Eating Disorders, Trauma, and Intimacy Difficulties

**Please be aware that this blog covers topics of trauma and abuse. Please use your own discretion when reading and speak to your therapist or support system as needed. If you need someone to speak to about sexual assault or abuse, reach out to RAINN’s National Sexual Assault Hotline at 800-656-HOPE. If you need to talk with someone or need help fleeing domestic violence, reach out to the National Domestic Violence Hotline at 1-800-799-7233 or TTY 1-800-787-3224.

The existence of an eating disorder largely impacts a person’s ability and desire to be in sexual and/or emotionally intimate relationships. In those with anorexia, bulimia, binge eating disorder, compulsive overeating, or OSFED, one of the main symptoms is a concern about body weight, image, size, and/or shape. These body image disturbances and obsessive negative thoughts can create barriers to entering into an intimate relationship or can prevent intimacy in current relationships. Oftentimes, those with eating disorders struggle getting close to others because their eating disorder becomes their primary focus.

Sexual Trauma, Abuse, and Intimacy Issues

The National Eating Disorder Association (NEDA) explains that eating disorders are rarely just about food. While eating disorders have a variety of causes—social factors, psychological factors, physiological factors, environmental factors, etc.—studies have demonstrated a clear connection between untreated or unresolved trauma, post-traumatic stress disorder, and eating disorders.

Individuals who suffered abuse and trauma are often at a higher risk for developing an eating disorder. NEDA explains that “There tends to be a strong view that body shame sparks a large amount of eating disorders related to abuse. The body shame might trigger habits geared toward destroying the body of which the victim may be ashamed, resulting in starvation, purging, or binge eating” (NEDA, 2012). Following trauma, eating disorder behaviors may be used as a way of coping. Behaviors such as restricting, binging, or purging may be used to establish or to regain a sense of control over an individual’s body or life.

Those suffering from trauma and an eating disorder often struggle with relational intimacy. The emotional closeness that a friendship or relationship requires may be challenging for those already struggling with pressing mental health concerns. This additional pressure may increase stress and cause an individual to isolate further. Close relationships may also “threaten” the individual’s eating disorder if the other person is concerned about disordered behaviors, which may cause the individual to back away or withdraw from the relationship.

In addition to non-romantic relationships, physically intimate relationships are often difficult for those struggling with eating disorders, and even more difficult for those who are also struggling with past trauma and abuse. An article written about the relationship between trauma, eating disorders, and intimacy acknowledges that physical intimacy is often hard for trauma survivors due to a belief that their body is shameful or bad. In addition, individuals who have suffered trauma may disassociate with their body and find it “flawed,” thus choosing to refrain from engaging in intimate relationships to protect themselves.

Eating Disorders, Intimacy, and Medical Complications

Oftentimes when an individual has suffered at length with an eating disorder or frequently engages in disordered behaviors, their physical body begins to change. Those struggling with anorexia may experience a myriad of physical symptoms that can affect their bodily systems (read more about the physical effects of anorexia here). Typical complications of anorexia, bulimia, and avoidant/restrictive food intake disorder can include extreme weight loss, nutritional deprivation, anemia, and low heart rate. These complications often decrease hormonal functioning in both men and women, causing individuals to experience a decrease in energy, mood, and libido. This decrease in energy, mood, and libido may result in individuals not seeking out intimate relationships or causing them to isolate in current intimate relationships. This reaction is completely normal and it is important that no one forces or tries to persuade an individual to engage in any behaviors they do not want to.

Eating Disorders, Intimacy, and Psychological Complications

While there are physical reasons individuals struggling with eating disorders may choose to back away from intimate relationships, there are also psychological reasons as to why individuals step away from emotionally and/or physically intimate relationships. Those suffering from eating disorders may believe that they are unworthy of being loved and fear rejection, leading them to detach from relationships out of fear.  

Individuals with eating disorders often struggle from other mental health illnesses as well, including anxiety and depression. These co-occurring illnesses often make it challenging to lead a “normal” day-to-day life. Anxiety and depression, in addition to an eating disorder, may result in further social isolation and withdrawal from friends, family, and loved ones.

For those suffering from body dysmorphia, a mental illness involving an obsessive focus on perceived flaws in appearance, intimacy can be especially challenging. Body image issues and an individual’s relationship with their body have a significant impact on emotional and physical intimacy. If someone is feeling like there are physically flawed or imperfect, it is unlikely that they will feel comfortable opening up in close relationships, whether it be emotionally or physically. This disdain for their image may cause then to disconnect from both themselves and those around them.

Tips for Starting or Restarting Non-sexual Intimate Relationships

If your eating disorder or trauma has caused you to withdraw from friendships or relationships with loved ones, here are a few tips to keep in mind when starting new or strengthening old relationships.

1. Seek help. If you have an eating disorder, reach out to a specialized treatment center such as The Emily Program. It is important to address your eating disorder and any other underlying trauma or mental health concerns—so it’s important to seek treatment at a facility that can treat co-occurring disorders.
2. Be honest. If it feels safe, tell your family or friends what you are going through. Open up about your struggles with mental illness and/or trauma. While this can be extremely hard, it opens a dialogue and gives those around you a window into your experience. This can increase communication and understanding, and allow those around you to become strong support systems in your recovery.
3. Be gentle. Be kind to yourself during this process. Opening up and rebuilding connections can be vulnerable and exhausting. Make sure you are taking time to recharge and take care of yourself.
4. Keep trying. If your eating disorder is telling you to isolate, don’t listen. Make sure you try to maintain the connections and support systems you have made during your recovery. These connections are important to a positive, lasting recovery.

Tips for Starting or Restarting Physically Intimate Relationships

If you are interested in pursuing or returning to physically intimate relationships during or after your eating disorder recovery, it’s important to make sure you are ready. Keep in mind that if something doesn’t feel right, it probably isn’t. If you feel coerced, pressured, or persuaded into any sexual activity that you don’t want to do, that is NEVER okay. All sexual and intimate acts should be done with consent. Consent is all about setting boundaries and being safe and respectful. Consent must be freely given, reversible (you can take it back whenever you want!), informed, enthusiastic, and specific. If you and your partner are both consenting adults, here are some tips for being intimate during or after recovery.

1. Seek support. If you are suffering from disordered eating, reach out to a specialized treatment center such as The Emily Program. It is important to address your eating disorder and any other underlying trauma or mental health concerns before entering into new relationships.
2. Be honest. If you are entering or already in an intimate relationship, make sure to be open and honest with your partner. Share your feelings, worries, and fears around intimacy.
3. Find comfort. It’s important that you are comfortable with both yourself and your partner. If this means you don’t engage in physical intimacy, for the time being, that’s okay! Make sure you feel safe and comfortable with the choices you are making.
4. Set boundaries. If certain things feel more okay than others, it’s okay to set boundaries and have preferences. The most important thing in any relationship is safety and comfort.
5. Talk about it! If things get awkward, have a conversation with your partner. It’s always an option to speak with a professional or therapist as well.

The Emily Program is a national leader in eating disorder treatment. We understand that eating disorders often come with other mental health concerns, trauma, or abuse. That is why treat co-occurring disorders and approach recovery with the whole person in mind. If you are seeking help with your eating disorder, reach out to us at 1-888-364-5977.