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Anorexia Nervosa and Sexual Function

  • Integrating the Psychosocial (B McCarthy, RT Segraves and AH Clayton, Section Editors)
  • Published:
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Abstract

Little empirical evidence exists concerning sexual functioning and sexuality in women suffering from anorexia nervosa (AN). The current review of the literature since 2000 on AN and sexual functioning produced only a small number of studies on the subject. Most of the research was conducted with small numbers of individuals and utilized different measurements and methodological approaches. Almost all studies showed that AN was related with lower sexual functionality. The factors that influence this reduction in sexual functionality are various and may differ according to the subtype of AN. There is an almost unanimous view based on the research findings that the biological effect of starvation on the human body is the main reason why AN patients report loss of interest in sex and sparse sexual activities. AN symptomatology itself and, more specifically, body image distortion and body dissatisfaction, seem to increase the feeling of shame associated with nudity and hinder the ability of the sufferers to enjoy unobstructed having sex with their partners. On the other hand, personality traits, and especially obsessionality and emotional restraint, seem to have a negative influence both on the ability of the AN patients to create meaningful romantic relationships and to enjoy their sexual life. It is still unclear whether comorbidity with depression and/or anxiety disorders can further deteriorate AN patients’ sexual function. Due to the small number of publications, no definite conclusions can be drawn yet, with the exception that AN can be related with lower sexual function.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Daniluk JC. The meaning and experience of female sexuality. A Phenomenological Analysis. Psychol Women Q. 1993;17:53–69.

    Article  Google Scholar 

  2. Raboch J, Faltus F. Sexuality of women with anorexia nervosa. Acta Psychiatr Scand. 1991;84(1):9–11.

    Article  CAS  PubMed  Google Scholar 

  3. Currin L, Schmidt U, Treasure J, Jick H. Time trends in eating disorder incidence. Br J Psychiatry. 2005;186(2):132–5.

    Article  PubMed  Google Scholar 

  4. Weaver L, Liebman R. Assessment of anorexia nervosa in children and adolescents. Curr Psychiatry Rep. 2011;13(2):93–8.

    Article  PubMed  Google Scholar 

  5. Campbell K, Peebles R. Eating disorders in children and adolescents: state of the art review. Pediatrics. 2014;134(3):582–92.

    Article  PubMed  Google Scholar 

  6. Klump KL. Puberty as a critical risk period for eating disorders: a review of human and animal studies. Horm Behav. 2013;64(2):399–410.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Crisp AH. Some aspects of the relationship between body weight and sexual behaviour with particular reference to massive obesity and anorexia nervosa. Int J Obes. 1978;2(1):17–32.

    CAS  PubMed  Google Scholar 

  8. Romeo FF. Adolescence, sexual conflict, and anorexia nervosa. Adolescence. 1984;19(75):551–5.

    CAS  PubMed  Google Scholar 

  9. Fassino S, Pierò A, Tomba E, Abbate-Daga G. Factors associated with dropout from treatment for eating disorders: a comprehensive literature review. BMC Psychiatry. 2009;9:67.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Leon GR, Lucas AR, Colligan RC, Ferdinande RJ, Kamp J. Sexual, Body-image, and personality attitudes in anorexia nervosa. J Abnorm Child Psychol. 1985;13(2):245–57.

    Article  CAS  PubMed  Google Scholar 

  11. Beumont P, Abraham S, Simson K. The psychosexual histories of adolescent girls and young women with anorexia nervosa. Psychol Med. 1981;11:131–40.

    Article  CAS  PubMed  Google Scholar 

  12. Hick KM, Katzman DK. Self-assessment of sexual maturation in adolescent females with anorexia nervosa. J Adolesc Health. 1999;24(3):206–11.

    Article  CAS  PubMed  Google Scholar 

  13. Ruuska J, Kaltiala-Heino R, Koivisto AM, Rantanen P. Puberty, sexual development and eating disorders in adolescent outpatients. Eur Child Adolesc Psychiatry. 2003;12(5):214–20.

