Letter from the Editor
Staff Articles
- Non-Suicidal Self-Injurious Behavior in Adolescents across Gender and Sexual Orientation
- The Impact of Eating Disorders on Sexual Functioning in Women
- Effects of Participation in Sports on Men’s Aggressive and Violent Behaviors
- The Major Influences of Self-Regulation Development in Early Childhood
- The Effectiveness of Music Therapy in Treating Symptoms of Alzheimer’s disease
Mary Murphy Corcoran
In the United States alone, approximately twenty-four million people suffer from eating disorders and the number of hospitalizations as a result of eating disorders has significantly increased in the past decade (von Hausswolff-Juhlin, Brooks, & Larsson, 2015; Zhao & Encinosa, 2009). According to The Diagnostic and Statistical Manual of Mental Disorders, eating disorders include anorexia nervosa, bulimia nervosa, and binge eating disorder (5th ed.; DSM-5, American Psychiatric Association, 2013). Due to a persistent, distorted view and fear of food, individuals with anorexia nervosa maintain a significantly low body weight through severe caloric restriction (Vaz-Leal & Salcedo, 1991; Wiederman, 1996). In contrast, people with bulimia nervosa often consume large quantities of food quickly, and then engage in compensatory behaviors, including self-induced vomiting and an overuse of laxatives. Despite these compensatory behaviors, individuals with bulimia tend to display average or slightly above average body weight (Wiederman, 1996). Similarly, individuals with binge eating disorder also experience uncontrollable, repeated periods of overeating, but do not engage in compensatory behaviors. As a result, individuals with binge eating disorder are often overweight (Castellini et al., 2010). Though these eating disorders are characterized by distinct differences, all are associated extremely negative body image and an obsession with appearance (von Hausswolff-Juhlin et al., 2015).
Approximately 90% of eating disorder cases occur in females, and disorders are more prevalent during adolescence and young adulthood (Ghizzani & Montomoli, 2000). During this developmental period in which sexuality is explored, females tend become especially aware of their appearance. This awareness may be heightened because a woman’s sexual appeal tends to depend on her level of sexual attractiveness as perceived by potential male partners. Feminist theorists argue that this awareness is particularly problematic as most women determine their self worth based on whether they are deemed sexually attractive by men (Woertman & van den Brink, 2012). Women’s views of themselves as sexual objects likely stem from American media’s sexualized portrayal of women (Calogero & Thompson, 2008). By exclusively presenting slim women, the mass media promotes a beauty ideal that leads to many women feeling ashamed about their bodies (Woertman & van den Brink, 2012). Women who internalize this beauty ideal are more likely to develop body dissatisfaction, and thus, engage in harmful behaviors, including disordered eating, in order to control and modify their appearance. As a result, these women can experience dysfunction and dissatisfaction in their sex lives (Yean et al., 2013).
It has been suggested that women with eating disorders experience disturbed sexual functioning in both the physiological (e.g., lubrication and ability to orgasm, fulfilling interpersonal sexual experience, such as having sexual partner; Castellini et al., 2012), and psychological (e.g., sexual anxiety; Castellini et al., 2012) dimensions of sexuality (Ghizzani & Montomoli, 2000). In an effort to understand the relation between eating disorders and sexual functioning, this paper examined the physiological, emotional, and behavioral effects of eating disorders on sexual functioning in women.
Physiological Effects
Eating disorders negatively impact women’s physiological sexual functioning, resulting in symptoms such as a lack of libido and vaginal lubrication (Morgan et al., 1995; Pinheiro et al., 2010). Retrospective reports reveal that many women experiencing a lack of libido had a normal sexual appetite prior to developing an eating disorder, suggesting that eating disorders may lead to this decrease in sex drive, also known as loss of libido (Ghizzani & Montomoli, 2000). While most eating disordered women report a loss in libido, this effect is especially prevalent in women with anorexia nervosa. This phenomenon may be due to anorexic women’s low body mass indexes (BMI), a factor that is associated with a loss of libido in the general population (Pinheiro et al., 2010). Researchers believe that the lack of sex drive in women with anorexia is largely caused by changes in ovarian steroids and central nervous system neurotransmitters that occur as a result of malnutrition (Ghizzani & Montomoli, 2000). In addition to decreased libido, women with eating disorders often have difficulty reaching orgasm during sexual intercourse (Castellini et al., 2012).
Women with eating disorders often report symptoms of vaginismus, a condition involving painful, involuntary vaginal tightness, which may contribute to an inability to orgasm (Haimes & Katz, 1988). Women with anorexia are particularly vulnerable to vaginismus, as low body weight impairs the physiological functioning of sexual organs (Pinheiro et al., 2010). Women who restrict their food also tend to have lower levels of lubrication compared to women with bulimia or binge eating disorder, meaning anorexic women have more difficulty reaching orgasm (Castellini et al., 2012). Because women with disordered eating have difficulty reaching orgasm, they often experience less sexual satisfaction than healthy individuals (Abraham, 1996; Casetellini et al., 2012; Morgan et al., 1995). Altogether, these negative physiological effects on sexual functioning, such as vaginismus and lack of libido, may prevent eating disordered women from pursuing sexual activity and experiencing sexual satisfaction (Pinheiro et al., 2010).
