Why don’t we talk about Sexual Anorexia?

I was working with a client this week on identifying the reasons he struggles with intimacy with his wife. As we were working through the problem, he identified a number of reasons. We both had a realization at the same time. We have done work on all of the reasons on the list but one, Sexual Anorexia. Why haven’t we really worked onSexual Anorexia? This is a long term client who takes his sobriety very seriously and works really, really hard. This was not a case of avoidance. To be honest, I truthfully could not point the finger at him. We BOTH were unintentionally avoiding the topic. In our discussion, he mentioned that the topic is not really addressed in the 12 step literature either. There is a little bit of mention in the big book and a little bit of work on the topic in Patrick Carnes workbook, Facing the Shadows. Carnes also authored a book titled Sexual Anorexia in 1997 but nothing further. So, I wonder why?

First, let’s start by identifying what I mean by Sexual Anorexia. For some, it can be conceptualized as the opposite of sexual compulsivity or acting out. Sexual Anorexia is more “acting in”. It has been described as an aversion or loss of appetite for sexual connection or intimacy. The Center for Healthy Sex nicely outlines the symptomology of Sexual Anorexia (http://centerforhealthysex.com/sex-therapy/sexual-anorexia-and-sexual-aversion). Individuals dealing with sexual anorexia may be in marriages or relationships that are devoid of sex or physical contact. The idea of sexual contact may induce great fear, anxiety, shame and/or emotional discomfort. Obviously Sexual Anorexia can hurt a marriage or a committed relationship. However, it also deprives the person who is anorexic from enjoying the emotional connection and intimacy that comes from healthy relational sex.

The explanation of Sexual Anorexia still leaves me with the question of why don’t we talk about it more? Perhaps we, as clinicians, are more focused on the obvious acting out than acting in? Is the client perhaps more ashamed of the anorexia than the acting out behaviors? Is it just easier to work with behavioral management of acting out versus the deep seated emotional work that is necessary to work with the anorexia?

This post was truly not meant to answer these questions as much as to pose them.

What I have learned from my session on Monday is that I need to start paying more attention to both the acting out and the anorexia when working with my clients.