Because Carol was deeply afraid of sex, she starved herself of every last morsel of sexual feelings.
She is not alone. Sexual anorexia affects Carol and as many as 40 percent of people with sexual dysfunction. Just as dietary anorexics starve themselves of food, sexual anorexics cut themselves off from all sexual contact and obsess about avoiding sexual situations.
"Deprivation is a way to mount an offensive against anxiety — it's about control," said Dr. Patrick Carnes, clinical director of sexual disorders at The Meadows, a treatment facility in Arizona. "It gives them a feeling of elation when they are able to resist any sexual response, and they become frozen that way."
Carol, one of the patients Carnes describes in Sexual Anorexia: Overcoming Sexual Self-Hatred, grew up in a family rife with alcohol abuse and dysfunction. Her violent father lavished compliments on his daughters' skimpy bathing suits; her mother flirted with their boyfriends and took an uncomfortable interest in her children's sex life.
"Carol connected sex with dysfunction and violence," Carnes writes. "She believed to her core that if she were sexual, she would be like her family." As a result, she hated having sex. And although she hated it, she went along with her husband's wishes anyway.
About 60 percent of sexual anorexics are women. Research in the journal Sexual Addiction and Compulsivity indicates sufferers commonly have a history of sexual, physical and emotional abuse; their families are often extremely strict and emotionally withdrawn.
In addition to psychological causes, some people are biochemically disposed to sexual anorexia. In fact, self-denying behavior like anorexia actually produces an endorphin rush, a euphoric high most commonly caused by intense exercise.
Disease or Preference?
The desire not to have sex does not, on its own, mean something is wrong, experts agree. There are many reasons — moral, religious, personal reasons — behind the decision to abstain.
"I've always wanted to be able to turn [sexual urges] off," said Allison, a 25-year-old law clerk in Los Angeles. "Because love hurts — you don't want to have those feelings. Prior bad experiences make you want to not feel them at all."
Somebody just getting over a relationship may find they have little sexual drive until a proper grieving process is completed, but that's far different from the irrational terror of sexual anorexics. Some patients have never kissed or even held hands with anyone well into mid-life — and they don't want to.
William, another of Carnes' patients, attempted suicide in his early 40s. He had never dated, and thoughts of sexual contact were repugnant to him — feelings that were linked to his troubled childhood, in which his mother's promiscuity spurred his father to kill himself. After his father's death, his mother propositioned him sexually and flirted with his friends.
"He felt like he had to keep women at a distance," Carnes said. "And one of the other issues was that if he ever was sexual with a woman, his dad's death would become meaningless."
At its root, sexual anorexia is as much about expressing love physically as it is about the act of sex itself.
"People who aren't being sexual are withholding sexually and emotionally from their partners," said Dr. Douglas Weiss, executive director of Heart to Heart Counseling Center in Fort Worth, Texas.
Just as the body-image disease anorexia is closely related to the binge-and-purge cycle of bulimia, sexual anorexics often swing to the opposite extreme of sexual addiction. In one example of this, sufferers may prefer sex with strangers — safer, in the their minds, because it requires no emotional connection. The irony is anonymous encounters pose a serious risk of HIV and other sexually transmitted diseases.
Recovery from sexual anorexia, also known as aversion desire disorder, is a slow but rewarding process, according to Carnes. Tracking a group of 144 patients, "we've seen some great successes," he said.
Part of the process relies on teaching patients about addiction and sexual abuse and trauma, so they can realize the factors that have crippled their sexuality were ultimately not their fault.