Eating Disorders and Sexuality: The Conversation We Keep Avoiding
When people talk about eating disorder recovery, they usually focus on food, weight, and body image. While these are important, other parts of healing often get missed. Sexuality, desire, and intimacy are often seen as less important and ignored.
As a sex therapist working with people in eating disorder recovery, I often hear clients ask similar questions:
“Why do I feel so disconnected from my body?”
“Why don’t I want sex?”
“Why does intimacy feel overwhelming?”
“Could I be asexual?”
Many people feel confused or ashamed about these experiences, especially because they are rarely discussed in treatment. But eating disorders affect more than just hunger. They can have a big impact on desire, arousal, embodiment, and relationships.
Research shows that people with eating disorders often have low libido, avoid sex, feel disconnected from their bodies, and have trouble feeling pleasure. Anorexia, bulimia, binge eating disorder, and other eating problems can all affect how someone relates to their body and sexuality. These issues can happen with any eating disorder diagnosis and at any body size.
It’s important to note that asexuality is a valid and healthy sexual orientation. This is different from changes in desire, arousal, or embodiment that can happen because of an eating disorder or ongoing stress in the nervous system.
For LGBTQ+ people, these challenges can be even more complicated. LGBTQ+ communities have higher rates of eating disorders and body dissatisfaction, often because of stigma, marginalization, gender dysphoria, or pressure to fit in. Some transgender and nonbinary people may use eating disorder behaviors to try to change or hide body features that cause distress. For many LGBTQ+ individuals, recovery can also mean learning that their body deserves safety, expression, and care.
When the Body Has Never Felt Fully Safe
To understand why eating disorders affect sexuality so much, it helps to look at how the nervous system works. When someone is stuck in survival mode — feeling anxious, on edge, numb, or emotionally shut down—the body often chooses protection instead of pleasure.
Eating disorders often develop from long-term patterns of survival and self-protection. People might ignore their body’s signals, push down their needs, obsessively monitor their bodies, or disconnect from physical sensations. Over time, the body can start to feel like something to control instead of a place to live. Some people feel numb, anxious about touch, or uncertain about what they really want. Many say it feels like they are “watching themselves” instead of authentically connecting during intimate moments.
Sexuality requires something different. Healthy sexuality depends on being present, feeling sensations, being open, and feeling connected to your body. Desire usually appears when your body feels safe, not when you are always monitoring or on high alert.
This is especially important for LGBTQ+ people since many grow up learning that being seen in their bodies can be risky. Bullying, rejection, hiding their identity, religious shame, objectification, or fear of discrimination can make people stay on guard. Their bodies might feel exposed or unsafe long before any eating disorder symptoms show up.
It is important to rebuild trust and safety in the body as a key part of healing. This is where concepts like interoception and embodiment matter. Interoception means noticing and understanding signals from inside your body, like hunger, fullness, emotions, tension, comfort, or desire. Embodiment is about feeling present and connected in your body instead of feeling separate from it. Eating disorders regularly disrupt both of these.
So recovery often means slowly learning that body sensations are not dangerous. This can include practicing mindfulness, intentionally drawing attention to hunger and fullness, accepting emotions without trying to control or numb them, and learning to feel sensations safely again.
Remember, reclaiming desire is not about “fixing libido” or becoming a very sexual person. Healing is not judged by how often you have sex or how you perform. The real goal is to feel more choice, connection, and safety in your body.
For some people, this might mean finding sexual desire again. For others, it could just mean feeling less distant from touch, intimacy, or closeness. For LGBTQ+ people, working on embodiment can also help them explore gender, attraction, pleasure, and identity beyond just surviving or protecting themselves.
Sexuality is Missing From Recovery Conversations
Unfortunately, sexuality is still not often discussed in eating disorder treatment. Providers might feel uncomfortable talking about sex or may focus on medical issues first. Many clients hesitate to bring it up because of shame or fear of being misunderstood. LGBTQ+ clients may worry that providers will mistake parts of their identity for a problem or will not talk about sexuality in an affirming way. People deserve recovery conversations that include pleasure, intimacy, agency, and embodiment as important parts of being fully human, not just side issues.
Healing encourages people to stop monitoring their bodies and start listening to them. No one is expected to suddenly feel comfortable or confident in their body. Instead, the goal is to build enough safety to get curious again about hunger, feelings, connection, pleasure, identity, and desire. This change can feel vulnerable, but it can also be deeply healing.
