Intimacy And Eating Disorders

In the following blog post, I offer some thoughts on intimacy within restrictive eating disorders. I want to preface this by saying that it is an immensely complex issue, so if your experience does not fit with what I share, there is nothing ‘wrong’ with you. There is no single way an eating disorder affects relationships. To ensure that the experiences shared aren’t just my own, three ex-clients have very kindly contributed their thoughts. These are woven throughout the blog.

If you have ever searched for resources on this topic of intimacy before, you’ll probably have found that the subject as a whole is immensely overlooked. You might have also noticed that there is a very strong emphasis on the interplay between body image and intimacy. I don’t disagree with its importance, so it’s a good place to start.

Body Image

When we have spent a significant amount of time scrutinising our appearance, or believing that certain parts of us need to change before we can feel comfortable, it can be immensely difficult — or feel impossible — to switch off those thoughts when we are with someone else. When our eating disorder has taught us to evaluate our body as though it determines our worth, it can also feel beyond belief that someone else might experience us in an entirely different way.

This can result in intimacy feeling like an acutely self-consciousness and experience, where instead of being fully present, one finds themself caught up in how they look, how they are perceived, and whether they are enough.

Furthermore, the honest reality is that the vulnerability of intimacy is not unique to those who struggle with our body image. Even in the absence of these difficulties, intimate moments can leave those who are comfortable in their body’s feeling exposed, uncertain and with a sense of nervous excitement. In many ways, this can actually be part of what makes intimacy so special, but when this vulnerability is compounded by a distorted and deeply critical perception of our own bodies, it can become all too easy for our attention to shift away from the person beside us and towards the relentless monitoring, adjusting, and second-guessing of ourselves. As K describes, this overshadowing can happen even when the moment is shared with somebody we love and trust sincerely:

When my eating disorder was rampant, I found most body image peace came from ignoring my body’s existence. But when I was in intimate situations with my long-term partner, this disconnection and conscious re-directing of attention became impossible. I remember incessantly wondering what he might think of my tummy. Needless to say, nothing along the lines of what my eating disorder was!

Thus, when we hold discomfort in or about our bodies, instead of experiencing the moment, it can feel almost as though we are watching ourselves experience it. In my own memory too, the only way I can describe it is as though I was standing behind some sort of glass wall; an onlooker held hostage by concern, entirely and unnaturally ‘stuck in my own head’ as opposed to immersed.

Another added layer of complexity to this is that if somebody has experienced feeling acceptable, appreciated, complimented or loved at a suppressed body weight, the eating disorder can present a narrative suggesting that change from this point would be undesirable, and perhaps result in withdrawn love. This theory is a conniving ED ploy to legitimise inaction that results in the current body feeling necessary to maintain in order to preserve connection and stability. The Eating Disorder proposal is that if healing did happen, and a relationship were not to be successful, the changed body would have been to blame. In this way, one's physicality can unfairly become a stick to beat oneself with, and ED behaviours a blanket to wrap oneself in.

If there is one single thing alone you take from this blog post, please let it be this: you do not need to maintain a particular body size to deserve love, affection or intimacy. A partner who shames your body, pressures you to change it or makes their affection conditional on your appearance is not offering the kind of safe, respectful connection you deserve. What another person thinks about your body does not determine your worth.

The importance of this is so significant because whilst feeling desired, accepted or attractive in the eyes of significant-other might promise to provide temporary reassurance, it does not offer ultimate liberation. Ultimate liberation actually involves learning that our worth does not rest on our ability to remain desirable in a particular way. We cannot control another person's feelings indefinitely, and we cannot build genuine safety by trying to make ourselves impossible to leave. What we can begin to build is a relationship with ourselves in which another person's changing perceptions do not determine our sense of worth.

Beyond physically close intimate circumstances bringing body image into direct attention, intimacy can also bring simple, intensely uncomfortable reminders of our physicality. For example, as G notes,

even relaxing into a hug with my mum was a reminder of how my body felt.

Due to this, when self-perception is hostile or conditional, opportunities for connection often become yet another situation in which we feel we need to manage, assess or control. For many, this scrutiny becomes so tiresome that circumstances that risk this vulnerability being exposed can feel safer to avoid entirely.

