Eating Disorder Recovery: The Connection to Sex and Intimacy

People recovering from an eating disorder struggle to feel happy, experience pleasure, and find joy in their relationships. Typically, they also struggle with arousal, sexual pleasure, and relational intimacy during the active and early recovery phases of their disorder. Some can experience pleasure while lacking in relational intimacy; many others have varying degrees of emotional and relational intimacy. There are those for whom both pleasure and relational intimacy are absent; the eating disorder is their partner.

As with any aspect of eating disorder recovery, awakening or reconnecting patients to their bodies and sexual and relational lives takes time and careful attention.

Self-care is primary, encompassing learning how to feed oneself healthfully and loving the body as a whole rather than as split off components of good parts versus bad parts.

For the eating disorder sufferer, experiencing joy and pleasure is often discarded or repressed and can actually provoke more anxiety than the ritualistic eating disorder and self-defeating behaviors. Joy and pleasure pose greater risks as they are associated with loss of control. Subjecting oneself to trusting that no harm will come or nothing will be taken away if they are happy and pleasured in life are risks. There is no punishment for happiness. Seeking physical pleasure and relational joy are the end goals. They are pure in their intent. Yet, for eating disorder sufferers, these "desires" are often complicated and threatening.

What keeps a person with an eating disorder from pleasure and joy in life? Though the reasons are ultimately unique to each person, there are some common psychological threads.

Guilt, shame, fear, or the need to use the eating disorder as voice of aggression are high on the list. Refusal to eat, purging, or overeating counter and simultaneously convey that desire and need DO exist. The proverbial “fear of fat” is the metaphoric voice for fearing success, outdoing others, and generally the fear of one’s sexual appetite and craving for relational bliss and intimacy.

Helping to Orient a Patient Toward Pleasure and Joy

Experiencing self pleasure, and the joy that comes in being happy in one’s own skin, that is, liking and loving who you are as a person, are goals in recovery. Experiencing and integrating pleasure and joy in a relationship are the replacements for an eating disorder. This process takes time and is the essence of therapy, unfolding in the therapeutic relationship. Trust in the therapist enables truth and resultant self-awareness. Action can then be taken in response.

What are a few of the ongoing steps?

Step One: Analysis of why pleasure and joy are absent help orient the person toward introspection and psychological awareness.

Has the eating disorder been an attempt to punish for wanting pleasure? If the eating disorder is a substitute for comfort, what does the person fear about relationships? Do guilt and shame play a role? Has trauma been a factor?

Asking the following questions are helpful throughout the recovery process as the answers like change and deepen in detail over time:

What are your perceptions, attitudes, and experiences about sex? What makes you happy? What would be pleasurable? What does a joyful life mean to you? What constitutes a healthy relationship? What does physical pleasure mean to you? What does sexual pleasure mean to you? How do you feel about it?

I have found questions that ask patients to consider both physical pleasure and relational joy tend to help elicit thoughtful reactions and are revealing of conscious and unconscious issues. Pleasure and joy are discrete and autonomous entities; however, in combination, they are the sine qua non of relationships. Discussion of sexual topics can reveal the level of comfort a person has with their body, as well as their comfort with sexual pleasure and relational intimacy.

Through these questions, the person also has an opportunity to connect to what is possible in their own life. It also allows the therapist to maintain a running account of whether the person is moving in a forward direction toward pleasure and intimacy. The answers reveal progress and the resistances to progress.

Often it takes a very long time, and timing is everything, when it comes to facilitating growth across all arenas in a patient’s life. Pleasure and intimacy are typically the farthest afield for the patient and sometimes for the therapist as well, who may be uncomfortable with topics about sex. Just as it is necessary for a therapist to be fully qualified to treat eating disorders, it is also necessary for a therapist to explore her/his own feelings, attitudes, and perceptions about pleasure, sex and intimacy.

Step Two: Utilizing CBT to explore and commit to change.

A famous psychoanalytic saying is, “Psychoanalysis never claimed to cure the symptom.” Eating disorder patients ultimately accept that understanding and implementing change go hand in hand.

As patients are ushered in to welcoming food as a source of health and pleasure, the focus around achieving pleasurable experiences and relational joy are parallel processes.

Shifting cognition through psychoeducation about sex and sexuality can facilitate change in thinking, attitude and approach toward sex. Discussing female and male arousal patterns, dispelling myths, and shifting judgment and perception regarding cultural taboos and sexual practices often help a great deal. After all, sex is just another topic worthy of focus, time and attention.

As a patient begins to comprehend that sex is a language, discussion of topics becomes easier. What turns you on in life? What turns you on sexually? These are no simple questions and usually have no direct answers, at least at first, second, or even third attempts.

Asking patients at various times during recovery to think about self and relational pleasure and joy and to respond is purposeful.

The therapist must remain sensitive to the patient’s level of comfort at any given time in replacing food with pleasure and relationships.

Step Three: The use of sensate-focus techniques, designed by Masters and Johnson, a series of touching exercises that progress through stages designed to increase intimacy in a sexual relationship.

The techniques can also be utilized by individuals who are experiencing a variety of sexual awareness, desire, and arousal issues. Sensate focus may be particularly valuable to
eating disorder patients who have yet to understand their body and experience pleasurable body sensations, sexual arousal, and pleasure. Often there is no physical sense of pleasure associated with the touching of any part of their body, especially genitalia. Patients who have experienced trauma are often disengaged from arousal or sometimes conversely, require extreme sadomasochistic experiences to allow for orgasm.

Utilizing, for example, Step One of sensate-focus techniques, includes touch of one’s body everywhere except genitalia, breasts, or anus. Step One, for an individual patient with an eating disorder, can start the process of connection to body parts in general and the sensations associated with pleasurable touch.

The recovery process for eating disorder patients is extraordinary as they awaken to new pleasures, experiences, and discover joy in their life. Shedding the skin of an eating disorder in exchange for living life authentically is the goal throughout the recovery process.

Timing and sensitivity to patients as they face each new chapter or awakening can take a very long time. Remember that the eating disorder has been an extremely reliable partner, despite the significant harm it causes to body, mind, and relationships. Remaining acutely aware that helping patients to address sexual pleasure, sexuality and relational intimacy can, and typically will be, a protracted process.

Getting to first base with patients and not shooting for the home run is a good note on which to end this Blog Post; all things will be revealed if the therapist and patient move slowly around the ball field.