let’s talk about sexuality in eating disorder treatment

In treatment topic groups often focus on specific emotions that people with eating disorders tend to have more difficulty feeling and expressing, or sometimes there is a discussion on how diet culture impacts body image. Don’t get me wrong, these groups are important, but oh, “sigh,” there is such boredom with redundancy and avoidance of issues beneath the superficial.

Our country’s current diet culture is highly problematic (as evidenced if nothing else by the insanity that ensued over Starbuck’s Unicorn Frappuchino. But personally, my eating disorder and my coexisting desire to be small don’t have anything to do with the desire to look like “those women in magazines” (consciously). The issue for me and many others is more profound and complicated. For many of us, the issue we need to discuss in a topic group is: sexuality.

I’m writing this post with an infuriating sense of urgency.

I’ve been in treatment where, more than once, the community was asked if we would feel comfortable having a group on sexuality. WTF?!?!

Groups on anger are consistently rotated throughout a small cycle of limited topics. We are not given the option to discuss whether we would want a topic group on Anger. Why? Because anger and other emotions aren’t as stigmatized as sexuality. Yes, there’s research that shows women aren’t as “good” at expressing their anger as men because of annoying gender stereotypes and expectations, but that stigma is minimal compared to the stigma and misunderstanding surrounding sexuality.

It’s not as if talking about anger is comfortable. And anyway, I thought treatment wasn’t supposed to be comfortable?! After actively working to dispel myths around eating disorders, this blatant avoidance of addressing sexuality is shaming, stigmatizing, and perhaps ironically hypocritical? Why is the topic of sexuality treated as if talking about it could break us? There is no topic that is “too much” or “too scary” or “too loaded” or “debatable” in treatment. There are skills and ways to manage even the hardest of emotions without our eating disorders, and the only way to learn that is to experience it. There should not be prescribed, acceptable topics that exist within a rigid systemic structure.

When I am questioned whether I feel comfortable participating in a group on sexuality, the physical space, a space meant to hold healing, immediately feels less safe to talk about sexuality. Polling the audience on sexuality sends a subliminal message that it’s deemed taboo, but that there is a [lame] attempt at a willingness to go rogue – that is, if everyone in the group agrees (e.g. under certain prescribed contingencies).

There is no question that sexuality is one of the larger white elephants in treatment. This doesn’t surprise me as it is one of the most shamed topics in today’s culture. But this is incredibly problematic and the effect this has on people in eating disorder recovery is underestimated.

Here’s where I’m not going to fail to live boldly right now:

This is bullshit.

Sexuality is not taboo, it is not something that should evoke shame, and in my opinion, is an integral, even essential part of the healing process from an eating disorder.

I guess I should explain what sexuality means to me and with that, what it doesn’t mean.

PSA: sexuality does NOT equal sex. Do me a favor and humor me, move beyond the first three letters.

Yes, sexuality is difficult to define, but is any part of recovery easy?

Sexuality encompasses one’s thoughts, attitudes, beliefs (personal and cultural), knowledge of oneself and intimate relationships with others.

Sexuality is more ubiquitous than your sexual orientation. It is more than whether you identify as gay or straight. In fact, that really is a small piece of it.

Sexuality includes things that influence our behavior and willingness or willfulness to engage in a relationship with another person.

Sexuality influences whether we feel positively or negatively about our behaviors.

Sexuality influences on what behaviors we place value and morality. 

Sexuality is inherently linked to physicality, self-esteem, and body image.

In regards to this last statement, how is it possible to talk about body image then, without talking about sexuality? My answer? You can’t. Yet in my experience, that is what keeps happening. Over and over again.

I’ve heard from various women (although I’m certain this transcends the entire gender spectrum) that to them, sexuality is immediately linked to trauma. While this intersection might be an important part of some people’s recovery, mine included, I argue that it is equally as important to also discuss sexuality as a crucial element of eating disorder treatment outside of the parameters of sexual trauma and/or abuse. Sexuality is multifaceted, but this complexity is rarely addressed. [For those interested, Virgie Tovar recently opened up about her history of oppression and trauma and how it influenced her sexuality on the 100th episode of Christy Harrison’s FoodPsych]

Struggles with sexuality can result in shame, isolation, addiction, and difficulties in interpersonal relationships, all which further perpetuate eating disorder behaviors. Sexuality can be an extremely disrupting topic that often times results in coping through the use of behaviors, but that doesn’t mean the topic should be avoided.

For people in general, but especially for those of us with eating disorders, we tend to avoid the unknown, the scary, and the complicated, all adjectives that can be used to describe “sexuality”. The eating disorder, thus, is a brilliant, albeit, highly maladaptive strategy to succeed at avoidance. The very action of defining and redefining words that have inaccurate or loaded implications though can feel empowering, and is in and of itself an exercise in decreasing the shame around the topic. 

Talking about activating topics related to sexuality may be placed on the back burner in treatment out of fear of destabilization. While I’m certainly not an expert in the field, I am an expert on my experience and to me, this feels so dangerous! Intersectionality is important in the effort to reach a true and whole recovered state. Without discussing sexuality we are missing out on an entire opportunity to discuss an intimate part of the eating disorder.

I feel passionate about the importance of giving ourselves permission to explore sexuality in the group and individual treatment settings. Considering our values, our capacity for emotional intimacy, orientation, and boundaries is a significant piece of work that needs to happen in order to repair intimate relationships with others and ourselves. First, though, we need to increase the number of safe (emotional and physical) spaces to think about and question the values and boundaries we hold around the topic of sexuality.

in strength and healing,


let’s talk about sexuality in eating disorder treatment
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