For this reason, and its obvious interference, the ubiquitous focus on body image in articles about intimacy doesn’t surprise me at all. However, there are many other, lesser-acknowledged ways an eating disorder can affect our experience of intimacy, as it encompasses far more than self-perception. It can also significantly restrict our ability to form emotional closeness, soften into physical affection, allow ourselves to be vulnerable, feel empowered in ourselves, set boundaries and experience pleasure.

What Do We Mean By Intimacy?

When we hear the word intimacy, physical affection is what usually first springs to mind. But intimacy is much, much broader than this, and I think establishing this is of paramount importance to the rest of this blog.

Emotional intimacy is allowing someone to know you. Properly. It involves being able to express your feelings, share your fears, communicate your needs and let another person support you. It is a deep psychological and neurobiological bond where two people feel safe, seen, and trusted enough to share their honest vulnerabilities.

Physical intimacy, meanwhile, involves bodily touch. It might involve sitting close beside somebody, holding hands, cuddling, kissing, sex, or simply being in contact with somebody else’s skin.

These different forms of intimacy can overlap, but aren't interchangeable, per se. For example, someone might feel comfortable with emotional closeness but struggle immensely with physical intimacy. Someone else may enjoy physical affection, while finding it difficult to express how they feel.

In the rest of this blog, I am going to get on with discussing the ways in which intimacy can be impaired beyond what I have already spoken of in relation to body image. As I want to reiterate, this topic is so multi-layered, so this exploration really will just touch the surface.

The topics are:

1.    Energy Deficit: Priorities

2.    Energy Deficit: Physical Symptoms

3.    Control and Composure

4.    The ED Taking Up Space

5.    Lack of Experience

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Energy Deficit

The first acknowledgement I think is essential to detail is how influential energy deficit can be to our biology, and priorities. A mammal who is undernourished is not a pleasure-seeking vessel. He or she is surviving. Getting through. Vigilant. Alert. Weary. Anxious. Braced.

It must also be mentioned that an undernourished body is extremely likely to experience some degree of hormonal disruption. The suppression of both GnRH and LH is associated with energy deficient state, which consequently impacts estrogen, progesterone and testosterone. Even if hormones are ‘within reference range’, the neurochemical impact of energy deficit can still cause a litany of issues, from steep reduction in libido, mood changes and fatigue. K describes an experience that resonates deeply with me:

In the years when I was most lost to my eating disorder, I felt less and less like a woman… To be honest, my connection to humanity felt tenuous. Thinking about that now… my sense of womanhood and connection to my humanity eroded… it’s really painful to think of the exhaustion . It is so sad to recall that having connection to other humans felt surrounded by mere apathy due to the extra effort and energy that company cost. Everything except food just felt irrelevant.

The energy deficit can profoundly affect our relationship with sexuality and pleasure in other ways too. When a body is underresourced, priorities tend to shift towards immediate survival, leaving less energy and capacity for desire, connection and enjoyment.

This is starkly validated by the results of the Minnesota Starvation Experiment — a study undertaken to examine the physical and psychological effects of severe semi-starvation. The author Ancel Keys noted: As semi-starvation progressed, enthusiasm of the participants waned; the men became increasingly irritable and inpatient with one another. One participant remembered … "noticing what's wrong with everybody else, even your best friend. Their idiosyncrasies became great big deals … little things that wouldn't bother me before or after would really make me upset.” (1)

The study reveals survival usurped social tolerance, survival depreciated frivolity and fun and survival trumped the procreation drive.

And it is in these same ways that the vast neurobiological changes associated with prolonged energy deficit can contribute to profound physical, cognitive-emotional, and behavioural changes in us, that can create disinterest, or even acute anxiety, about intimacy.

As G describes, the fumes of energy deficit meant that relaxing into a of moment of calm felt far down the hierarchy:

When I woke up in the morning, I felt as though I had a mountain of things to get done. I found it so hard to lie in, let alone enjoy doing so. My mind was just whizzing over all of the things I could/should get on with doing.