    Article  PubMed  Google Scholar 

  14. Tuiten A, Panhuysen G, Everaerd W, Koppeschaar H, Krabbe P, Zelissen P. The paradoxical nature of sexuality in anorexia nervosa. J Sex Mar Ther. 1993;19:259–75.

    Article  CAS  Google Scholar 

  15. Wiederman MW, Pryor T, Morgan CD. The sexual experience of women diagnosed with anorexia nervosa or bulimia nervosa. Intern J Eat Disord. 1996;19(2):109–18.

    Article  CAS  Google Scholar 

  16. Morgan CD, Wiederman MW, Pryor TL. Sexual functioning and attitudes of eating-disordered women: a follow-up study. J Sex Mar Ther. 1995;21(2):67–77.

    Article  CAS  Google Scholar 

  17. Morgan JF, Lacey JH, Reid F. Anorexia nervosa: changes in sexuality during weight restoration. Psychosom Med. 1999;61(4):541–5.

    Article  CAS  PubMed  Google Scholar 

  18. Gonidakis F, Kravvariti V, Varsou E. Sexual function of women suffering from anorexia nervosa and bulimia nervosa. J Sex Marital Ther. 2015;41(4):368–78. AN patients reported lower sexual functionality than BN and healthy controls. Sexual functioning of AN patients was strongly related to BMI measurement.

    Article  PubMed  Google Scholar 

  19. Pinheiro AP, Raney TJ, Thornton LM, Fichter MM, Berrettini WH, Goldman D, et al. Sexual functioning in women with eating disorders. Int J Eat Disord. 2010;43(2):123–9.

    PubMed  PubMed Central  Google Scholar 

  20. Mazzei C, Castellini G, Benni L, Godini L, Lazzeretti L, Pracucci C, et al. Sexuality and eating disorders. Riv Psichiatr. 2011;46(2):122–8.

    PubMed  Google Scholar 

  21. Rosen R, Brown C, Heiman J, Leiblum S, Meston CM, Shabsigh R. The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther. 2000;26:191–208.

    Article  CAS  PubMed  Google Scholar 

  22. Abraham S, Beumont P. The psychosexual experience in patients with anorexia nervosa. Int J Eat Disord. 1982;1(3):10–9.

    Article  Google Scholar 

  23. Rothschild BS, Fagan PJ, Woodall C, Andersen AE. Sexual functioning of female eating-disordered patients. Int J Eat Disord. 1991;10:389–94.

    Article  Google Scholar 

  24. Castellini G, Lelli L, Lo Sauro C, Fioravanti G, Vignozzi L, Maggi M, et al. Anorectic and bulimic patients suffer from relevant sexual dysfunctions. J Sex Med. 2012;9(10):2590–9. The main finding of the study was that AN restrictive type reported lower sexual functioning than the rest of the ED patients. Body shape concerns were associated with sexual function in AN restrictive type.

    Article  PubMed  Google Scholar 

  25. Seeger G, Braus DF, Ruf M, Goldberger U, Schmidt MH. Body image distortion reveals amygdala activation in patients with anorexia nervosa—a functional magnetic resonance imaging study. Neurosci Lett. 2002;326(1):25–8.

    Article  CAS  PubMed  Google Scholar 

  26. Grabhorn R, Stenner H, Kaufbold J, Overbeck G, Stangier U. Shame and social anxiety in anorexia and bulimia nervosa. Z Psychosomatic Med Psychotherapy. 2005;51(2):179–93.

    Google Scholar 

  27. Wiederman MW, Pryor T. Body dissatisfaction, bulimia, and depression among women: the mediating role of drive for thinness. Int J Eat Disord. 2000;27:90–5.

    Article  CAS  PubMed  Google Scholar 

  28. Mangweth-Matzek B, Rupp CI, Hausmann A, Kemmler G, Biebl W. Menarche, puberty, and first sexual activities in eating-disordered patients as compared with a psychiatric and a non psychiatric control group. Int J Eat Disord. 2007;40(8):705–10. ED patients were similar to healthy controls in age of menarche and most sexual milestones. The important finding was that ED patients were experiencing sexual function more negatively than healthy controls.

