Breaking the cycle: Sex addiction and eating disorders

According to the National Council on Sexual Addiction and Compulsivity, 18 million to 24 million Americans are sex addicts. At least 30 million Americans, meanwhile, suffer from an eating disorder, per the National Association of Anorexia Nervosa and Associated Disorders. Experts say it is not uncommon for a person struggling with one disorder to also have a form of the other, particularly female patients, although clinicians often fail to identify the connection.

Moreover, the relationship between a sex/love/relationship addiction and an eating disorder isn’t just co-occurring, but also cyclical, with one feeding into the other, says Robert Weiss, LCSW, CSAT-S, senior vice president of national clinical development for Elements Behavioral Health.

In a career that spans more than two decades, Weiss has developed and overseen multiple addiction and co-occurring mental health programs for nearly a dozen treatment facilities. Among the programs Weiss has helped launch is The Center for Relationship and Sexual Recovery at The Ranch (CRSR). The Nunnelly, Tenn.-based program offers specialized treatment for sex addiction and intimacy disorders for men and women. But as Weiss and other staff at The Ranch will tell you, treating a patient for a sex, love or relationship addiction often is only one piece of the puzzle in their recovery.

Karen Brownd, MA, LPC, CSAT, the CRSR program director at The Ranch, estimates 65% to 70% of the female population being treated for sex, love or relationship addiction in the program also has dealt with some form of an eating disorder—either active or in remission—or a disordered eating component.

Speaking with Addiction Professional, Weiss and Brownd offered the following treatment tips and considerations for clinicians addressing the cyclical nature of sex addiction and eating disorders:

Perform thorough assessments

A common misstep for treatment centers is failing to ask enough questions of clients upon intake, Weiss says. Clients who seek help with an eating disorder (or drug or alcohol addiction) can have underlying issues relating to sex and trauma that go undetected.

“We don’t ask those questions on intake,” Weiss says. “We ask about everything else—lifestyle, relationships, education, work, social relationships, dating, family—but nobody asks about this. If you don’t ask, you don’t know.”

Brownd recommends administering a Sexual Addiction Screening Test (SAST), a free online assessment for sexually compulsive behavior which may indicate the presence of sex addiction, as described by the International Institute for Trauma and Addiction Professionals (IITAP).

“If you get a lot of ‘yes’ answers on there, you’re looking at a potential problem that most people don’t ask about,” Brownd says.

Understand what’s underneath

Cyclical sex addiction and eating disorders in adulthood can often stem from traumatic events in childhood, Brownd says. The trauma can take on many forms—a lack of healthy attachment and relationships stemming from parents not making themselves emotionally available to their children, sexual abuse or an early exposure to pornography, to name a few examples.

“Bottom line, the deal is intimacy vs. intensity,” Brownd says. “Clients understand intensity, but they’ve never learned, been taught or seen true intimacy between people.”

Working with clients to see the big picture on this front is a critical component to recovery, Weiss adds.

“You can treat the eating disorder, but then they sexually act out. Or you can treat for intimacy or relationships, but then they eat,” Weiss says. “You really have to help clients understand the relationship between the two and that it isn’t about the eating or the sex. It’s about how are they going about identifying and getting their emotional needs met, and how are they going about regulating and soothing themselves when they are anxious or upset. It’s about the underlying stuff.”

Demographic differences

Still, even if patients who struggle with eating disorders and sex/love/relationship addictions present many similar symptoms, there are no universal statements to cover everyone who walks through the doors at treatment centers.

Along these lines, Weiss has made the following observations about clients:

• Men and women work through treatment differently. Men tend to be more linear, while women are more holistic.
• College-educated women are more likely to have sex casually and at a frequency normally observed in men. Non-college-educated women, meanwhile, continue to be more concerned about being used or taken advantage of sexually.
• More men with sex addictions are now being diagnosed with eating disorders, only they turn to excessive exercise, not altered dietary habits, in a quest to have a perfect body, and also release endorphins and cope with stress.
• Technology has played a critical role in how the millennial generation understands and explores sex, primarily attributed to having greater access to information. Young people today actually have less sex in the traditional sense than previous generations, but are more likely to have engaged in sexual activities online. Addictions to pornography are still more common among male patients at The Ranch, Brownd adds, but the number of younger female patients who say they look at pornography is growing.

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“What is the purpose of treatment?” asks Weiss. “Is it merely to eliminate the symptom the person came in for? Or is it to look at the whole person and look at whole-life solutions for all of the things they’re dealing with that contribute to the primary issue?”

Weiss leans toward the latter. He acknowledges that adding specialties to treatment can be costly, but failing to do so can lead to relapse, which can be more expensive in the end.

“My belief is that we can do all of it,” Weiss says. “We can invite people into treatment with a thorough understanding of what their issues are from the get-go. We can prioritize those issues. We can give them primary treatment for the most consequential ones. Then we can give them books, referrals and information for the secondary issues. But if we don’t tell them about the whole picture, then we’re not fully helping the client.”

Tom Valentino is Senior Editor of Addiction Professional.