiss, 1998).
Consequences of Sexual Anorexia on the Spouses
The constant rejection from the anorexic spouse and their mood-swings put these spouses
in a dilemma about themselves making them wonder if they arent attractive enough for their
spouse. Most of them feeling lonely and sometimes even say that I feel Single of We are great
roommates (Douglas Weiss, 1998). It is an unbearable burden which most of the spouses bare it
sometimes even blame themselves as one of the patients says and I quote I am paying for my
sins of the Past. There is a lot of emotional, psychological and social stressors which affects
these spouse too. Some of those affects are as follows (Douglas Weiss, 1998):

Depression: Because of avoidance and rejections from their partners, spouses get into
depression and feeling of Hopelessness about their future as they dont find any hope in
change in the situation of their partners

Devastated Self-esteem; as the anorexic spouse doesnt show affection or attraction

towards their partners this makes to blame themselves of being not attractive to their
partners leading to a low self-esteem and despair

Eating Disorder: This is usually found in women just to compete to show up on their
husbands radar;

Sexually Anorexic: The spouses sometimes become sexually anorexic because of the
treatment that they get from their partners.

13

Infidelity: There is a high risk of getting into sexual relationship outside of the marriage
because of no sexual contact from the partners. Sometimes even lead to other addictions
such an Alcoholism and pornography.
Diagnosis
Even though having the basic guidelines and assessment tools to help us to find out if a

patient is anorexic or not, it is hard to diagnose sexual anorexia. While Blood tests are helpful in
understanding the medical aspects of a sexual anorexic client such as hormone levels which can
interfere with the normal sexual functioning of a person.
While the other side of the coin for a sexual anorexic client is the fear of being hurt or
rejected by others, so they usually tend to satisfy their themselves sexually through other means
such as masturbates through pornography or paying for sex as it doesnt include any fear of
rejection or being hurt. As the causes for sexual anorexia include both the physical and
psychological aspects, so if left undiagnosed it can lead to a serious relationship problems and
sometimes even lead the patient to other kinds of addictions. There is treatment for sexual
anorexia lets look at the different treatment plans which can help the anorexic client to
overcome this aversion (Sexual Anorexia: Marked by Sexual. 2006)
Medical Treatment: There isnt much research to prove that Sexual Anorexia is caused
because of some sexual dysfunction of human body. Because of this lack of research, therapists
dont want to rule out this option.
Hormone Therapy: It is a process in which medication containing hormones to replace
the ones the body no longer makes is called a Hormone Therapy; which is usually for women. It
is one of the effective forms of treatment for some people suffering with sexual anorexia. Though
14

it has a positive side such as Systematic Hormone therapy which is the most effective way for
treatment; but it also has high risks such as Heart disease, Strokes, Blood Clots as well as breast
cancer due to combination of estrogen progestin pills. While other medical treatments can be
used for Adults who suffer from inhibition sexual desires because of low testosterone for men.
Counseling Therapy: As there is a psychological emotional aspects attached to sexual
anorexia counseling can be an effective tool. There are many different types of counseling which
a sexual anorexic client can use such as Couples Counseling. Relationship training or an
Attachment based treatment
Attachment Based Treatment: It is a process which includes accessing and reprocessing
the emotional response of partners, thereby facilitating a shift towards accessibility and
responsiveness. The main theme of this treatment based on a fact that in any romantic
relationship the couple comes together with an attachment styles which are based on their
respective childhoods and these styles reciprocally impact the sexual functioning which can
decrease or increase individuals capacity to enjoy or participate in sexual intimacy. It is an eight
step treatment model that provides, creates enhances and solidifies of securement solidification
of secure attachment between long-term sexually intimate partners designed to reduce sexual
dysfunctions and increase mutually satisfying sexual functioning. This model is premised on the
notion that attachment styles may shift over time and experience and become a product of both
earlier and current interpersonal circumstances (Collins &Read, 1990).

Conclusion:
15

Clients looking for a recovery process usually say that they would get into a relationship
only if there isnt any risk of getting hurt. It is role of a counselor to explain to the client that
Emotional intensity, over which you can feel some control, is not the same as genuine
closeness. Being vulnerable enough to allow yourself to be fully known creates the potential for
true intimacy. So there is a need for greater research in this areas as it can help the clinicians
and counselors to understand the outlook of a sexual anorexia. If sexual anorexia was a just a
medical issue it could have been easily treated. But there are cases whose wounds are much
deeper to understand and interpret creating a deeper psychological scar on the client, it is a time
consuming process. But suggesting the patient and the partner to keep the communication open
thereby preventing any miscommunication as well as avoiding the feeling of rejection on both
the sides. At the same time encouraging the clients having a nonsexual affections such a touch
may help couples work through the inhibited sex drive with feelings of hope for the future.
I believe that marriage was intended by god between a man and a women so that they
both can become one in unity (Genesis 2:24) and become one flesh through love, passion,
intimacy and also with pleasure. That is whats primarily missing in a Sexual Anorexia. God
intended sex in marriage not only for reproduction but also for a man and women find pleasure
and satisfaction in each other.
As Christ accepted us in spite of us being filthy as dirty rags, he never being god made us
humans feel orphaned. We as Christians learn to see our self as righteous through God and in
God. Just in the same way sexually anorexic people need to find love and acceptance that has
been buried under their psychological and emotional wounds and come to an understanding and
acceptance not only in Christ but hopefully in their spouse too and create a life filled with love
and intimacy that had been lost.
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Bennett, E., Beal, A., & Beal, B. (2012). Counseling for Sexual Dysfunction through the Lens of
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