    Article  PubMed  Google Scholar 

  29. Wonderlich SA, Lilenfeld LR, Riso LP, Engel S, Mitchell JE. Personality and anorexia nervosa. Int J Eat Disord. 2005;37(Suppl):S68–71.

    Article  PubMed  Google Scholar 

  30. Lavender JM, Wonderlich SA, Crosby RD, Engel SG, Mitchell JE, Crow SJ, et al. Personality-based subtypes of anorexia nervosa: examining validity and utility using baseline clinical variables and ecological momentary assessment. Behav Res Ther. 2013;51(8):512–7.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Eddy KT, Novotny CM, Westen D. Sexuality, personality, and eating disorders. Eat Disord. 2004;12:191–208.

    Article  PubMed  Google Scholar 

  32. Reynaert C, Zdanowicz N, Janne P, Jacques D. Depression and sexuality. Psychiatr Danub. 2010;22(Suppl1):111–3.

    Google Scholar 

  33. Nascimento ER, Maia AC, Nardi AE, Silva AC. Sexual dysfunction in arterial hypertension women: the role of depression and anxiety. J Affect Disord. 2015;181:96–100.

    Article  CAS  PubMed  Google Scholar 

  34. Ghajarzadeh M, Jalilian R, Togha M, Azimi A, Hosseini P, Babaei N. Depression, poor sleep, and sexual dysfunction in migraineurs women. Int J Prev Med. 2014;5(9):1113–8.

    PubMed  PubMed Central  Google Scholar 

  35. Zelená V, Kuba R, Soška V, Rektor I. Depression as a prominent cause of sexual dysfunction in women with epilepsy. Epilepsy Behav. 2011;20(3):539–44.

    Article  PubMed  Google Scholar 

  36. Santos PR, Capote Jr JR, Cavalcanti JU, Vieira CB, Rocha AR, Apolônio NA, et al. Sexual dysfunction predicts depression among women on hemodialysis. Int Urol Nephrol. 2013;45(6):1741–6.

    Article  CAS  PubMed  Google Scholar 

  37. Fernandez-Aranda F, Pinheiro AP, Tozzi F, Thornton LM, Fichter MM, Halmi KA. Symptom profile of major depressive disorder in women with eating disorders. Aust N Z J Psychiatry. 2007;41(1):24–31.

    Article  PubMed  Google Scholar 

  38. Godart NT, Perdereau F, Rein Z, Berthoz S, Wallier J, Jeammet P, et al. Comorbidity studies of eating disorders and mood disorders. Critical review of the literature. J Affect Disord. 2007;97(1–3):37–49.

    Article  CAS  PubMed  Google Scholar 

  39. Godart N, Berthoz S, Rein Z, Perdereau F, Lang F, Venisse JL. Does the frequency of anxiety and depressive disorders differ between diagnostic subtypes of anorexia nervosa and bulimia? Int J Eat Disord. 2006;39(8):772–8.

    Article  PubMed  Google Scholar 

  40. Carter FA, Carter JD, Luty SE, Jordan J, McIntosh VV, Bartram AF. What is worse for your sex life: starving, being depressed, or a new baby? Int J Eat Disord. 2007;40:664–7.

    Article  PubMed  Google Scholar 

  41. Castellini G, Lelli L, Lo Sauro C, Vignozzi L, Maggi M, Faravelli C, et al. Childhood abuse, sexual function and cortisol levels in eating disorders. Psychother Psychosom. 2012;81(6):380–2.

    Article  PubMed  Google Scholar 

  42. Castellini G, Lo Sauro C, Lelli L, Godini L, Vignozzi L, Rellini AH, et al. Childhood sexual abuse moderates the relationship between sexual functioning and eating disorder psychopathology in anorexia nervosa and bulimia nervosa: a 1-year follow-up study. J Sex Med. 2013;10(9):2190–200. The study stresses the negative impact of childhood sexual abuse and sexual functioning in patients suffering from ED. The main finding was that sexual functioning can improve when ED is treated only in those patients that have not suffered a traumatic sexual experience during their childhood.

