"Sexual Anorexia:" Equating Low Sex Drive With Eating Disorders

Today a Times reader asked Dr. Drew Pinsky, "Why do we not treat 'too little' sex as a disease or give it the same prominence as sexual addiction?" But Pinsky's subsequent explanation of "sexual anorexia" left some commenters cold.

Here's "Mobocracy"'s full query, sent to the Times Consults blog:

Why do we not treat "too little" sex as a disease or give it the same prominence as sexual addiction? It strikes me that having little or no sex, denial of eroticism, placing life-curbing restrictions on sex or sex partners should be considered just as much of a problem as too much sex. And it's not a Viagra issue, which treats a physical dysfunction, not a behavior.

Mobocracy seems like he or she may be suffering from a chip on the shoulder ("placing life-curbing restrictions on sex?"), but Pinsky takes the question seriously. He says,

Categorically, professionals do take this problem very seriously. It is often referred to as sexual anorexia, and it is treated with the same rigor as sexual addiction.

Pinsky adds that "sexual anorexia is yet another manifestation of intimacy disorders, among which sexual addiction is one of the more common manifestations today," and that "the anorexia commonly kicks in when a patient gets involved with someone who might be genuinely available for true intimate connection." It may well be true low — or no — sex drive can be correlated with intimacy problems, and Pinsky's correct that the term "sexual anorexia" has been used to describe the condition. But is this a useful label?

A Times commenter who identifies himself as Mark Warren, MD, cautions,

As a professional in the treatment of Anorexia Nervosa, a biologically based disorder with a specific set of criteria, with a mortality rate of up to10%, well defined and explained in the DSM-IV, I would caution against using the term anorexia to describe a disorder of intimacy. I trust Dr. Drew's knowledge of his field, but the labeling process used to describe this syndrome may do a significant disservice to those who suffer from the life threatening disorder of Anorexia.

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. As commenter cinnabar points out, "humans don't die from lack of sex." Several other commenters mention that low sex drive can be devastating to relationships, and certainly it can be upsetting to individual sufferers as well. But researchers noted earlier in the week that many older women don't consider lack of sex a problem — and there are undoubtedly people of both genders and all ages for whom little or no sex is a choice, not a disorder.

Part of treating anorexia is restoring the patient to a healthy weight through a sufficiently caloric diet — but there's no accepted standard of what a healthy or sufficient amount of sex is, and because of people's widely divergent desires, we're unlikely to ever arrive at one. The DSM-5 proposes a category of "Sexual Interest/Arousal Disorder," which, while it has its problems (why do there have to be separate Arousal Disorders for men and women?), does include the caveat that diagnosis requires "clinically significant distress or impairment." Low sex drive is really only a problem if it makes a person or his/her partner feel bad, and in that case, examining deeper intimacy issues may be warranted. But unlike anorexia, celibacy can't kill you, and it seems wise to keep the two separate.

Is Sexual Anorexia The Flip Side Of Sex Addiction? [NYT Consults Blog]