192 CENTROS EN LA PROVINCIA DE VALENCIA
E. ESCUELAS OFICIALES DE IDIOMAS: Otros centros que han de
2. INFRAESTRUCTURAS
1.3 PUNTOS DE REFERENCIA OBLIGADOS
4.5 Sexual Anorexia
4.5.1 Terminology
The concept of sexual anorexia or sexual aversion disorder has been presented as part of the spectrum of sexual addiction. Carnes defined it as ‘an obsessive state in which the physical, mental, and emotional task of avoiding sex dominates one’s life.’116 The labelling is unfortunate, DSM-‐IV speaks instead of sexual aversion disorder,117 which is a much more appropriate term.
115 Carnes, Don't Call it Love, 67.
116 Carnes and Moriarity, Sexual Anorexia, 1.
117 Diagnostic and Statistical Manual of Mental Disorders : DSM-IV, 499.
An-orexis just means loss of appetite, which applied to sexuality could be caused by depression or a physical illness and is in itself a neutral descriptive term, not necessarily implying a pathology. For sex addicts this could even be a positive fruit of sobriety: loss of sexual appetite. However, the term is used to describe sexual aversion disorder, deliberately in parallel to Anorexia Nervosa, which in DSM-‐IV has the following essential features:
‘the individual refuses to maintain a minimally normal body weight, is intensely afraid of gaining weight, and exhibits a significant disturbance in the perception of the shape or size to his or her body. In addition,
postmenarcheal females with this disorder are amenorrheic. (The term anorexia is a misnomer because loss of appetite is rare.)118
Considering those criteria, any referral to sexuality makes no sense at all. However, the term sexual anorexia remains widely used.
4.5.2 Function
Similarly to food deprivation behaviour or the compulsive hoarding of money, sexual starvation can offer pleasurable feelings of control and can be used to control one’s affects and perception of self. It has long been noticed that deprivation behaviours of various kinds share common characteristics.119
According to the research, most addicts are not only prone to excessive appetites and experience craving if they withdraw from their particular behaviour, but these excessive appetites interact with areas or periods of compulsive aversion.
118 Diagnostic and Statistical Manual of Mental Disorders : DSM-IV, 539.
119 Kaplan, Helen Singer, The Sexual Desire Disorders : Dysfunctional Regulation of Sexual Motivation (New York: Brunner/Mazel, 1995).
Deprivation and addiction share similar psychological architectures and are able to serve similar functions.120
Within the integrative theoretical framework sexual anorexia appears as another possible response to the underlying addictive process, appearing in isolation as well as in binge-‐purge scenarios of different kinds. Four different constellations are possible and have been observed by practitioners:
a) Somebody is almost solely sexually compulsive or sexually anorectic and the other side of the spectrum is invisible.
This used to be seen as the norm among addicts, but may just be a long binge or purge phase of somebody who is a “periodic addict”, following the pattern
described in c). In this case it is also possible that somebody else close to the addict acts out the other part of the continuum as described in d).
b) sexual addiction and anorexia occurs within the same person at the same time.
This is very common but the sexual anorexia is often hidden due to the high level of suffering caused by the sexual compulsion. A possible scenario could be a sex addict acting out with anonymous sex with a large number of partners and
compulsively avoiding sexuality connected with intimacy – making them unable to function sexually with their partners or spouses. Only in recovery, when the acting out behaviour ceases, do addicts then notice their inability for sexual intimacy and start to address this area of their addiction.
c) sexual addiction and anorexia are part of a binge-‐purge scenario.
120 Carnes et al., 'Bargains With Chaos,' 92; Huebner, Endorphins, Eating Disorders and other Addictive Behaviors.
This often looks like a), depending on the periods of time spent on either side of the addiction continuum. Many cases like this have been described in the clinical literature.121 The case of the religious minister who preaches against sexual immorality in his professional life and acts out sexually on occasions is almost proverbial. The situation where someone’s sexual acting out behaviour is stopped through a shock from outside is also very common: somebody is found out by an employer, a family member or by the police and switches to an anorectic form of sexual addiction – the huge problem is that this may be sexual sobriety in one area, but it is certainly not the same as recovery.
d) sexual addiction and anorexia are part of a family system.
If a sex addict acts out sexually, the anorectic part of the continuum may be
expressed by a family member. This can also cross generations: it is no coincidence that children of alcoholics often become compulsive teetotallers, whereas their own children may return to alcohol abuse.
The picture is further complicated by the fact that addictive behaviour is not restricted to one area, but there are typical co-‐morbidities and addicts can use different types of addictive behaviour with similar effect. This has been termed alternating addiction cycles, 122 addictive cycles123 or oscillating cycles of control and release.124
121 e.g. Birchard, 'The Snake and the Seraph.'; Birchard, 'Those Twin Levers that Move the World.';
Carnes et al., 'Bargains With Chaos.'; Knauer, Sandy, Recovering from Sexual Abuse, Addictions, and Compulsive Behaviors : "Numb" Survivors (New York: Haworth Social Work Practice Press, 2002).
122 Carnes et al., 'Bargains With Chaos.'
123 Schwartz, Mark F., 'Developmental Psychopathological Perspectives on Sexually Compulsive Behavior,' Psychiatric Clinics of North America 31, no. 4 (2008), 582.
124 Birchard, 'The Snake and the Seraph.'; Birchard, 'Those Twin Levers that Move the World.'
4.6 Addiction Interaction: Alternating Addiction Cycles or Oscillating Cycles