    Article  PubMed  Google Scholar 

  43. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. Fifthth ed. Arlington: American Psychiatric Association; 2013.

    Google Scholar 

  44. Hepp U, Milos G. Gender identity disorder and eating disorders. Int J Eat Disord. 2002;32:473–8.

    Article  PubMed  Google Scholar 

  45. Couturier J, Pindiprolu B, Findlay S, Johnson N. Anorexia nervosa and gender dysphoria in two adolescents. Int J Eat Disord. 2015;48(1):151–5.

    Article  PubMed  Google Scholar 

  46. Strandjord SE, Ng H, Rome ES. Effects of treating gender dysphoria and anorexia nervosa in a transgender adolescent: lessons learned. Int J Eat Disord. 2015;48(7):942–5.

    Article  PubMed  Google Scholar 

  47. Turan Ş, Poyraz CA, Duran A. Prolonged anorexia nervosa associated with female-to-male gender dysphoria: a case report. Eat Behav. 2015;18:54–6.

    Article  PubMed  Google Scholar 

  48. Winston AP, Acharya S, Chaudhuri S, Fellowes L. Anorexia nervosa and gender identity disorder in biologic males: a report of two cases. Int J Eat Disord. 2004;36(1):109–13.

    Article  PubMed  Google Scholar 

  49. Tiller JM, Sloane G, Schmidt U, Troop N, Power M, Treasure JL. Social support in patients with anorexia nervosa and bulimia nervosa. Int J Eat Disord. 1997;21(1):31–8.

    Article  CAS  PubMed  Google Scholar 

  50. Keski-Rahkonen A, Raevuori A, Bulik CM, Hoek HW, Rissanen A, Kaprio J. Factors associated with recovery from anorexia nervosa: a population-based study. Int J Eat Disord. 2014;47(2):117–23.

    Article  PubMed  Google Scholar 

  51. Zak-Hunter L, Johnson LN. Exploring the Association Between Partner Behaviors and Eating Disorder Symptomology. Fam Syst Health. 2015.

  52. Bundock L, Howard LM, Trevillion K, Malcolm E, Feder G, Oram S. Prevalence and risk of experiences of intimate partner violence among people with eating disorders: a systematic review. J Psychiatr Res. 2013;47(9):1134–42.

    Article  PubMed  Google Scholar 

  53. Fischer MS, Baucom DH, Kirby JS, Bulik CM. Partner distress in the context of adult anorexia nervosa: the role of patients’ perceived negative consequences of AN and partner behaviors. Int J Eat Disord. 2015;48(1):67–71.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Bulik CM, Baucom DH, Kirby JS, Pietsky E. United couples (in the treatment of) anorexia nervosa (UCAN). Int J Eat Disord. 2011;44:19–28.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Dick CH, Renes SL, Morotti A, Strange AT. Understanding and assisting couples affected by an eating disorder. Am J Fam Ther. 2013;41:232–44.

    Article  Google Scholar 

  56. Maier CA. Feminist-informed emotionally focused couples therapy as treatment for eating disorders. Am J Fam Ther. 2015;43(2):151–62.

    Article  Google Scholar 

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Correspondence to Fragiskos Gonidakis.

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Fragiskos Gonidakis, Vassiliki Kravvariti, and Eleftheria Varsou declare that they have no conflicts of interest. Melissa Fabello reports that she is currently employed by Everyday Feminism, an online magazine about social justice, as a Managing Editor

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This article is part of the Topical Collection on Integrating the Psychosocial

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Gonidakis, F., Kravvariti, V., Fabello, M. et al. Anorexia Nervosa and Sexual Function. Curr Sex Health Rep 8, 19–26 (2016). https://doi.org/10.1007/s11930-016-0064-3

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