Many people experience the energy-deficient state as one in which they are constantly being aware of the time, short of time or in a rush. The ‘each minute matters’ survival mentality means that unplanned moments of rest (heaven forbid spontaneous pleasure!) can feel deeply and unbearably inconvenient, unnecessary and frivolous. For me, it felt like trying to jam an extra puzzle piece into an already completed jigsaw — the jigsaw being a well-worn goldilocks ED rhythm it perceived was already ‘just right’.

Many people I have interacted with share this same experience. Allowing their body to soften when they are driven to relentlessly keep going feel immeasurably uncomfortable. This can result in avoidance of intimacy altogether, or a mentality of ‘can we get this over with?’. I think it goes without saying, this ‘grin-and-bear-through it’ experience is the antithesis of intimacy.

L also described how energy levels were influential to his ability to soften.

During the evenings, I felt exhausted. I just wanted to be with myself, relaxing and undisturbed. The thought of having company, let alone close physical proximity, felt really undesirable, and I often felt myself growing more irritable by the moment. My tank was empty. Emotionally and physically, I had given everything I had. I was just about getting through, with nothing spare.

Physical Symptoms

Layered upon the mental symptoms of being in energy deficit, there are, of course, many physical ones. Whilst active engagement with the eating disorder can leave one experiencing a constant feeling of coldness, fatigue, muscle aches and poor digestion, stepping into recovery can also bring sensations that are less than comfortable: a swollen tummy, extreme fullness, hot flushes and night sweats. 

These symptoms undoubtably have the potential to be a barrier to feeling comfortable in our skin, and very often lead to a desire for increased personal space.

When I was in early recovery, I often felt like a furnace. My skin would radiate heat. The last thing I wanted was to be close to somebody. I’d prefer to take myself off to another room — L

Several people I have interacted with have described to me the dreadful dilemma this puts them in: listening to their body’s rejection of the situation or having to reject their partner’s advances. Sometimes, again an again. With these two options — turning away from oneself and ignoring those inner sirens, or, performance — it is obvious why intimacy can become such an incessant challenge to one’s sense of safety.

There is another important piece here, too: you are allowed to say no. Whenever. Always. You can love somebody deeply and still not want to be touched. You can enjoy cuddling without wanting anything more, or begin an intimate moment and decide that you want to stop. Your partner's feelings matter, but there should never be an occasion that you perform because you think you ought to, or because it feels due. Nobody else’s desire creates an obligation to override your own. Part of rebuilding a relationship with ourselves is learning that closeness can exist alongside boundaries, and that saying no does not make you unloving.

Control and Composure

Although I don’t personally connect with the notion that eating disorders commence as a form of control when all else feels out of control, I do believe that after a while living within its system, the behaviours can develop into means of achieving regulation. This is not true control, of course, but the analgesic effect of plodding along in the same old routine can certainly settle into one’s mind as ‘the way things ought to be’.

The prospect of intimacy, consequently, can begin to feel like a threat because it asks something of us that an eating disorder generally finds difficult to tolerate: uncertainty. Where there is uncertainty, there may be vulnerability, and when there is vulnerability without self-acceptance, pain is a possibility.  

As well as this, when we let someone into our personal world, we can no longer completely control how they perceive us. We may be misunderstood. We might be seen. We might need to communicate things that are difficult to put into words. We might need to trust. We might need to somewhat depend. And that can be almighty scary.

And it goes without saying that aspects the recovery journey itself (e.g., weight gain, extreme hunger, digestive issues etc) can showcase a different reality than the person who appears to have 'everything under control'. There is something particularly vulnerable about allowing another person to see us beyond the version of ourselves we carefully present to the world.

It conceivable therefore, that for some, it becomes easier to retreat into familiar eating disorder behaviours than to sit with the uncertainty of being fully seen by another person. Perhaps privately known food rules and movement rituals can create a sense of predictability when other aspects of life can only ever remain uncertain. Maybe focusing on the body can provide a familiar distraction from emotions that feel more difficult to understand or express. Perhaps letting somebody else into our inner world could unpleasantly disturb the sense of autonomous control and increase the number of unknowns.

