Anorexia Nervosa and Sexuality in Women: A Review

Patients affected by anorexia nervosa (AN) have difficulties expressing themselves both emotionally and sexually. Relational problems seem to have a multifactorial origin similar in its complexity to that of the pervasive eating disorder. Endocrine disorders, neurological disease, and genetic factors may cause anorexia, but psychological factors are believed to play the prominent role. Data in the literature do not support the evidence of psychopathology associated with AN so severe as to warrant the primary diagnosis, but psychopathological traits are almost always present. Anorectic patients show repetitive behaviors and perfectionism, leading to rigidity and social introversion that may worsen the cohort of clinical symptoms of AN. Problems in maintaining interpersonal relationships are part of a generalized emotional disturbance, where inadequate sexual functioning and conservative attitudes are only additional elements. Most patients develop anorexia during adolescence. Those who became anorectic in adulthood report that their sexual functioning was normal before the illness. Therefore, most scientists believe that the altered balance of ovarian steroids and central nervous system neurotransmitters explains the lack of sexual interest. In fact, endocrine and neuroendocrine alterations can be found in depressed patients and are associated with loss of sex drive; in addition, according to some reports, these alterations seem to precede malnutrition, apparently assuming a causative role that is not yet explained. These findings support the hypothesis that difficulties in sexual functioning seen in AN patients have an origin as complex as that of the eating disorders.