Associations Between Sexual Function and Disordered Eating Among Undergraduate Women: An Emphasis on Sexual Pain and Distress

Why Do Women with Disordered Eating Engage in Sex? The Mediating Role of Sexual Motivations in the Association Between Disordered Eating Behaviors and Attitudes and Sexual Dysfunction

Although there is growing evidence of an association between disordered eating and sexual dysfunction, the mechanism underlying this association is still unclear. In the current study, we sought to examine the mediating role of sexual motivation between disordered eating and sexual dysfunction. We used a multi-path mediation model to examine the mediating role of sexual motivation between disordered eating and sexual functioning among a sample of 341 non-clinical women in a steady relationship. Analysis revealed two significant mediation paths associating disordered eating with sexual functioning: (1) a high level of disordered eating was significantly linked with higher motivation for partner approval via sex and sexuality which, in turn, was associated with lower sexual functioning and (2) a high level of disordered eating was significantly linked with lower enhancement sexual motivation which, in turn, was associated with lower sexual functioning. This study extends the existing knowledge by offering an explanation for the relation between disordered eating and sexual dysfunction via sexual motives. Findings from the current study suggest women with disordered eating utilized sex for self-affirmation, for coping with negative emotions, for partner approval, and to increase intimacy. Also, these women were not likely to engage in sex for enhancement reasons.

Sexual self-concept, functioning, and practices of women with binge eating episodes

PURPOSE

Positive sexuality has received little empirical attention in relation to eating disorders. Two tendencies related to sexuality have been identified among women with anorexia nervosa (avoidance) and bulimia nervosa (disinhibition), but it is unclear if they also apply to women with binge eating episodes without compensatory behaviors. This study aimed at (1) exploring the sexual self-concept, functioning, and practices of women with binge eating episodes with or without comorbid restrictive and/or compensatory behaviors, considering past experiences of violence, and (2) verifying the presence of distinct profiles of sexual dispositions among this population.

METHODS

In total, 253 women reporting recurrent episodes of loss of control related to food intake in the past 5 years, completed a web-based questionnaire. Descriptive and correlational analyses were conducted to outline participants' sexual self-concept, functioning, and practices and to examine the relationship between these factors. A two-step cluster analysis was also performed to determine whether participants presented distinct profiles of sexual dispositions.

RESULTS

Participants were generally characterized by a negative sexual self-concept and poor sexual functioning. While a first subgroup of participants displayed a pattern of sexual difficulties and avoidance, a second subgroup had a positive sexual self-concept, better sexual functioning and a wider range of sexual practices. Subgroups did not differ relative to binge eating.

CONCLUSIONS

Sexuality offers a platform for positive embodiment, which can lead to the improvement of body image and mind-body connection and may thus constitute an essential clinical target to improve treatment related to binge eating episodes.

LEVEL OF EVIDENCE

Level II: The experimental study is a non-randomized controlled trial.

Associations Between Eating Attitudes, Mental Health, and Sexual Dysfunction during Pregnancy

This cross-sectional study looked into sexual dysfunctions in a sample of Lebanese pregnant women (N = 433) while assessing their psychopathological correlates. It was a first attempt in research to examine the role of disordered eating attitudes in pregnancy, using the Arabic version of the Disordered Eating Attitudes in Pregnancy Scale. The pre/post comparison in terms of sexual functioning was based on the women's recall, using the Pregnancy Sexual Response Inventory. According to the pregnant persons perceptions of their sexual functioning before and during pregnancy, 66.1% of the participants reported a lower frequency of sexual activity during pregnancy, 52.7% lower sexual desire, and 47.3% dyspareunia; 33% were sexually satisfied contrasted to 70% before pregnancy. Pregnancy was significantly associated with lower sexual outcomes compared to before. Higher anxiety and more disordered eating attitudes during pregnancy were significantly associated with lower sexuality composite scores. Our study accentuates the need for rigorous medical guidance on sexual activity during pregnancy and highlights dysfunctional eating behaviors and anxiety disorders as pejorative predictors of the sexual response among pregnant women. It thus sustains the hypothesis that mental health disorders pertain to the pathogenesis of sexual problems and should therefore be targeted in sexual health promotion during prenatal care.

Exploring the link between eating disorders and persistent genital arousal disorder/genito-pelvic dysesthesia: first description and a systematic review of the literature

BACKGROUND

Persistent Genital Arousal Disorder/Genito-Pelvic Dysesthesia (PGAD/GPD) characterized by recurrent physiological genital without corresponding psychological arousal is a poorly understood and researched condition. Based on the first two case descriptions of eating disorders directly linked to PGAD/GPD the aim of this paper was to systematically review the literature on possible associations between eating disorders and PGAD/GPD.