Another aspect of control that I think deserves attention is the experience of receiving. It seems to be exceptionally common for somebody with an eating disorder to feel incredibly accustomed to giving, doing, anticipating other people's needs, but allowing somebody to care for them (without needing to earn it or immediately give something back!) feels deeply uncomfortable, and even guilt-inducing. For somebody who has learnt to derive safety from being capable, accommodating or self-sufficient, not directing an experience can feel very unfamiliar, and potentially unsafe.

I am also very curious as to whether the controlled, almost ascetical approach to life that many with an eating disorder seem to live by links back to the energy deficit. Whilst this martyrdom is often attributed to the low self-worth which is fairly typical of somebody with an eating disorder, I believe that this overall ‘deprivation mindset’ is one that can materialise when the brain perceives famine conditions. In this scarce environment, it seems that there is a shortage abundance of all forms, including pleasure. I don't disagree with the deduction that low self-esteem contributes significantly, but believe that the biology of the famine environment creates an overall tendency of self-denial. I see this rejection of comfort show up in so many ways, from a declination pain relief medicines, a postponement of toilet breaks, to a withholding of perceived ‘unnecessary’ purchases.

If any of this resonates, it may be that control has become a familiar way of navigating feelings that are difficult to tolerate for you, or something you don’t have much experience letting go of. It also may be a biologically induced propensity. Whatever the causation, remember that the opportunity in recovery isn't to force yourself to become vulnerable before you feel ready. The aim is to gradually uncover that you can experience difficult feelings, communicate your needs and build connection without needing to control every outcome.

ED takes up the space that connection needs

You don’t need me to tell you that eating disorders are incredibly consuming. When so much of your mental energy goes towards thinking about food, planning meals, living out ED-OCD routines … there is often very little time or space left for anything else. Inevitably, this can affect the way we show up in relationships. As K reflects below, it can be possible to be physically present with a partner, but entirely mentally preoccupied. Unsurprisingly, the brain can often wander off towards the sensual — almost intimate — promise of being alone with food instead:

When I was trying to relax at a fancy meal out that was planned, I couldn’t stop thinking about getting back home for my night snack. I sat thinking of my low-calorie hot chocolate sachet, my granola bowl and carefully selected chocolate plate. I often become increasingly agitated by the lateness of evenings out, and just wished for the time we could go home so that I could eat what I had been waiting for.

And beyond this mental preoccupation due to hunger, fear of food and of a disrupted routine can of course also be a barrier to accepting invitations that might otherwise assist with building emotional closeness with somebody.

Over time, then, the illness itself can begin to feel like the principle relationship that demands the most attention, becoming the thing we organise our days around, the thing we turn to when distressed and the entity that influences decisions that might otherwise be guided by what we enjoy, value or want. As G describes, connection was only possible after eating disorder hoops had been navigated:

When I first met my (now) husband, he wanted to meet for lunch at 12. I made up an intricate lie that I had an appointment prior, so would be busy until 12.45, because I didn’t want to eat lunch until 1. 

Whilst I do not hold the belief that we can only experience intimacy once we have ‘achieved’  self-actualisation, I do know that my own experience of intimacy was significantly stunted by not feeling like I knew myself at all.

Did I actually hate the music concerts I went to with him, or was that hatred caused by energy deficit related fatigue and ED heightened sensitivity to noise?

Did I actually know my genuine opinion on a Greggs sausage roll he offered, or was that melodramatic stance infiltrated by judgement?

In my opinion, allowing somebody to know me involves getting to truly know my ever-developing myself, too. It means providing myself with space to explore, getting a sense of my preferences, expressing opinions without worrying whether it is the ‘right’ one, or realising that I don't need to be impressive, accomplished or endlessly agreeable to be interesting company. In my eyes, intimacy can become an opportunity not simply to be accepted by another person, but to discover more of who we are in their company. This reminds me of sentiment my mum said to me once: we love a person when we love who we are in their presence.

Aka. we can be drawn not only to another person, but also to the version of ourselves that emerges — who we are allowed to be — when we're with them.

