What Are Romantic Relationships Like When You Have Anorexia Nervosa?
By Mandi Newton, RN, PhD
Anorexia nervosa is diagnosed in women of all ages, and many of these women are in romantic relationships when they are diagnosed or after their diagnosis. What do these relationships look like and how are they experienced? Published literature offers several perspectives on these questions by studying the sexuality features of women who are in relationships and those who are not, as well as how women in relationships relate to their partners and vice versa.
Literature on sexuality for women with anorexia nervosa contains variation in its report of the women’s sexual knowledge, attitudes, and experience. In general, however, 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.
In the early 1980s, studies exploring sexuality for women with anorexia nervosa began to appear. In one of the first studies by Beumont, the majority of women (64%) aged 18 and older had experienced sexual intercourse prior to or after their diagnosis. Of these sexual experiences, 40% of the women evaluated them as negative, and cited sexual problems, marital conflict, and feelings of guilt as contributing to the maintenance of their anorectic behaviors.
A study by another group of researchers in the late 1980s noted reduced interests in sexual matters: only 10% of married women with anorexia nervosa expressed interest compared to 13% of single women. Similarly, both groups of women reported a comparable (and high) avoidance of sexual relations (ranging from 70–80%). These findings suggest sexual disturbances for women with anorexia nervosa irrespective of relationship status.
More recent research tells us that positive sexual experiences are an infrequent experience for both married and unmarried women with the disorder, with both women and their sexual partners reporting significant dissatisfaction with their physical relationship. Women report discomfort as a sexual person, dissatisfaction with, or avoidance of, sexual activity, and negative relational experiences. Studies also show that their partners report significant symptoms of depression and feelings of inadequacy in the relationship.
The quality of relationships for women with anorexia nervosa has also been examined in the past decade, but is very limited. This small amount of research has focused on two areas: perceptions and values attributed to dating women with the disorder, and perceptions of relationship quality from the perspective of the women and their partners.
In 1998, the attitudes and beliefs of dating individuals with anorexia nervosa within a university student population were studied. Students were asked questions regarding perceived dating experiences for an individual with the disorder and their own comfort dating someone with the disorder. The results indicated that although 95% of students reported knowing about anorexia nervosa, most students had little personal experience with it or with dating someone who had the disorder.
In addition, 59% of female university students believed that individuals with anorexia nervosa would experience "much conflict" during dating, while 45% of young men believed that dating would result in "some" conflicting issues. The students also had negative expectations of personally dating an individual with the disorder, including the anticipation of stress, difficulties, frustration, and dislike of the individual. When the students were asked about personally dating someone with anorexia, 52% of men and 57% of women reported feeling "not very," or "not at all" comfortable with the idea.
Engagement & Distancing
In research exploring relationship quality, both women with anorexia nervosa and their partners have reported significant relational dissatisfaction, and express a lack of intimacy in their relationship. A study published in 2005 found that while the women had diverse relational experiences, they were all characterized by themes of engagement (connecting) and distancing (disconnecting). For the women, engagement was emphasized as a state of emotional and physical connection attained in their relationship. It included feeling understood and supported by their partners and was described as being achieved through open dialogue that fostered trust and comfort. Distancing, on the other hand, was described as a state of emotional and physical disconnection. Contributing factors were secrecy, fear of exposure to judgment and rejection, and an inward focus on their eating disorder rather than their relationship.
In general, published research emphasizes many of the negative consequences of having anorexia while in a romantic relationship. Since this may be the reality for many women, romantic partners need to be mindful of focusing solely on these negative aspects. It can be a natural tendency to want to "fix" the issues that are causing discomfort; however, it is also important to emphasize the positive aspects of the relationship. This balanced approach will help women evaluate their relationships realistically, recognizing the negative impact their eating disorder has, while reminding them of the positive aspects they bring to and derive from the partnership.
This article is the first of a two-part series on romantic relationships and anorexia nervosa. Next installment: Intimacy Is an Essential Relational Component for Women with Eating Disorders.
Reprinted from: Eating Disorders Recovery Today
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