Ellen, a 33-year-old marketer in London, hadn’t heard of sexual anorexia until her then-boyfriend suggested several years ago she might have it. “He was obsessed with the idea that something was wrong with me sexually, because my sex drive had dropped off completely in our relationship,” she tells me. “He must have done a deep dive on Google and came back to me saying I probably had sexual anorexia or HSDD” — hypoactive sexual desire disorder.
In Ellen’s view, however, the problem was that she simply wasn’t attracted to her boyfriend anymore. “Unfortunately, we stayed together for another year or so, but I eventually ended things when it became clear that I probably wasn’t going to feel the same level of desire for him that I felt at the beginning of the relationship,” she continues. “Plus, he treated me like shit.”
Sexual anorexia — an extreme fear of sexual intimacy and obsessive avoidance of sex — is a controversial psychological concept. First proposed by a student of psychology in the 1970s, it became popularized in the 1990s by the publication of Sexual Anorexia: Overcoming Sexual Self-Hatred, a book authored by Patrick Carnes, a proponent of controversial ideas about sex addiction including that “at least 40 percent of female internet users engage in problematic cybersex.” Unlike HSDD, sexual anorexia is theorized as being parallel to, and even comorbid with, sexual addiction: a compulsive attitude to sex, which is treated like “a furtive enemy to be fought and defeated.”
The term has received criticism for many reasons, including that it compares low sexual desire with a fatal eating disorder. “In addition to potentially trivializing anorexia (a criticism also leveled at terms like ‘pregorexia,’ ‘drunkorexia’ and orthorexia), the term ‘sexual anorexia’ might pathologize what, for some, isn’t strictly a problem,” writes Anna North at Jezebel. “As commenter cinnabar points out, ‘humans don’t die from lack of sex.’” It also has very little professional weight among psychologists. “It’s absolutely not a reputable psychological diagnosis,” Elise Franklin, a psychotherapist in L.A., tells me. “I’ve never used that language.”
Franklin says that the link with anorexia obscures the totally disparate causes and manifestations of the two conditions. “The reason one is anorexic and the reason one is sexually inactive are usually very different,” she explains. “Sexual inactivity isn’t usually a medical issue but rather a dynamic issue,” i.e., it depends in large part on the dynamics of the individual’s intimate relationship(s). She says she’s noticed that female clients who report very low sexual interest in their relationships but who then have affairs or cheat on their partners often “suddenly gain a huge interest in sexual activity,” which casts doubt on the idea that there’s something wrong with their bodies or psyches — as opposed to their relationships or environments.
Still, dissatisfied lovers often seize on medical terminology when their partners show low sexual interest in them. “I dated a guy and eventually stopped being attracted to him, and when I stopped having sex with him, he absolutely blamed my anxiety,” Celia, a 23-year-old law student in L.A., tells me. “In reality, my sex drive dropped because of our relationship issues and how those affected my attraction to him. But he couldn’t fathom that. He was just like, ‘Oh, it must be your mental illness.’” She’d confided in him previously that she suffered from anxiety, something he weaponized in their conversations about her decreased sexual interest in him.
Allison, 33, who works in digital marketing in Seattle, is experiencing a similar struggle with her current partner. “My partner and I always argue about sex — he’d prefer to have sex much more often,” she says. “He basically either calls me a lesbian or says I’m not capable of intimacy because I have a lower sex drive.” She says that in her opinion, he’s confusing sex with intimacy. “My view of intimacy is more centered on sharing and communication, and my love languages are shared interests and quality time,” she continues. “I also feel that sexual intimacy can’t be forced.”
Franklin acknowledges that it can be distressing for individuals whose partners show little sexual interest in them, but cautions those people to consider the state of their relationship, and whether one party is shouldering an unfair burden. “If women are expected to caretake, it’s incredibly unsexy,” she says as an example. “If they’ve also been taking care of children or a grown-ass manchild, they may not need any more physical or emotional connection because they’re spent.” Franklin says women, like everyone else, “like to have sex when they’re choosing it, not when it’s expected of them.”
But it’s not just women at the receiving end of these armchair diagnoses. “My girlfriend recently left me because of my lack of sex drive, and she framed it as something wrong with me — a comment I remember very specifically was that I should go to the doctor because I might have low testosterone,” Josh, a pseudonymous 26-year-old education worker in New Zealand, explains. “I think I did have a low sex drive, but I also had a pretty rough year. My father has been very unwell with cancer, and my brother’s drug addiction got quite a bit worse.” He doesn’t resent his ex for leaving him, but says the way she framed the issue was really tough. “It was either that I needed to fix it because it was wrong, or I couldn’t fix it because there was something innately ‘wrong’ with me.”
It’s for this reason Franklin encourages patients not to cast blame on a partner. “It’s not a fault issue, it’s an issue of understanding what is the key to [your partner’s] desire,” she tells me. “Calling it ‘sexual anorexia’ puts the onus on [your partner], and I can see why hearing that term could feel gross and weird.”
In the end, that’s probably why Harriet, a 29-year-old writer in Australia whose abusive ex-boyfriend would constantly pester her for not initiating sex, says, “Sexual anorexia sounds extremely fake to me. How many friends have you had who are like, ‘I’ve completely lost my sex drive, I don’t know what’s wrong with me. Yes, I still love my boyfriend,’ and then a few months later, they break up?
“Is your sex drive gone,” she continues, “or are you not admitting something about your relationship to yourself?”
Madeleine Holden
Madeleine Holden is a lawyer and freelance writer based between Berlin and New Zealand. She writes about relationships, sex, gender and whatever the hell else she feels like for MEL.