METHOD

A systematic literature search on eating disorders and PGAD/GPD was conducted in PubMed, PsycINFO, and Scopus, complemented by Google Scholar. We included case reports, case series, cross-sectional studies and review articles published in peer-reviewed journals written in English or German-language.

RESULTS

The included original papers described a total of 2078 cases with PGAD/GPD symptomatology. Of these, 892 participants fulfilled all five PGAD/GPD core criteria. The aetiology of PGAD/GPD is unknown. Multifactorial genesis of PGAD/GPD is presumed including neurological, pharmacological, hormonal, vascular and psychological causes. A high degree of psychological comorbidity is reported. No study was found that drew a direct link between eating disorders and PGAD/GPD. Although PGAD/GPD symptoms also occur in adolescents, there are no findings in this regard. However, we found a gap in data collection: eating disorders as potential psychiatric comorbidities were systematically recorded in only a few studies.

CONCLUSION

The existing literature have not yet considered a possible link between eating disorders and PGAD/GPD so far. According to the authors' knowledge, this work is the first review to systematically explore the associations. We suspect underreporting of PGAD/GPD cases in eating disorders and particularly during adolescence. We argue that there are several common factors that appear to be important in the etiology, course, and treatment of both disorders (e.g. hormonal dysregulation or sensory sensitivity and avoidance), warranting future research on the possible comorbidity of these disorders.

Associations between pathological eating, relational attitudes and satisfaction in romantic relationships

OBJECTIVE

Women with disordered eating report low satisfaction from romantic relationships. We wished to examine whether this may be explained in part by a restricted or inflated sense of relational entitlement, pathological concern and low authenticity levels.

METHOD

A community sample of 170 women aged 18-60 (M = 24.89 + 6.22), who had experienced a meaningful romantic relationship, completed questionnaires online. These included measures of disordered eating (EDE-Q), sense of relational entitlement (SRE-R), pathological concern (PCQ), relational authenticity (AIRS) and basic relational needs satisfaction (BNSRS). Structural equation model (SEM) was employed to assess the mediating effect of the SRE-R, PCQ and AIRS on the association between ED symptoms and BNSRS.

RESULTS

Participants with high EDE-Q scores tended to score high on inflated and restricted SRE-R, PCQ, AIRS and BNSRS. SRE-R, PCQ and AIRS scores mediated the negative association between EDE-Q and BNSRS scores.

CONCLUSIONS

An imbalanced sense of relational entitlement, pathological concern and inauthenticity seem to underlie the dissatisfaction that women with disordered eating experience from romantic relationships. Since these relational characteristics seem to take a high toll on the intimate relationships, it is important to encourage healthy eating attitudes and assertiveness within romantic relationships, in life and in therapy.

LEVEL OF EVIDENCE

Level III: evidence obtained from well-designed cohort or case-control analytic studies.

Eating Disorders and Sexual Satisfaction: The Mediating Role of Body Image Self-consciousness during Physical Intimacy and Dissociation

Women with eating disorders experience difficulties related to sexual activity, yet little is known about the indirect association between eating disorders and sexual satisfaction. This study examined the indirect association between eating disorders and sexual satisfaction using body image self-consciousness during physical intimacy and dissociation as mediators. Online questionnaires were answered by 985 Israeli women. Of them, 98 were identified as likely to have eating disorders (study group). A matching control group (n = 98) was selected from the remaining respondents. Participants in the study group had significantly higher body image self-consciousness and dissociation than the matched controls, as well as significantly lower sexual satisfaction. The research model revealed that body image self-consciousness during physical intimacy mediates the link between eating disorders and sexual satisfaction, while dissociation does not. Women with eating disorders have higher levels of self-consciousness about their body during sexual activity, which may distract them from their own sexual needs and desires and those of their partners, and this, in turn, is associated with sexual dissatisfaction. Findings highlight the need for improved evidenced-based assessment and management of the sexual satisfaction of women with eating disorders.Abbreviations: ED: eating disorders; AN: anorexia nervosa; BN: bulimia nervosa; BED: binge eating disorder.

Avoidant Attachment Style Moderates the Recovery of Healthy Sexuality in Women With Anorexia Nervosa Treated With Enhanced Cognitive Behavior Therapy (CBT-E): A 2-Year Follow-Up Study

BACKGROUND

Insecure Attachment style has been associated with interpersonal problems in persons with Anorexia Nervosa (AN), and it might moderate the recovery of healthy sexuality in these subjects.

