When we think about intimacy, we often think just about sexuality. While sexuality is certainly an important component of intimacy, intimacy generally refers to the overarching idea of interpersonal connection and relationships. Indeed, sex is one way humans connect with one another on a meaningful level; however, many other actions and feelings can be described as intimate—including honesty, transparency and communication.
If honesty, transparency, communication and sexuality comprise intimacy, it’s not surprising that individuals struggling with eating disorders often have problems achieving healthy intimacy and connecting meaningfully with others. Eating disorders thrive in secrecy, and women and men with anorexia, bulimia and binge eating disorder work tirelessly to hide their behaviors and mask the fact that food, weight and shape consume their every thought. They will often withdraw from friends and family, or cut off communication altogether, particularly when others voice concern or the need for intervention. For those that continue to communicate with loved ones, chances are they are not sharing the truth about their restriction, bingeing and/or purging. Physical intimacy is also challenging for eating disordered individuals, who generally have severely distorted body image. Because they feel such intense dissatisfaction with their own bodies, it’s unlikely that they will be able to comfortably engage in intimate situations with spouses or significant others.
I’m lucky to work alongside an emerging thought leader on the topic of eating disorders and intimacy, Brittany Lacour, LCSW, DAACS*. A Primary Therapist at Denver-based eating disorder treatment center Eating Recovery Center, Lacour describes the connection between eating disorders and intimacy issues in more detail below.
The hallmark of an eating disorder is an “impoverished sense of self,” which presents the individual with a deficiency in their knowledge about themselves as whole beings. As a result, their likes, dislikes and limits end up revolving around avoiding or controlling certain aspects of themselves or their world, which they believe—if left unmanaged—would be detrimental to them in some way. This dynamic can produce a crippling discomfort with uncertainty, as well as impair intimacy and connection.
Adherence to distorted or unworkable relational beliefs is not unique to eating disorders. However, patients struggling with eating disorders tend to be challenged by self-to-self relating, black and white thinking and experiential avoidance, which further complicate the actions of intimacy and connection. These rules and adherences can also be reinforced by the rules of their eating disorder, as well as the need for predictability, perfection, and often the profound influence of mainstream culture. For instance, entertainment and advertising suggest that we’re driven by hunger for intimate connection. But in fact, we’re after something else: We want someone to make us feel acceptable and worthwhile. We’ve assigned the label “intimacy” to what we want (validation and reciprocal disclosure) and have developed avoidance and control strategies that give it to us while keeping risky, vulnerable intimacy away. We’ve distorted what intimacy is, how it feels, how much we really want it, and how best to get it. Once we realize that intimacy is not always soothing and often makes us feel insecure, it becomes clear why we often try to avoid or control it.
The same confusion can arise regarding sexual desire; it is often spoken about as a “drive” and compared to a drive to satisfy a biological hunger, much like our need for food. That’s because the “biological hunger” view of sex is deeply rooted in societal norms, labeling those who stray from this view as having “sexual anorexia” or a sexual “eating disorder.” The notion behind this is that, since desire for sex is supposedly like desire for food—a basic biological drive—you have to be ill not to want either one. This is a double blow to many eating disordered patients—you can imagine the pain and stigma that comes with falling outside of this “normal” and “biological” paradigm.
Lacour’s insights describe a simple yet important idea—how can we connect with others when we are so disconnected with ourselves? Individuals struggling with eating disorders use their illness to avoid feeling sad or painful feelings, hence the poor sense of self. Add secrecy about eating disorder behaviors and feelings, and limited or uncomfortable physical intimacy, and it’s understandable how relationships suffer as a result of an eating disorder.
Because eating disordered patients struggle with connection and relationships, eating disorder treatment will often address intimacy along the road to recovery. Whether in an outpatient setting or in an intensive treatment program, treatment professionals are likely to explore three distinct topics that play a role in intimacy:
- Patient beliefs about relationships, sex and communication. These beliefs may be distorted, stemming from traumatic past experiences or unrealistic cultural narratives that dictate how we “should” look, act and be.
- Patient values—in other words, what’s important to them in life. It can be helpful to compare what a patient values to what they actually do, which often conflict with one another. For example, if a patient is married and values honesty, yet she hides a history of abuse and the extent of her current eating disorder behaviors from her husband, a therapist might acknowledge the inconsistency between her values and actions, helping to demonstrate the role of the eating disorder in impairing intimacy in her marriage. This therapeutic approach is referred to as Acceptance and Commitment Therapy, which has been found to be particularly effective in the treatment of eating disorders.
- Beliefs and values of close loved ones. Individual therapy may be used in conjunction with family or couples therapy, engaging those whose intimacy with the patient has suffered as a result of the eating disorder. During sessions, loved ones can share their feelings and experiences in a safe setting, offering patients another perspective to consider. The therapist can also help loved ones better understand the perspective of the patient, who may not be able to communicate effectively as a result of the eating disorder.
Intimacy can be a difficult topic to broach in eating disorder treatment, but it’s an essential component of the recovery process. The ability to connect meaningfully with others and develop and maintain mutually beneficial relationships is not only rewarding and enjoyable, but relationships provide a supportive network to help patients navigate recovery. Together, patient, therapist and loved ones can compassionately observe distorted beliefs and feelings of inadequacy, and identify the role of the eating disorder in creating or magnifying relationship problems.
How have eating disordered behaviors contributed to an inability to have an intimate relationship with others in your life? I look forward to hearing your comments.
*Brittany Lacour, LCSW, DAACS is a licensed clinical social worker, Board certified sex therapist and a diplomat to the American Academy of Clinical Sexology, and has specialized in the treatment of sexuality and intimacy issues for over 10 years. She is a Primary Therapist in Eating Recovery Center’s Adult Services, and has worked with the eating disordered patient population for over five years.