"We can hide with sex, we can hide from sex, but we cannot be fully ourselves sexually and hide."
-- Patrick Carnes, Sexual Anorexia
It's easy to mock the prim, tidy bachelor who stammers refusals; the disapproving spinster who wears a navy-blue cardigan all summer; the wife who shuts her eyes and thinks of England. These are the stereotypes of sexual aversion, and we know instinctively that such people are vulnerable.
When we meet real-life examples, though, we seldom subject them to further scrutiny. Maybe we're secretly afraid they're right -- sex is dirty. Or maybe we simply agree with most sex therapists: If people like that had the right information and gentle teaching, desire would awaken.
Not true. People who go to extreme lengths to avoid sex; who have sex to please their spouse but dread it; who lead celibate lives, not out of choice but out of fear, are -- to flip-flop the moralists' favorite word -- sick. Officially, they have "sexual aversion disorder," now popularly called "sexual anorexia": anorexia, meaning an interruption in the appetites, a deliberate self-deprivation.
So is this just a new name for '50s frigidity? Arousal can freeze, we all now know, if a sexual partner approaches too crudely, roughly or greedily; it can also freeze with guilt, religious scruples or parental weirdness. But anorexia is not frozen desire. It is self-hatred.
"Anorexia involves a profound disgust and loathing, a horror of anything sexual," explains Patrick Carnes, Ph.D., clinical director at The Meadows in Wickenburg, Ariz. "This is not inhibition, this is obsession. The thought of being sexual is almost unbearable. And the anxiety interferes with everyday life."
Carnes, who visited St. Louis last week to give the keynote address for a National Council on Sex Addiction conference, describes the frequently unrecognized, misunderstood and mistreated problem of sexual anorexia. "Freeing people up or helping them understand sexual response isn't going to do it," he begins. "They are very unconscious of this. In therapy, we talk about the 'examined life' -- well, they do not want to reflect; that's what they're running from. It's a terror-based illness."
Given society's strictures on female sexuality, you'd think anorexia would plague women in disproportionate percentages. But in 1997, Carnes launched a two-year study of 144 patients with sexual disorders. About 44 percent met standard criteria for sexual aversion, with another 15 percent demonstrating a combination of aversion and addiction. Of the 84 individuals, 41 percent were male. "I treat men in their late 30s who have never kissed a woman, never held hands and have absolutely no desire to do so," he notes. "Often they are social isolates. One even had his groceries delivered, so he never had to leave home." What caused such damage? "He'd been sexually abused, and he was frightened." It's a common pattern but often an unacknowledged one, adds Carnes, "because men don't want to admit being frightened."
Sexual anorexia starts with a trauma so painful, the person unconsciously vows never to combine intimacy and sexuality. The solution? Control; a sexual aversion that keeps everything orderly, with precise black-and-white boundaries. Sexual anorexics are often perfectionists, glorying in the triumph of mind over body. They may also exercise compulsively, save compulsively or clean compulsively. They tend to dress dowdily and button up tight.
The internal logic, explains Carnes, is that your needs will never be met if you have to depend on others. There's a self-hate that often bursts forth in anger -- at a partner who's pressuring you to be sexual; at your family, for not easing the original trauma; at our sex-soaked culture; at your own uptight self. Anything erotic is threatening. Anyone who is sexual is by definition out of control, immoral, base. Any sexual overture is exploitive or self-serving. Any sexual desire from a partner must be matched by greater reserve.
"There is a kind of life stance with deprivation," remarks Carnes: "areas in which you're in control and areas in which you're out of control." One patient, the daughter of a prostitute, was out of control sexually by adolescence. "Her cure was to marry, but as soon as she did, she began to overeat." In her promiscuous days, this woman was thin as a stick, but after she married, she ballooned. She divorced, and got skinny again. She remarried, and ballooned. "When intimacy entered into the sex," explains Carnes, "the anxiety became unbearable."
Both anorexia and its opposite, sex addiction, spring from the same deep-seated terror. And in a culture that links sex with sleaze, oppression, manipulation and trauma, "the terror has much to draw on," as Carnes wrote in his groundbreaking book Sexual Anorexia. Environment -- from the Oval Office to the sex shops -- feeds the problem. What about the newer standby, brain chemistry? "If you think of the brain as having little waterfalls, cascades of neurochemicals, there are four main ones," he replies. "Pleasure (triggered by, say, cocaine or orgasm), self-soothing (Twinkies, scotch or masturbation), escaping from reality altogether (fantasy, dissociation) and abstinence (anorexia, self-injury and other deprivations)." In this last category, the neurochemical Niagara is a tumble of endorphins, released as the body prepares for hardship.
Are there certain points in history when something like sexual anorexia -- which, after all, we used to call purity -- is more appealing? "Whenever there is a major cultural trauma or natural disaster -- the Black Plague, for example -- it's followed by a wave of extreme asceticism," notes Carnes. "And a book called Holy Anorexia made the case that many of the medieval saints were young adolescent women revolting against male authority; they got tremendous attention by not eating, shutting down, drinking the pus from lepers' sores.... "
Even today, it's easiest to imagine sexual anorexia in the context of celibate religious orders. Indeed, many are beginning to explore these issues -- seeking healing, not for the purpose of becoming sexually active but to unstick anxieties that can block spiritual energy. But even more often, sexual anorexia crops up behind the privacy fence of a marriage. A wife might strategize a different bedtime to avoid sexual overtures, then spend all her free time dreading the next encounter. Or a husband might combine addiction and anorexia, having frequent sex with prostitutes but strenuously avoiding his own wife, who's too close for comfort.
Often someone who "acts out" winds up marrying someone anorexic, hoping the "other half" will provide balance, adds Carnes: "Like heat-seeking missiles -- the shut-down person finds the out-of-control person." Sometimes sexual anorexics are repeating family history, or punishing themselves with further trauma. Sometimes it's a healthy but misguided attempt to heal themselves. And sometimes it even works. "I have this Jewish couple from New York, both descendants of Holocaust survivors," Carnes says, his voice softening. "What has happened for them is a kind of loosening-up that has been genuinely beautiful to watch. They're flirting with one another, becoming more assertive ... they're blossoming."
On the dark side of that coin, you'll find the face of the woman whose first husband played Russian roulette with a gun in her vagina. She left him and married a very nice man who masturbated a lot. She found this disgusting, but he had her convinced that it was her fault because they only had sex a few times a year. "Turns out he'd had a (compulsive) problem since he was 5," reports Carnes. "She had unerringly found another man who was not quite reliable."
And she was still starving.