Sexual addiction and eating
disorders:
AN EXPLORATION OF ADDICTION
INTERACTION IN THE COUPLE DYAD
Jayme Koerselman, MA, CSAT,
NZAC (Provisional)
Lecturer – School of Counselling
Laidlaw College
Addictions defined - Sex
 Controversial term especially in the area of sex and
eating

“Out of control behavior” (Carnes, 1992, 2001)



Both binging and restricting – “Sexual Anorexia” (Carnes, 1997;
Nelson, 2003)
Sexual compulsivity (Quadland, 1985) or impulsivity (Barth &
Kinder, 1987)
Sexologists have been more reluctant to accept this
terminology instead using the DSM IV terminology
hypersexuality and hyposexuality (Kaplan, 1995)
Addictions defined - Eating

“Vandereycken (1990) cautions against bulimia being a form of
addiction in spite of the similarities to other addiction as he
states this is mainly based on analogy only and clinicians (and
patients!) wanting to reassure each other of a known entity. He
goes on to say it’s important to look at what is similar but also
what is dissimilar between eating disorders and addiction.

Addiction model of eating disorders see Handbook of
Addiction Disorders (Coombs, 2004)
Addictions defined
 For the purpose of our discussion addiction is
defined as:




Loss of control of behavior
Behavior continues in spite of significant consequences
Preoccupation with the behavior or preparation of it
Distress, anxiety, irritability if unable to engage in the behavior
(Carnes, 2001: Goodman, 1993, 1998)
 The cycle of destructive thoughts and behavior that
affect mind, body, and relationships
Self/Couple
concept &
beliefs
Restriction/
Compensatory
Physical and
emotional
consequences
Preoccupation
Life consequences/
Unmanageability
Ritualization
Acting out
How this became an interest
 Clinical observation
 Case examples
 Common Characteristics
 Addiction parallels and interaction (Carnes, 2005; Petrucelli
& Stuart, 2001; Orford, 2001; Huebner, 1993)

Carnes (2005) describes “the understanding of excessive
behaviors as addictive disorders that share similar features,
causes, and even cures. As part of that clarification we are
proposing a model that integrates the addictions and proposes
that the addictions have metapatterns that are important and
discernable clinically” (p. 87).
How this became an interest
 Professional studies/Literature Reviews
 Attachment styles
 Addiction characteristics
 Neurobiological aspects
 Studies of differentiation – Bowen, Winnicott, Sullivan,
Schnarch, Bowlby
 Relational anthropology
Common Characteristics
 Process addictions (Power, 2005)
 “Series of events repeated in the course of acting out selfdestructive patterns” (Glass, 2011).
 Addictive cycle
 Problem of desire – “Appetites” (Knapp, 2003)
“In short, the things we once needed in order to survive—food,
shelter, intimate partnerships—have become the things we
want in order to feel sated. But satiety is itself a tricky subject,
in large part because our culture—visual, commercially
rapacious, oriented toward quick fixes and immediate
gratification—both fuels and defines the wish for it at almost
every turn, on almost every front.”
Common Characteristics - Problem of Desire

“They [women] value their independence and find it difficult to
bond with another person. They are afraid of their dependency
needs, of becoming vulnerable in a love relationship. In this age,
it is easy to turn to something impersonal, non-demanding and
seemingly free from conflict—something like food, the new lover.
Food as a lover is always there. It accepts them unconditionally
they do not have to pencil it into their appointment books or
worry about herpes or AIDS. But just as a lover can bring them
satisfaction and unhappiness simultaneously, so, too, can food
bring emotional upheaval—the dilemma we have mentioned: to
eat is to be thin and happy or fat and sad.” (Meadow, 1992)

“Not wanting to want and wanting to be wanted” - (Schnarch,
1991)
Common Characteristics
 Relational disorders
 Bulimics in particular tend to show a high selfconsciousness and inability to enjoy sex yet have a
prevalence to be hypersexual (Schembri & Evans, 2008;
Rodríguez et al., 2007; Pinheiro, et al., 2009) which
suggests that they may use sexual activity as a means of
relational security and approval (Culbert & Klump,
2005).
 Similarly, sex addicts often objectify and avoid any
meaningful intimacy in sexual encounters.
 “Other-centered validation” (Schnarch, 1991)
Common Characteristics – Relational disorders

