3.5 Eating, Sex and Sleep
Week 4
Integration
,Dunkley et al (2020) → Eating Disorders and Sexual
Function Reviewed: A Trans-Diagnostic Dimensional
Perspective
Summary → review of sexual dysfunctions in EDs and how this can be viewed trans
diagnostically (HiTOP)
Introduction
● Sexual function difficulties have been clinically observed but research on this is sparse
● Disorders found across all areas of sexual response
● Sexual dysfunction is associated with psychological concerns characteristic of
women with ED (body dissatisfaction, physiological consequences)
○ Maintenance & risk factors
● Onset of puberty, menarche, early sexual experiences have also been found as risk
factors of ED development
● Sexuality is not often addressed in ED treatment unless sexual abuse is present
● This paper → biopsychosocial framework
● Few studies on sexual function differentiate between ED types, the disorders have many
shared features and patients often move between each diagnostic criteria over time
○ Because of this less categorical and more dimensional system of
classification
○ Association of stable psychological features, symptom presentation, body image
disturbance
Methods
● Looked for papers examining different EDs and sexual dysfunction
Sexual function and eating disorders
● Anorexia nervosa
○ AN women have reported pervasive dysfunction → decreased sexual desire,
heightened sexual anxiety, sexual infrequency, difficulties with arousal,
lubrication, satisfaction, sexual pain
○ There is not a lot of research into sexuality & AN subtypes
■ Restricting tend to have more sexual difficulties than binge-purge
○ Diminished levels of reproductive hormones, endocrinological dysfunction,
menstrual abnormalities, hypogonadism from emaciation and caloric restriction
and malnutrition, low BMI contribute to problems
○ Weight loss has been linked to dysfunction (more severe weight loss, more
dysfunction and reduced enjoyment), weight restoration improves sexual
satisfaction & increases libido
○ Aversion to sexual contact is linked to maintenance of body weight
○ Some conflicting findings say low BMI do not impair physiological function of
sexual or reproductive organs
, ● Bulimia nervosa
○ Research on sexual function in women with BN shows sexual difficulties, but less
severe than in AN
○ In BN women are more likely to have a romantic relationship, higher levels of
sexual esteem, disinhibition, engage in sexual behavior more frequently, less
negative attitudes
○ Studies have conflicting findings
○ Extent to which women with binge-purge tendencies experience problems may
be linked to symptom severity → found higher BMI, poor body image, greater
frequency of binges to be associated with greater dysfunction
○ Some evidence of being more likely to engage in risky sexual behavior, earlier
age of sexual debut, sexual disinhibition, more likely to have multiple partners
○ More prone to self harm behavior, impulsivity and a tendency towards
dissociative states as mediators of sexual risk taking
○ Similar results to AN binge/purge subtype
○ Can have negative consequences → less aware of sexual health risks &
contraceptive use, more likely to contract STIs
● BED & obesity
○ More likely to have sexual dysfunction than obese individuals and healthy
controls
○ Greater frequency of binge eating correlated with lower orgasmic ability, sexual
satisfaction and overall sexual function
○ Emotional eating was associated with sexual dysfunction
○ Particularly more likely to have vaginismus and sexual avoidance compared to
non BED obese individuals
○ Caused by → being significantly overweight, obesity related general dysfunction,
reduced vascular function in genital tissues due to metabolic disruptions,
psychological consequences of obesity, metabolic abnormalities from
uncontrolled overeating
■ Uncontrolled overeating is the only factor separating BED from obese
without BED, so most dysfunction is probably caused by being
overweight
● Longitudinal and treatment research
○ Majority of research is cross sectional, few is longitudinal
○ Long term study (12 years)
■ After recovery from AN improvements in sexual problems
■ Sexual problems, impulsivity, long duration of inpatient treatment, long
duration of ED predicted 45% of variance in outcome
○ 4 year prospective study
■ Maturity fears and fears of becoming a sexual being in women with
restrictive AN is highly correlated with poor outcome
○ 1 year follow up after CBT
■ Sexual function of BN women improved