Emotional Effects
In addition to sexual dysfunction and decreased libido, women who suffer from eating disorders may also avoid sex due to emotional disturbances (Pinheiro et al., 2010). Women with eating disorders often have such severe body dissatisfaction and self-consciousness that they are too anxious to engage in sexual activity and feel as though they are sexually unappealing to their partner (Pinheiro et al., 2010; Wiederman, Pryor, & Morgan, 1996). Anorexic women, compared to women with bulimia or binge eating disorder, exhibit the highest levels of sexual anxiety because they do not feel as sexually competent and this stress can manifest itself somatically (Haimes & Katz, 1988; Morgan et al., 1995). For example, women with anorexia report experiencing uncomfortable sensations as a result of their anxiety, such as “bugs” crawling on their skin when they are being kissed (Haimes & Katz, 1988). This sexual anxiety can inhibit eating disordered women from having an interest in sex (Wiederman, 1996).
Studies have also found that weight and nutrition also have a large impact on an individual’s sexual interest, such that being a healthy weight can allow for a healthy sex drive. While researchers are unsure as to the reason for this correlation, results demonstrate that eating disordered women have especially disrupted interests in sex compared to healthy women (Pinheiro et al., 2010). Both anorexic women and binge eating disordered women have particularly low sexual desire and experience more symptoms of depression, anger, and disillusion. Additionally, women who habitually binge-eat are often so insecure about their lack of control that they shame themselves out of having any sexual interest (Castellini et al., 2012). Bulimic women can have brief moments of sexual impulsivity, but generally lack sexual interest (Morgan et al., 1996). Because eating disordered women have disrupted sexual interests, they engage in less frequent or consistent sexual behavior, one of the behavioral effects of the disorders (Castellini et al., 2012).
Behavioral Effects
Women with eating disorders often have fewer normative sexual experiences relative to healthy women (Morgan et al., 1995). Female eating disordered patients report having intercourse 80% less frequently than the normative female population (Wiederman, 1996). However, compared to anorexic women, women with bulimia or binge eating disorder report having more sexual experience, and at a younger age (Haimes & Katz, 1988). This difference may occur because women with bulimia or binge eating disorder show more impulsivity, which is associated with hypersexuality, the engagement in unprotected sexual behavior with strangers (Castellini et al., 2010). These women may have sex with strangers because eating disordered women often have difficulty maintaining sexual partners and romantic relationships (Ghizzani & Montomoli, 2000; Pinheiro et al., 2010).
Not only do eating disordered women have fewer sexual partners, they also have fewer sexual relationships (Pinheiro et al., 2010). Anorexic women have the least number of sexual partners or relationships compared to women with bulimia or binge eating disorder (Morgan et al., 1995). However, bulimic women who have sexual partners experience more tension, instability, and less intimacy in their relationships (Castellini et al., 2012; Pinheiro et al., 2010). Furthermore, bulimic women who are married are more likely to get divorced compared to healthy women (Abraham, 1996). Taken together, the existing literature suggests that all three of the most common eating disorders are associated with fewer healthy sexual relationships (Vaz-Leal & Salcedo, 1991).
Sexual behavior also includes behavior with oneself, as well as with partners. Women with eating disorders report lower frequencies of masturbation compared to women who do not have eating disorders, which may be due to their severe body dissatisfaction (Calogero & Thompson, 2008; Morgan et al., 1995). Specifically, anorexic women engage in the least amount of masturbation compared to women with bulimia or binge eating disorder. Researchers suggest that anorexic women may refrain from masturbation because they tend to deny themselves any form of self-pleasure, such as food and sex, as a way to punish themselves (Morgan et al., 1995). In contrast, bulimic women are twice as likely as anorexic women to masturbate, as well as achieve orgasm through masturbation, because bulimic women do not deny themselves the right to feel pleasure (Abraham, 1996; Morgan et al., 1995). Overall, women with bulimia, anorexia, or binge eating disorder do not exhibit normative sexual self-pleasure behaviors compared to healthy women (Calogero & Thompson, 2008).
Conclusion
The existing literature on the relation between eating disorders and sexual functioning demonstrates that eating disordered women exhibit impaired physiological, behavioral, and emotional sexual functioning. Eating disordered women experience more sexual dysfunction, such as decreased vaginal lubrication and libido, as well as more sexual anxiety and sexual dissatisfaction compared to normative women (Morgan et al., 1995; Pinheiro et al., 2010; Wiederman et al., 1996). Additionally, eating disordered women have fewer sexual experiences and relationships than healthy women, depending on the eating disorder (Castellini et al., 2012; Haimes & Katz, 1988). These findings have serious implications for the development of future eating disorder treatments. Future psychological treatments for eating disorders should include an examination of patients’ sexual functioning during their overall assessment in order to determine the severity of their disorder (Castellini et al., 2012; Raboch & Faltus, 1991).
While the current research is significant, it has limitations. Many of the studies include samples that are small and homogeneous, and therefore lack strong statistical power and external validity (Calogero & Thompson, 2008; Castellini et al., 2010; Wiederman, 1996). Secondly, most studies are cross-sectional, meaning causal inferences cannot be made (Pinheiro et al., 2010; Wiederman, 1996). Additionally, researchers have examined self-reported symptoms, which means women’s responses could have been affected by memory bias or a discomfort with talking about sex (Pinheiro et al., 2010). Future research should investigate possible factors, such as personality characteristics, the family of origin’s culture, and history of sexual abuse, that could act as mediators in the relation between eating disorders and sexual functioning (Wiederman, 1996). Furthermore, future research should also focus more on the potential influence of cultural norms on the relation between eating disorders and sexual functioning, as sexual functioning in women from different cultures or geographical areas may be affected differently due to different cultural views on sex and female sexuality (Calogero & Thompson, 2008). Understanding the role of eating disorders on sexual functioning in women is vital, as it has the potential to influence the development of effective interventions for eating disorders.
References
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