Sexual anorexia – What is it?

Sexual anorexia, also known as sexual aversion disorder, is a term used to describe the aversion to, avoidance, or fear of any sexual activity. The treatment for sexual anorexia may vary depending on the underlying cause of the condition and severity of symptoms, but typically involves therapeutic intervention and desensitization.

What is sexual anorexia?

Sexual anorexia is another frequently used term for the condition known as sexual aversion disorder, and is characterized by an extreme aversion, avoidance, or fear of any type of sexual activity or intimacy ^[1].

Sexual aversion disorder was included in the previous version of the Diagnostic and Statistical Manual of Mental Disorders, the DSM-IV ^[2], but has since been removed due to a lack of clarity and evidence around diagnostic criteria, so is no longer an official diagnosis according to the DSM-5 ^[3][4].

Some argue that, due to the fearful and anxious aspects of the disorder, it may be more closely related to anxiety disorders, or more specifically to phobias, than to sexual disorders. Although the presentation may vary depending on the individual’s symptoms and the cause of their behaviors ^[5].

The reason that sexual anorexia is a commonly used term for this condition is because it shares many similarities with anorexia nervosa, an eating disorder in which people compulsively restrict food intake due to a fear of weight gain. Both disorders share symptoms of compulsive avoidance and obsessive abstinence ^[1][6].

Symptoms of sexual anorexia

Sexual anorexia, or sexual aversion disorder, may cause varying symptoms depending on the individual, their history, and the cause of the disorder. Commonly, symptoms of sexual anorexia include ^[1][3][4]:

• The avoidance of any sexual activity, including not initiating or engaging in sexual intimacy, or actions that may lead to sexual activity.
• Experiencing sexual dysfunction if sexual activity does take place, such as a lack of desire or arousal, or an inability to orgasm.
• Difficulty maintaining relationships due to the avoidance of sexual activity.
• Feelings of shame or guilt when experiencing feelings of sexual desire, following sexual advances, or listening to comments relating to sexuality.
• Being critical or judgmental of others who engage in sexual activities, behaviors, or attire.
• The avoidance of professional or social occasions, due to a fear of the possibility for discussions or advances of a sexual nature.
• Constantly being afraid of being exposed to sexual advances or witnessing others’ sexual intentions or discussions.
• Having very few friends, little or no social engagement, and trouble forming and maintaining romantic relationships, due to a fear of potential exposure to sexuality.
• Discussing or being exposed to sexual behavior causes extreme fear, anxiety, and distress.
• Experiencing feelings of depression or suicidal thoughts.
• Engaging in self-harming behaviors, potentially of the genitals, in an attempt to decrease sexual attractiveness or viability.
• The presence of other mental health conditions or addictions, particularly alcohol or substance use disorders and eating disorders.

Causes of sexual anorexia

The exact cause of sexual anorexia is not known and may vary from person to person but is often caused by one or more contributing factors.

Abuse

Many people with symptoms of sexual anorexia have a history of abuse, particularly sexual abuse, but also physical or emotional. Their abuse history is likely to contribute to the development of the condition, due to extreme distress around the idea of or engagement in sexual activity ^[1][7].

Family history

A family history of substance abuse or sex addiction can contribute to the development of sexual anorexia, as growing up in an environment of addictive, obsessive, or sexual behaviors can lead to an aversion to these behaviors.

Similarly, having a family member with addictive behaviors may cause parents to be strict and rigid with their children in the aim to prevent these behaviors, thus potentially contributing to avoidant behaviors or sexual aversion ^[1][5].

Sex addiction

People who have a history of sex addiction may develop an aversion to sexual activity in response to negative feelings surrounding their past behaviors or as an attempt to correct harmful attitudes. Similarly, they may engage in a type of binge-purge behavior, similar to that of bulimia or anorexia, engaging in excessive sexual activity followed by abstinence, as a compulsion or fear response ^[1][7].

Sexual dysfunction

Various medical or hormonal conditions as well as certain types of medications can cause sexual dysfunction and decreased sexual arousal, which could contribute to the development of fear related to sexual activity. This fear can potentially lead to an avoidance or aversion ^[8][9].

