One major difference separates food and sex (and thus eating disorders and sex addiction) from other things that people sometimes use to escape reality: Food and sex are necessary for survival. Obviously, you can't just be abstinent from food. And while we could survive without alcohol or drugs, giving up sex would lead to the end of the human race. Giving up either one means the loss of pleasure.
Our bodies are designed for both. This makes recovery from both eating disorders and sex addiction more difficult. Now we are learning that these two problems often exist together in the same person. And many times, one of the two remains hidden from treatment providers.
I believe that the parallels between eating disorders and sex addiction are compelling. It seems likely that the two interact with each other, and that they may even be two expressions of the same core addictive process.
Are Eating Disorders and "Sexual Addiction" Really Addictions?
There is some debate about whether these phenomena are addictions in the strict sense of the word, but both have many parallels to addictions. It's common for a person to have multiple addictions, and those with eating disorders and those who are sexually compulsive often have substance addictions, gambling problems, or other compulsive behaviors.
Whether you decide that eating disorders and compulsive sexuality fall into the "addictions" category or not, they certainly coexist in individuals. One study of 932 sex addicts found that 38% had eating disorders as well.
Similarities: Rituals in Eating Disorders and Sex Addiction
Both eating disorders and sex addiction commonly involve ritual behaviors. For example, a person who wants to stop purchasing adult videos may begin the ritual in the car by turning left (toward the video store) instead of right (to his home). Although he is far from the video store at that point, he has already started a chain of patterned events that will ultimately lead him to doing something he wants to stop. He may circle the block twice before going in, or wrap his purchase in a certain way to avoid being seen. Even waiting two or three days to watch it may be part of the ritualistic behavior.
With bulimia nervosa, ritual behaviors might begin with the purchase of a certain food, or in beginning to make a particular dish. Since familiar food preparation and ingredients have led to binge eating in the past, they do so again.
Interactions Between Sex Addiction and Eating Disorders
Clearly, eating disorders feed on the notion that being thin means being attractive. So it's easy to understand how a person who suddenly gets compliments on her body after self-starvation and increases sexual activity may equate the two.
But what happens when someone is sexually frustrated? She may turn to food for consolation. This reinforces the role of food as something used to soothe difficult emotions. The reverse is possible as well: Frustration with physical appearance may drive her to seek relief from the emotions by acting out in sexual ways.
Not everyone is out for more food or more sex. The term "sexual anorexia" refers to a person who avoids sex. In some cases, this is a likely problem for a person who struggles with anorexia nervosa, because both food and sex bring stimulation and pleasure of different kinds. These can be overwhelming to a person with anorexia.
Similarly, a "sexual binge" refers to a high rate of sexual activity in a relatively short time, paralleling the eating pattern of a person with binge-eating disorder or bulimia nervosa.
Why Eating Disorders and Sex Addiction Should Be Treated at the Same Time
In many cases, it's easy for a person to recognize one kind of compulsive behavior and avoid dealing with the other. Many veterans of 12-step groups like Alcoholics Anonymous and Overeaters Anonymous are fearful of having shameful experiences at similar meetings for sexual issues. Others recognize sexual problems and want help, but are very reluctant to address eating disorders. For those who seek treatment for sex addiction for religious reasons, eating problems may seem to be less troubling morally.
It seems reasonable that both can be part of the same addictive process. For example, it's common to see an eating disorder worsen as sex addiction lessens. When the eating disorder weakens, sex addiction returns in force. The addiction essentially moves back and forth to avoid being fully treated. This kind of interaction supports the notion that sexual and eating issues are parts of the same underlying problem. Failing to address both thus makes relapse more likely.
Recovery from Sex and Eating Issues
Since complete avoidance of sex generally is not an appropriate lifelong goal, the emphasis must be on healthy sexuality. This mirrors recovery from eating disorders. A person struggling with either or both must re-learn behaviors that contribute to health, rather than addictive processes.
But the first step is for clinicians to learn that people with addictions often have more than one. Improved interviewing techniques will help treatment providers to address all addiction-like problems within a person, which requires the person to learn new and more effective ways to self-soothe.
Sources:
Carnes PJ, Murray RE, Charpentier L. Bargains with chaos: Sex addicts and addiction interaction disorder. Sexual Addiction and Compulsivity 12 92005): 79-120.
Power C. Food and sex addiction: Helping the clinician recognize and treat the interaction. Sexual Addiction and Compulsivity 12 (2005): 219-234.