Week 4
Integration
,Dunkley et al (2020) → Eating Disorders and Sexual
Function Reviewed: A Trans-Diagnostic Dimensional
Perspective
Summary → review of sexual dysfunctions in EDs and how this can be viewed trans
diagnostically (HiTOP)
Introduction
● Sexual function difficulties have been clinically observed but research on this is sparse
● Disorders found across all areas of sexual response
● Sexual dysfunction is associated with psychological concerns characteristic of
women with ED (body dissatisfaction, physiological consequences)
○ Maintenance & risk factors
● Onset of puberty, menarche, early sexual experiences have also been found as risk
factors of ED development
● Sexuality is not often addressed in ED treatment unless sexual abuse is present
● This paper → biopsychosocial framework
● Few studies on sexual function differentiate between ED types, the disorders have many
shared features and patients often move between each diagnostic criteria over time
○ Because of this less categorical and more dimensional system of
classification
○ Association of stable psychological features, symptom presentation, body image
disturbance
Methods
● Looked for papers examining different EDs and sexual dysfunction
Sexual function and eating disorders
● Anorexia nervosa
○ AN women have reported pervasive dysfunction → decreased sexual desire,
heightened sexual anxiety, sexual infrequency, difficulties with arousal,
lubrication, satisfaction, sexual pain
○ There is not a lot of research into sexuality & AN subtypes
■ Restricting tend to have more sexual difficulties than binge-purge
○ Diminished levels of reproductive hormones, endocrinological dysfunction,
menstrual abnormalities, hypogonadism from emaciation and caloric restriction
and malnutrition, low BMI contribute to problems
○ Weight loss has been linked to dysfunction (more severe weight loss, more
dysfunction and reduced enjoyment), weight restoration improves sexual
satisfaction & increases libido
○ Aversion to sexual contact is linked to maintenance of body weight
○ Some conflicting findings say low BMI do not impair physiological function of
sexual or reproductive organs
, ● Bulimia nervosa
○ Research on sexual function in women with BN shows sexual difficulties, but less
severe than in AN
○ In BN women are more likely to have a romantic relationship, higher levels of
sexual esteem, disinhibition, engage in sexual behavior more frequently, less
negative attitudes
○ Studies have conflicting findings
○ Extent to which women with binge-purge tendencies experience problems may
be linked to symptom severity → found higher BMI, poor body image, greater
frequency of binges to be associated with greater dysfunction
○ Some evidence of being more likely to engage in risky sexual behavior, earlier
age of sexual debut, sexual disinhibition, more likely to have multiple partners
○ More prone to self harm behavior, impulsivity and a tendency towards
dissociative states as mediators of sexual risk taking
○ Similar results to AN binge/purge subtype
○ Can have negative consequences → less aware of sexual health risks &
contraceptive use, more likely to contract STIs
● BED & obesity
○ More likely to have sexual dysfunction than obese individuals and healthy
controls
○ Greater frequency of binge eating correlated with lower orgasmic ability, sexual
satisfaction and overall sexual function
○ Emotional eating was associated with sexual dysfunction
○ Particularly more likely to have vaginismus and sexual avoidance compared to
non BED obese individuals
○ Caused by → being significantly overweight, obesity related general dysfunction,
reduced vascular function in genital tissues due to metabolic disruptions,
psychological consequences of obesity, metabolic abnormalities from
uncontrolled overeating
■ Uncontrolled overeating is the only factor separating BED from obese
without BED, so most dysfunction is probably caused by being
overweight
● Longitudinal and treatment research
○ Majority of research is cross sectional, few is longitudinal
○ Long term study (12 years)
■ After recovery from AN improvements in sexual problems
■ Sexual problems, impulsivity, long duration of inpatient treatment, long
duration of ED predicted 45% of variance in outcome
○ 4 year prospective study
■ Maturity fears and fears of becoming a sexual being in women with
restrictive AN is highly correlated with poor outcome
○ 1 year follow up after CBT
■ Sexual function of BN women improved
