11/20/2015 03:48 EST | Updated 11/20/2016 05:12 EST

How Eating Disorders Impact Sexuality

There is an association between low BMI and loss of libido, sexual anxiety and sexual relationships. These findings are consistent with the explanation that low body weight impairs the physiological functioning of sexual organs.

young woman suffering from a...

A study published in 2010 found that nearly two-thirds of women with eating disorders reported loss of libido and sexual anxiety.

Food and weight preoccupation runs the gamut from concern about weight to compulsive dieting to compulsive over-eating to anorexia nervosa and bulimia nervosa. In 2002, 1.5 per cent of 15 to 24-year-old Canadian women surveyed had an eating disorder.

While there is a big gap between a perception that one is "too fat" and a behaviour that is compulsive, it is a truism that media images feed girls' and women's desire to be thin. Certainly in the general population, negative body image can affect self-esteem and the ability to enjoy one's sexuality. These issues are clearly magnified for women with eating disorders. But the physiological effects go much deeper.

One consistent finding in the 2010 study was

the association between low lifetime minimum BMI and loss of libido, sexual anxiety and sexual relationships. These findings are consistent with the explanation that low body weight impairs the physiological functioning of sexual organs...

The researchers concluded that "independent of physical changes, individuals with lower BMIs experience a more severe presentation of the eating disorder" which

may be associated with more profound body dissatisfaction, distortion, depression and discomfort with physical contact, all of which may be associated with loss of libido and elevated sexual anxiety...

In other words, sexual intimacy is a fundamental aspect of healthy relationships that can be disrupted by an eating disorder.

From dissatisfaction to compulsion

We understand from the literature that women with eating disorders primarily seek to have control over their bodies. A controlling family, a traumatic series of events like sexual trauma and even the arrival of puberty may all contribute to a feeling of lost control.

For someone living in a controlling family, for example, food intake and weight are areas of their life they believe they can bring under their own control. Anorexia may be triggered by this realization. The National Eating Disorder Information Centre sees control as the "central paradox."

They argue that faced with high social expectations and a "shaky sense of self," a woman assumes that she can at least gain approval by being thin. The ideal thin body holds promise. But controlling the body becomes a precarious substitute for real control in her life. "Women feel in control of their lives through controlling their bodies", yet the need to establish this false and precarious control suggests they are desperately out of control.

Another potential trigger is childhood sexual abuse. Mary Anne Cohen suggests

women who were sexually abused as children may develop an eating disorder because of guilt, shame or self-punishment. She says sexual abuse survivors may also be trying to de-sexualize themselves -- becoming either tiny and childlike or obese. They may try to make their bodies "perfect" and thus

...more powerful, invulnerable, and in control, so as not to re-experience the powerlessness they felt as children... Some survivors of sexual abuse are afraid [my emphasis] to lose weight because it will render them feeling smaller and childlike... Binge eating, purging or starving then becomes their ongoing self-induced punishment.

How can an eating disorder affect relationships?

A woman who is preoccupied with her relationship with food, may be less likely to develop the skills that are essential for successful intimate relationships. These skills include maintaining her status in a relationship as well as her ability to negotiate sexual activities and safety. Women who feel powerless; i.e., have lost control, may be less likely to be able to protect themselves from emotional or sexual abuse or from unsafe sexual practices.

If we are desperately attempting to control our bodies, we may feel ashamed of our "imperfections." Then how can we believe someone loves us? How can we be honest with a lover when we practice secretive behaviours? How can we demand respect or communicate openly? How can we say what we want sexually, what we prefer not to do sexually and insist on sexual safety?

Treatment for women with an eating disorder will, like treatment for substance abuse, need to examine root causes -- if they can be identified -- as part of their treatment. The upside is that for women who recover, the prognosis for their sexual lives is positive.

I like to imagine a woman who learns to accept her body, sees it as attractive, and begins to take pleasure in it. I imagine her learning to share her body with another's for mutual pleasure and admiration; and I imagine her gradual return to herself along with the desire and ability to love and take care of herself.

According to Eating Disorders Recovery Today: general, interest in, and pleasure from, sexual activity has been shown to decrease at the onset of the disorder and increase during weight restoration. Several explanations for this change in libido are a return to natural (and normal) hormone levels during weight restoration, and the women's growing comfort with body acceptance and expression during recovery.

So the good news is, sexual health can be restored. The bad news is, eating disorders and weight preoccupation in general are increasing. We have work to do.

Canadian statistics