Intimacy and Anorexia Nervosa

By Mandi Newton, RN, PhD
Reprinted from Eating Disorders Recovery Today
Spring 2006 Volume 4, Number 2
©2006 Gürze Books

This is part two of a series on romantic relationships and anorexia nervosa, click here for part 1.

In Western culture, intimacy is considered an essential indicator of healthy romantic relationships. Unfortunately, intimacy has been largely unexamined in the relationships of women with anorexia nervosa. Why is this oversight important? Anorexia is an eating disorder that goes beyond the classic symptoms of self-starvation and the attainment of an idealized thin physique to include afflicted women struggling with who they feel they are, who they feel they should be, and what others in their relationships expect of them.

This internal conflict raises questions about the nature and quality of intimacy given that the achievement and sustainability of it is related to a number of elements including authenticity and acceptance. Research studies, however, have only begun to focus on how women with anorexia nervosa develop meanings of intimacy in their romantic partnerships and to describe the nature of these experiences.

What is intimacy?

Although the term intimacy is used casually in everyday conversation, scholarly literature has explored how intimacy develops and is sustained in relationships. These include the degree of sharing (also called disclosure), acceptance, trust, understanding, physical and emotional closeness, as well as how much someone is able to be authentic or themselves in the relationship.1-3

How do women with anorexia view and experience intimacy?

Several studies show that women with anorexia have relational dissatisfaction related to: poor marital adjustment and a lack of openness between partners during communication, as well as limited and unsatisfactory sexual experiences. Our recent research4 addresses how women with anorexia nervosa develop meanings of intimacy. We asked women to describe their experiences of intimacy in relationships, how they would define what intimacy represented, and what they needed within their romantic relationships to be intimate. For many women in the study, their desired level of intimacy exceeded what was actually present in their relationship.

The elements of intimacy that emerged from the women’s descriptions reflected what was already known: emotional and physical closeness, as well as companionship. Emotional intimacy was described by the women as feeling that they were on the "same wavelength" or "connected" with their partner. That is, the women felt emotional closeness to be achieved predominantly through mutual disclosure; feelings of acceptance by their partner allowed them to be authentic and fostered their own disclosure in the relationship. Physical intimacy encompassed both sexual and non-sexual experiences.

For many women in the study, non-sexual experiences were valued over sexual experiences with women citing lack of desire and low self-esteem as a main contributor. Companionship was the final element of intimacy, which was felt to be achieved through recreational activity and parenting activities with their partner.

Do women with anorexia nervosa experience intimacy differently than women without the disorder?

The short answer is yes and no! Meanings of intimacy for women in our study had similarities to individuals without an eating disorder. However, the intimate experiences of these women as well as those in other studies were often comprised by their eating disorders. For example, a lack of responsiveness in their relationships included the women’s fears of judgment or rejection related to their eating disorder. In addition, decreased or a lack of interest in sexual relations is likely from diminished hormone levels as a result of weight loss.

Where do we go from here?

As a whole, research suggests that while women with anorexia nervosa report dissatisfaction in their intimate relationships, they also have satisfactory experiences. This suggests that these women have similarities regarding intimacy to women without the disorder. In this sense, women with anorexia nervosa should be considered first as women who have intimate relationships comparable to other women, but in the context of having an eating disorder.

References

  1. Dahms, A. (1972). Emotional Intimacy. Denver, CO: Pruett.
  2. Hatfield, E. (1988). Passionate and companionate love. In R. Sternberg & M. Barnes (Eds.), The Psychology of Love. London, UK: Yale University Press.
  3. Buhrmester, D. & Furman, W. (1987). The development of companionship and intimacy. Child Development, 58, 1101-1113.
  4. Newton, M., Boblin, S., Brown, B. & Ciliska, D. (2006). Understanding intimacy for women with anorexia nervosa: A phenomenological approach. European Eating Disorders Review, 14(1), 43-53.