Intimacy Issues and Eating Disorders in Women

Woman dealing with intimacy issues

For women with intimacy issues and eating disorders, it can be scary to enter into or be in a relationship.

Many individuals with eating disorders, both men and women, have body image disturbances and negative perceptions of how others view them.

This can create barriers to having an intimate relationship with a partner.  Often, women fear intimacy due to low self-esteem, depression, or anxiety.

Being afraid of being close with another is a big step in anyone’s life, but more so when it is coupled with an eating disorder.

Intimacy: It Really Isn’t Just About Sex

Researchers have studied over the decades how eating disorders affect families, but a great deal of the research has focused on either infant-mother bonding, mother-child heritability and influence, or the parent-child relationship [1].

Many romantic partners and spouses report that they feel second place to the eating disorder, and emotionally and physically distant from their partner.

Eating disorders affect all levels of a relationship. From where or what to eat, to birthday party planning, shopping, and starting a family. Typically, anorexia is accompanied with amenorrhea, or loss of menstrual cycle, for long durations of time.

Low body weight, physical complications, and hormonal imbalances can decrease a woman’s sexual drive, decreasing sexual intimacy even farther [1].

In many Western societies, intimacy is seen as a sign of a healthy relationship between couples. With eating disorders and intimacy issues in women, it can be seen as scary and a closeness that can put a barrier between the eating disorder sufferer and their partner.

When a person has an eating disorder, it gets into both their mind and body. It talks to them like a body-bashing, negative-thinking abuser. It develops its own personality within the person and lies constantly about what is occurring in their environment, and within their body.

Expectations are put on the person by the eating disorder of what others think, believe, and want for them. The individual has higher standards for himself or herself than they do for others, and it mostly revolves around food, body shape and size.

This ‘takeover’ by the eating disorder creates then a ‘false self’ of the person. It is who they show to the outside world, who they want others to see [2].

Intimacy is a word most of us use frequently to describe people and things in our world.

Intimacy, when researched, applies to the sustainability of relationships including the degree that a couple shares with each other, genuinely accepts each other (flaws and all), building and maintaining of trust, and physical and emotional closeness. This description most importantly involves being authentic within the relationship.

There are four types of intimacy:

  1. Intellectual, which is where the couple discusses and exchanges various thoughts and ideas around any topic.
  2. Experiential, where the couple participate in various activities together, such as sports, concerts, movies, outings with friends or as a couple, etc.
  3. Emotional, where each individual identifies and shares their feelings around an event, situation, or conversation. This step is essential in being able to connect and feel close with your partner, knowing they understand and accept your emotions.
  4. Sexual, which is sexual intercourse or non-penetrative sexual actions. This can also include hugging, holding hands, and cuddling to increase sexual intimacy within the relationship [3].

Research on Intimacy Issues in Women with Eating Disorders

There is very little research when looking at the intimacy issues in women with eating disorders. Many clinicians and physicians understand that loss of sexual interest is partly due to malnutrition in those with anorexia and/or bulimia.

Spouse supporting spouseSevere malnutrition is not the only factor, though. Distorted body image, body dissatisfaction, and body shame also play a role in an unhealthy intimate relationship [4].

Within the existing research, women with restrictive anorexia nervosa tend to not have a romantic partner or be in a sexual relationship.

Women with bulimia nervosa tend to have early sexual relationships, report a higher number of sexual partners, and increased sex drive.

One study looked at the impact of eating disorders on sexual relationships and partner relationships in women with restricting and purge-type anorexia [4]. Results showed that lower sexual intimacy and libido were found in those with a lower minimum lifetime body mass index (BMI) and earlier onset of the eating disorder than the placebo group.

This led the researchers to conclude that low BMI was associated with loss of libido, increased sexual anxiety, and avoidance of a sexual relationship. Overall, over half of the women in the study did report having an intimate relationship at some point in their life, where they were able to have intimate and significant relationships [4].

The study, as well as an analysis of previous research on intimacy levels within the relationship, showed at follow-up analysis that upon weight restoration and recovery, intimacy factors were improved and relationships were reported to be more satisfying [4].

Mental Health Support for Improved Intimacy

When working with your spouse who has an eating disorder and fear of intimacy, it can help to remember that it is a vulnerable feeling to be intimate, regardless of the physical or emotional connection. It is difficult to be vulnerable with another person when the sufferer is unable to be vulnerable with himself or herself.

Therapy is a wonderful tool to help couples who are struggling with intimacy issues. A clinical therapist can work with you on being able to identify triggers, emotions, and underlying issues regarding intimacy.

Development of health communication, trust, openness, and genuineness is done within the couples counseling and can greatly increase the connection and commitment to the relationship.

Supporting your partner in their eating disorder recovery and mental health treatment is invaluable. Being able to attend family sessions, family therapy groups, and education workshops can help you learn how to best support your spouse for their recovery.

To recap, intimacy has four components within any relationship. Being intimate on any level is extremely difficult for the eating disorder person to do, even with himself or herself. Engaging in therapy, supporting eating disorder recovery, and working together can strengthen and grow your relationship.


Image of Libby Lyons and familyAbout the Author: Libby Lyons is a Licensed Clinical Social Worker and Certified Eating Disorder Specialist (CEDS). Libby has been practicing in the field of eating disorders, addictions, depression, anxiety and other comorbid issues in various agencies. Libby has previously worked as a contractor for the United States Air Force Domestic Violence Program, Saint Louis University Student Health and Counseling, Saint Louis Behavioral Medicine Institute Eating Disorders Program, and has been in Private Practice.

Libby currently works as a counselor at Fontbonne University and is a Adjunct Professor at Saint Louis University, and is a contributing author for Addiction Hope and Eating Disorder Hope. Libby lives in the St. Louis area with her husband and two daughters. She enjoys spending time with her family, running, and watching movies.


[1] Gottileb, C. (2016, February 12). Eating Disorders and Romantic Relationships. Retrieved June 11, 2017, from
[2] Newton, %. (2013, December 23). Intimacy and Anorexia Nervosa. Retrieved June 11, 2017, from
[3] Lackley, S. (n.d.). Dealing With Your Partner’s Fear of Intimacy. Retrieved June 11, 2017, from
[4] Pinheiro, A. P., Raney, T., Thornton, L. M., Fichter, M. M., Berrettini, W. H., Goldman, D., Bulik, C. M. (2010, March). SEXUAL FUNCTIONING IN WOMEN WITH EATING DISORDERS. Retrieved June 11, 2017, from
International Journal of Eating Disorders. Issues 4 Pages 123-129

The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Published on August 9, 2017.
Reviewed By: Jacquelyn Ekern, MS, LPC on August 9, 2017.
Published on