AIM

The aim of the present 2-year follow-up study was to evaluate the role of insecure attachment style as a moderator of the recovery of healthy sexuality in women with AN.

METHODS

63 Italian women with AN treated with a multidisciplinary approach including Enhanced Cognitive Behavior Therapy were evaluated by means of a clinical interview and self-administered questionnaires. Individual psychotherapy sessions were administered by experienced psychotherapists over the course of at least 40 weeks (median number of sessions = 43, range: 38-50); trained dieticians provided personalized nutritional counselling to facilitate weight recovery. The assessment was performed at baseline (T0) and after 1 (T1) and 2 (T2) years.

OUTCOMES

The administered questionnaires investigated general psychopathology (SCL-90-R), eating disorder-specific psychopathology (EDE-Q), female sexuality (FSFI) and adult attachment style (ECR).

RESULTS

At baseline, avoidant attachment style was associated with all domains of sexual dysfunction. Longitudinal analysis showed a significant decrease in both eating disorder-specific psychopathology and sexual dysfunctions at follow-up evaluations. However, only 45% of remitted subjects also recovered healthy sexuality: these women reported significantly lower avoidance scores than those who only recovered from AN. Moderation analysis indicated that sexual desire did not increase in participants with higher levels of avoidant attachment.

CLINICAL IMPLICATIONS

These novel findings highlighted the importance of the assessment of adult attachment in the clinical setting, for better characterization and treatment of persons suffering from AN.

STRENGTHS & LIMITATIONS

The long follow-up duration, the multidisciplinary nature of the treatment, and the novelty of the topic were major strengths of the study, whereas the limited sample size and the absence of biological data were the main limitations.

CONCLUSION

This study highlighted the crucial role of avoidant attachment in the relationship between AN and sexual dysfunctions, underlining the importance of integrating treatments with attachment-focused interventions. Cassioli E, Rossi E, Vizzotto C, et al. Avoidant Attachment Style Moderates the Recovery of Healthy Sexuality in Women With Anorexia Nervosa Treated With Enhanced Cognitive Behavior Therapy (CBT-E): A 2-Year Follow-Up Study. J Sex Med 2022;19:347-355.

Profiles of Sexual Disorders and Eating Disorder Symptoms: Associations With Body Image

BACKGROUND

Although the empirical evidence supporting the co-occurrence of sexual disorders and eating disorders is growing, it is not yet known how often these 2 conditions co-occur, and whether the comorbidities of sexual disorders and eating disorders differ in any specific ways.

AIM

To examine the co-occurrence of sexual disorders and eating disorders.

METHODS

In the current study, we used latent profile analysis to identify distinct profiles of sexual disorders and eating disorder symptoms among a large non-clinical sample of women (n = 985). We also examined how these profiles differed in terms of body image self-consciousness. The study was conducted as an online survey among a convenience sample of Israeli women.

MAIN OUTCOME MEASURES

For sexual disorders we used the Arizona Sexual Experience Scale, and for eating disorders we used the Eating Disorders Inventory 2.

RESULTS

Latent profile analysis revealed 4 profiles: no disorder (low levels of sexual disorders and eating disorder symptoms), eating disorder symptoms (low levels of sexual disorders and high levels of eating disorder symptoms), sexual disorders (high levels of sexual disorders and low levels of eating disorder symptoms), and comorbidity (high levels of both sexual disorders and eating disorder symptoms). Women in the comorbidity group had significantly more body image self-consciousness during sexual activity than did women in the other groups.

CONCLUSION

The 4 profiles identified in the study support the co-occurrence of sexual disorders and eating disorder symptoms, yet also raise many clinical considerations. Limitations of the study, directions for future research, and clinical implications are discussed. Gewirtz-Meydan A, Spivak-Lavi Z. Profiles of Sexual Disorders and Eating Disorder Symptoms: Associations With Body Image. J Sex Med 2021;18:1364-1373.

Disordered Eating and Body Dissatisfaction Associated with Sexual Concerns in Undergraduate Women

While research has shown an association between eating disorders and sexual dysfunction, few studies have examined the association between disordered eating and sexuality in non-clinical samples. Here we measured self-reported symptoms of disordered eating, body dissatisfaction, and psychological features characteristic of eating disorders in relation to sexual difficulties among a sample of n = 656 (mean age = 20.59 years) undergraduate women. Disordered eating symptoms were associated with sexual distress, sexual function problems, more cognitive distractions during sexual activity, and poorer sexual self-efficacy. Psychological features characteristic of those with an eating disorder were found to mediate the association between disordered eating and sexual concerns. These findings suggest that eating concerns are associated with sexual difficulties even among women without an eating disorder diagnosis. Further, results highlight the importance of assessing eating disorder symptoms and body dissatisfaction among those seeking treatment for sexual concerns.