Lack of Experience

For many people, an eating disorder develops during a stage of life when opportunities for intimacy and romantic connection may begin to emerge. The illness can then make it difficult to explore these experiences in the way we might otherwise have. This is one of the often-overlooked impacts of prolonged illnesses generally: missing out on some of the experiences and developmental milestones that others may navigate during the same period. In the case of an eating disorder, this might include first relationships, dating, sexual exploration, heartbreak, communicating our needs and discovering what we want from another person. It can also hinder participation in ‘normal’, connecting activities such as nights out, dinner parties or after work drinks. As L reflects, slinking off having dealt a very conceivable excuse became a default.

When colleagues were going out after work, I always had an exit strategy. Sometimes, I agreed to their plans with the knowledge I’d cancel from the moment I said yes.

It is absolutely possible to explore these experiences later in life, once recovery creates more space for them (more on this later). However, feeling as though we are behind our peers and arriving at these experiences later can bring up a painful sense of inadequacy.

We might feel as though everyone else has learnt a language we never had the opportunity to learn or develop. We may feel we have said ‘no’ too many times to be considered worth inviting now. We might worry that we are too old to be inexperienced, hold concern about not knowing what to even do in intimate settings or maybe that a potential partner will be able to tell that we are totally out of our depth. K’s feeling of lack is one that I know many, many individuals experience:

I felt so much embarrassment about the fact that I’d never had any sort of romantic involvement by the time I was 31. I felt like I couldn’t talk to anybody about it.

These fears can then become self-perpetuating: we feel too insecure to put ourselves out there, so we avoid opportunities for connection, which can reinforce the very fears that held us back in the first place. Further, if the eating disorder has taken up a great amount of space and time, and caused us to retreat into isolation, perhaps we don’t have the friendships or connections that would open up potential for an intimate occasion to arise.

The most essential thought distortion to correct here is that the absence of romantic experience isn’t evidence of being undesirable, but it can feel to be when we are already struggling to believe that we are worthy of love. Very likely, the presence of the disorder plays a significant role in any absence of connection, and I bet my bottom dollar it is not to do with your true nature or self at all.

Remember too that being inexperienced is not the same as being incapable. Intimacy isn't a skill that everybody else has mastered while you were away. Much of what helps us navigate closeness is learnt through communication, curiosity, listening and getting to know another (specific) person over time. You don’t need to arrive with a history of relationships to be capable of building a meaningful one. You are allowed to learn as you go, at your own pace, with somebody who respects that.

Finally on this topic, I also want to raise the prospect of a painful contradiction that can arise here: desperately wanting intimacy, whilst simultaneously finding it difficult to sink into when it becomes available. This might look like longing to be close to somebody, only to find ourselves retreating or shutting down when somebody begins to move towards us. I know myself can feel really confusing, particularly when loneliness has been such a significant part of our experience.

It is important to understand that wanting connection and feeling safe enough to receive it are not the same thing. We can yearn for an experience that also makes us feel exposed or uncertain. That doesn't mean our desire for connection is insincere, but that the unfamiliarity is not counterbalanced immediately by a longing. That is exactly why there can be no hurry, pressure or force. The clock is not ticking. Our body and mind must be allowed to gradually and gently learn to trust that closeness is not necessary to avoid any longer.

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Relearning Intimacy in Recovery

Before wrapping up this blog, I want to briefly speak about the opening we are presented with in recovery and beyond: the opportunity to reconnect with our truest selves.

For many people, I must be honest, intimacy feeling safe isn't a simple process of recovering physically. Like with almost all other areas of healing, becoming comfortable with intimacy is a gradual and individual journey that has no definable time. We can become more nourished, more connected to ourselves and more able to tolerate uncertainty without immediately feeling comfortable with every form of intimacy. We can also discover that certain forms of intimacy simply aren't important to us. Neither experience invalidates our progression to this point. The freedom lies in being able to make choices that reflect our genuine desires, rather than choices dictated by fear, obligation or the need to prove that we are better.

Whilst for some, improved nourishment and physical health does swiftly help restore energy, libido and sexual wellbeing (2), for others, anxiety, body image acclimatisation, past experiences, trust or relationship fractures need additional attention or time. No path needs to look the same to be ‘right’.

On that last point, I think it is important to acknowledge that not every difficulty with intimacy originates within us. Sometimes, discomfort is connected to the relationship itself. If we feel pressured, dismissed, criticised or unable to say no without fearing the consequences, our reluctance to be vulnerable may be telling us something important about the environment we are in.