Attachment styles
 Perceive families as rigid and disengaged (Waller,
Slade, & Calam, 1990; Carnes, 1992)
 Both individuals struggling with sex addiction and
eating disorders have been linked to an insecure
attachment – specifically highly anxious and highly
avoidant (Koskina & Giovazolias, 2010; Zachrisson &
Skårderud, 2010; Zapf, Greiner, & Carroll, 2008;
Carnes, 2011)
Common Characteristics
 Brain effects
 Reward circuitry of the brain – (Blum et al., 2012)
Drugs of abuse, sex, and food all activate the dopaminergic
mesolimbic reward system of the brain
 Similarly evidence showing that mate selection and “falling in
love” was linked to dopaminergic reward and motivation pathways
in the brain
 “Reward Deficiency Syndrome”

 Motivational circuit activation – (Rodriguez et al., 2007)
Common Characteristics
 Social influences
 Advertising increase and messages contained
Desire is evoked and answered through the product – often which
has a sexual component contained in the advertisement
 Idealized/sexualized imagery
 APA – sexualization of girls task force (Hatch, 2011)
 Recent European legislation for digital retouching
 Sexualization of food
 There is an aspect of something “wrong/naughty” about eating (at
least certain foods) and sex (Knapp, 2003; Meadow, 1992)

Common Characteristics - Social Influences

Obsession over beauty, bodies, and sex
11.7 million cosmetic surgical and non-surgical procedures in the
U.S. In 2007, an increase of 500% in past decade (91% of these are
women). $13.2 billion was spent and the most frequent
nonsurgical procedures were botox injections while liposuction
was the most frequent surgical. (The American Society for Aesthetic Surgery)
 $7 billion spent on cosmetic products in the U.S. (YMCA – Beauty at any

cost)
$46.3 billion spent on weight loss products in the U.S. (Marketdata)
 $97.06 billion spent world wide (top 16 tracked) on pornography
in 2006 (http://internet-filter-review.toptenreviews.com/internet-pornography-statistics.html)
 In 2010, The Nielsen Company estimated 28% of people who used
a work computer to access the internet visited an adult site.

(Heussner & Jaffe, 2010)
Common Characteristics
 Restricting/binging
 Carnes (1997) documents that 72% of sex addicts described
their behavior as binge/purge
 Both contain obsession/preoccupation
 “Separate lives”
 The question of abstinence

Developing a healthy relationship with food and sexuality
Dyadic interaction
 Mate selection
 Restricting/Binging within the dyad
 One partner’s behavior can directly fuel the other’s
 Hidden or separate lives (and often attachment style)
creates distance which reinforces the isolation of
addiction
Clinical Case examples
 “Tom and Sue”
 The “Fat Suit”

Acting out and the somatic embodiment of meaning
 “Jeff and Lisa”
 “Married with separate lives”
 “Brad and Megan”
 Boundaries - “to be close you have to be compliant”
Treatment implications
 Relational Diagnosis (Kaslow, 1996, 2006)
 How do the presenting problems help stabilize the couple?
 How do the presenting problems regulate closeness and
distance within a couple?
 What perhaps is the presenting problem communicating
nonverbally within the marriage?
Treatment implications
 Broaden treatment strategies
 Interpersonal/Relational Therapy
 Managing relational anxiety
 Bowen’s triangulation model
 Differentiation as “the process by which a person manages
individuality and togetherness in a relationship” (Schnarch,
1991, 2009)
 Siegel’s (1999, 2007) neural integration, mindfulness and the
“river of well-being” that runs between chaos and rigidity
Treatment implications
 “System” interaction awareness
 Family/Couple sessions (Bird, 2006)
 Addiction interaction awareness
 Break the cycle individually AND in the dyad
 RCA – couples 12 step
 To love is to be alone, at least initially and
momentarily, since it is unilateral and not dependent
on response from the loved one. And since the fear of
being separated makes us concerned with the
response of the other, and so keeps us from loving,
the very fear of aloneness and separation oddly
enough results in our awful aloneness and deadly
separation. (Malone & Malone, 1987, pp. 1011)
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