Other mental health history

Many people with sexual anorexia also meet criteria for diagnoses of other mental health conditions, such as obsessive-compulsive disorder (OCD), substance use disorders, anxiety disorders, depression, or eating disorders. This may indicate that these conditions could increase the risk of or exacerbate symptoms of sexual anorexia ^[1][10].

Diagnosing sexual anorexia

Sexual aversion disorder is no longer an official diagnosis in the DSM-5 ^[3]. However, sexual anorexia and sexual aversion disorder are terms still discussed and explored in psychological and scientific research, so an individual could be given an unofficial diagnosis ^[5][11].

If you are experiencing symptoms of sexual anorexia that are having a negative impact on your quality of life, it may be necessary to seek professional advice. Although a licensed professional can’t make a diagnosis of sexual anorexia, they could make a referral to a specialist who can complete an assessment and provide appropriate advice and treatment ^[11].

Professionals will likely ask questions relating to your symptoms and experiences. These questions will ascertain the severity and duration of your symptoms, how they are affecting your life, and the distress they cause you. The professional may utilize the diagnostic criteria for sexual aversion disorder from the DSM-IV to help gather information to complete their assessment, which include ^[2]:

• Avoiding sexual activity
• A dislike, disgust, or fear of sexual activity
• Difficulties with interpersonal relationships
• Ongoing distress and impairments in daily, social, or professional functioning

Treatment for sexual anorexia

Sexual anorexia is not an official diagnosis and it may be caused by several different factors, so treatment may vary depending on each individual’s symptoms.

Typically, treatment will involve psychoeducation and therapeutic intervention to treat the root cause of the disorder and develop healthier attitudes around sexual intimacy ^[11][12].

Talk therapy

Various types of talk therapy may be useful in treating sexual anorexia, such as interpersonal psychotherapy and cognitive behavioral therapy (CBT). Both therapeutic interventions can help individuals explore the underlying causes of their sexual aversion.

Therapy can also help treat emotional distress, assist in learning new emotional and behavioral responses, and increase distress tolerance. All of which can help individuals to develop healthier thoughts and behaviors around sex and intimacy ^[1][5][11].   

Sex therapy

Sex therapy is a specialized type of therapy aimed at helping to improve sexual relationships and attitudes. Sex therapy is tailored to the specific experiences, attitudes, and behaviors of the individual or couple’s sexual problems. Therefore, it could be a good option for treating sexual aversion disorder ^[13].

The therapist can help to individuals discover and treat causes of their condition, including any psychological and physical reasons behind certain behaviors and thoughts. The therapist can also teach individuals ways to better manage their symptoms. Management may involve systematic exposure and desensitization to sexual activity with specific exercises for the individual or couple to utilize ^[12][14].

Medication

In some cases, medication may be prescribed to treat the underlying causes of the condition, such as anti-anxiety medications. However, many medications, such as selective serotonin reuptake inhibitors (SSRIs), an antidepressant that is commonly used to treat anxiety, are known to decrease sexual desire and function, so would be unhelpful in treating sexual anorexia ^[5][10].

Frequently asked questions about sexual anorexia

Sexual anorexia vs sex addiction – what is the difference?

Sexual addiction is characterized by the inability to control sexual desires and engaging in excessive sexual behaviors, which can cause harm and distress to the individual and others. In contrast, sexual anorexia causes directly opposing symptoms, such as entirely avoiding and being fearful of sexual behaviors, but it may still cause distress to the individual and others ^[1].

Some people with sexual anorexia may also have a history of sex addiction, with sexual anorexia occurring consequently. In addition, individuals with sexual aversions may experience several sexual disorders or may experience just one of these conditions without the presence of another sexual disorder ^[1][7].

Is sexual anorexia the same as low libido?

Libido can be decreased due to several factors aside from sexual anorexia. Medication, hormones, physical and mental health conditions, and personal preferences can all affect libido ^[8].

Low libido may be a symptom of sexual anorexia, as some people with the condition experience no physical or psychological desire for sexual intimacy. However, many with sexual anorexia do experience sexual desire and arousal but feel an aversion to sexual activity, thus preventing them from engaging in these behaviors ^[1][7].

As such, low libido and sexual anorexia may be linked in some instances but are not the same.