Remember that healing does not ask us to become so comfortable with intimacy that we override our own discomfort. For some people, recognising when a situation or another person's behaviour is inhibiting intimacy is a conclusion arrived at by increased self-trust.

Whatever your path looks like, please do trust that unpressured steps led by curiosity can help you understand yourself more, and, importantly, continue to cement the practices that your recovery already asks of you. Woven into your existing journey, gradually and naturally letting healing aligned intimacy into your world may look like…

• Practising saying what you need, even when it feels uncomfortable.

• Allowing affection in a time that doesn’t feel comfortable to slow down 

• Learning to stay present with someone instead of monitoring how you look.

  
  

In relation to that last one, I want to share K’s experience – who, like so many I encounter, was left feeling more comfortable in her body than ever before after recovery (far better than the eating disorder foreboded as possible). As she learnt to unconditionally respect the vessel that carried her, intimate situations felt connecting, sensual and empowering, rather than something to ‘make it through’:

For the first time in my life, I felt confident in who I was, and that I was allowed to take up space. I felt free. Liberated from care. It wasn’t even about my body. It was about my Self.

Meanwhile, L’s journey of reconnection looked a little different:

Upon full recovery, it took me a while to reconnect with a desire for a relationship. I was in a phase for a while of ‘wanting to want’ but for one reason or another, it wasn’t an immediate draw. After a few years of revelling in the abundance of energy balance (some travel, making friends, putting time into aspects of my career), I ended up meeting my partner. It wasn’t anything I sought out with any sense of ambition. I was at a concert. She was too. I certainly wouldn’t have even been there if I still had my ED - I wanted to be in bed by 9! But, all of this is to say it all remained far from the front of my mind for a long while after full recovery.

The way I like to look at it is that recovery opens up a door. To choose, or to not choose. To explore, to be curious about the true desires of your heart; those once shrouded by fear.

In so many instances, I have seen recovery open a world beyond food, body image and movement, and invite connection in. It welcomes in laughter, affection, pleasure, spontaneity, the experience of being known by another person – should you decide that you want those things.

The outcome is not a person who is comfortable with every form of intimacy. It is to have the wonderful sense of genuine freedom to choose what feels right for you.

In my own experience, a full recovery left me with more presence, mental space and capacity to experience the world around me than I imagined I could ever reclaim. I softened out of ‘brace’ mode. I could enjoy things in my life simply because they felt good. I was able to communicate my needs without shame. All of those things are essential to how I personally experience intimacy now. But perhaps what a full recovery gave me most was the gift of self-trust: a base of evidence that I always listened in to myself without denial. I could choose closeness when I wanted it, and just as equally decline it when I didn’t.

If you recognise yourself in any of this blog post, I hope you can trust that you are not behind in some fundamental way. How could you be? This is YOUR life. Also, I hope you can trust that there is nothing inherently wrong with you because intimacy feels difficult. I believe whole-heartedly that progressing in your recovery can give you more room to discover what you want, what feels good, what your boundaries are and who you want to share yourself with. There is no deadline for any of that either.

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N.B

If you are reading this as a supporter, thank you so much for taking the time to do so. When your partner is struggling with intimacy, it can often be an extremely confusing experience. My plea to you is to refrain from ever exerting any shame or resentment on your loved one, despite this confusion. That shame is likely something he or she feels already, and so closely resembles the eating disorder’s chastising tone.

The way you can build closeness again is by supporting your loved one’s experience to feel safe and heard, by nurturing their healthy self, and by assisting with their full recovery. In between now and then, speaking about your own experience is almost certainly going to be a tool to help you navigate this emotionally yourself, and be that source of stability.

References:

1) Kalm L, Semba R

They Starved So That Others Be Better Fed: Remembering Ancel Keys and the Minnesota Experiment

The Journal of Nutrition, 135, 1347-1352

2) Morgan JF, Lacey JH, Reid F. Anorexia nervosa: changes in sexuality during weight restoration. Psychosom Med. 1999 Jul-Aug;61(4):541-5. doi: 10.1097/00006842-199907000-00019. PMID: 10443763.