Sexuality, embodiment and attachment style in anorexia nervosa

PURPOSE

Recent studies hypothesized that sexual dysfunctions represent not just complications of eating disorders (EDs), rather they should be attributed to the core psychopathology of these disorders. Therefore, disorders of the embodiment and insecure attachment may play a role in maintaining an abnormal sexual functioning, given their known relations with core ED features. The aim of the study was to investigate the relationship between sexual dysfunctions and both disorders of the embodiment and attachment style in people with anorexia nervosa (AN).

METHODS

111 adult women with AN and 120 healthy subjects completed the Symptom Checklist-90, Eating Disorder Examination Questionnaire, Identity and Eating Disorders, Attachment Style Questionnaire and the Childhood Trauma Questionnaire-Short Form.

RESULTS

Patients reported worse scores than controls in all areas assessed. In patients, low sexual desire was found to be associated with general and ED-specific psychopathology, and with disorders of embodiment and attachment style. Sexual dysfunctions had no associations with traumatic experiences. Dietary restriction showed an association with low sexual desire through embodiment disorder and Discomfort with Closeness, as confirmed by the serial mediation model.

CONCLUSION

The present study suggests that disorders of embodiment maintained by pathological eating behaviours have a key role in the development of sexual dysfunctions in EDs, through the compromise of intimacy.

LEVEL OF EVIDENCE

Level III, cross-sectional study with comparisons between cases and controls.

The relationship between eating disorder psychopathology and sexuality: etiological factors and implications for treatment

PURPOSE OF REVIEW

There is a remarkable overlap between eating disorders and sexual problems, both in terms of sexual dysfunctions and risky sexual behaviors. This systematic review of the recent literature aimed at clarifying the nature of this relationship in terms of psychopathological meaning.

RECENT FINDINGS

Body image disturbance, and particularly body dissatisfaction and embodiment disorder, emerged as shared psychopathological dimensions between eating disorder symptoms and sexual dysfunctions. Interpersonal difficulties, a disturbed intimacy and insecure attachment style, but not a history of sexual abuse per se, resulted to play a pivotal role in the interconnection between eating disorder psychopathology and sexual dysfunctions. On the other hand, several studies confirmed the association between eating disorder symptoms and risky sexual behaviors, which has been explained in terms of several common psychopathological dimensions, including impulsivity and addiction.

SUMMARY

Sexuality is deeply interconnected with eating disorder psychopathology, and it should be considered a fundamental aspect in managing these disorders. An accurate assessment of sexual function might allow to characterize etiological information (e.g., sexual abuse) and maintaining factors (embodiment disorder and emotion dysregulation). Accordingly, the recovery of a good sexuality should be considered a crucial signal of recovery.

Sexual function and dysfunction among women with anorexia nervosa: A systematic scoping review

OBJECTIVE

Research suggests that a variety of biological and psychosocial factors are associated with the sexual health of women diagnosed with anorexia nervosa (AN). This systematic scoping review, conducted in accordance to Preferred Reporting Items for Systematic Reviews and Meta-Analyses Guidelines, synthesizes the current literature concerning sexual function and dysfunction in women with AN.

METHOD

We searched PubMed, EMBASE, and PsychInfo for literature published until April 2020. All study designs were eligible for inclusion, providing they focused on sexual function and dysfunction in women with AN. Studies that only included outcomes related to gender identity or sexual orientation were excluded.

RESULTS

N = 28 studies met criteria for inclusion in the review. All studies were conducted in Western countries and the majority employed either a cohort or cross-sectional design. Although measures of sexual function and dysfunction varied markedly across studies, most studies adopted a biopsychosocial framework. Libido may be linked to body mass index (BMI), while other aspects of sexual functioning and behavior might not be specifically associated with weight status. Limited data are available on evidence-based interventions.

DISCUSSION

Sexual dysfunction in women with AN is common. Although some of the variance is explained by low BMI, associated physiological sequelae and other psychosocial factors are also involved. Sexual dysfunction is a relevant clinical problem and clinicians should sensitively incorporate questions related to sexual function into their eating disorder assessments. Future research, using more robust designs and validated outcome measures, is needed to better understand causal pathways between the biological and psychosocial correlates of AN and sexual dysfunction. Identifying predictors of sexual function and dysfunction in more diverse groups of people with AN will support the development of evidence-based therapies.