While you will not find Intimacy Disorders listed in the DSM-IV-TR, the American Psychiatric Association’s publication that is the standard in the mental health treatment community for categorizing mental disorders, it is a very common diagnosis with individuals and couples that come in to work on the quality of their relationship. Having read numerous books, attended dozens of hours of training and having worked with many couples affected by an intimacy disorder I have come up with my own definition.An Intimacy Disorder is a personality style and/or adopted behavioral pattern that fails to support the progressive healthy deepening of an interpersonal relationship. Put more simply, having trouble getting or staying close to others. Intimacy Disorders can be categorized into four common forms: Sexual Anorexia, Love Avoidance, Love Addiction, and Sexual Addictions. Let’s briefly introduce each form, look at some common patterns, and learn what you can do if you need help in recovering from any of these destructive disorders.
The International Institute for Trauma & Addiction Professionals (IITAP) website defines sexual anorexia as “an obsessive state in which the physical, mental, and emotional task of avoiding sex dominates one’s life.” Even within the diagnosis of Sexual Anorexia, there are several variations within this form of Intimacy Disorder, such as, Binge & Purging Type, where the anorexic bounces between total abstention and hyper active sexual consumption. Untreated Sexual Anorexics have a very difficult time maintaining quality long term relationships. Some common experiences for the sexually anorexic include:
- A dread of sexual pleasure
- A morbid and persistent fear of sexual contact
- Obsession and hyper vigilance around sexual matters
- Avoidance of anything connected with sex
- Preoccupation with others being sexual
- Distortions of body appearance
- Extreme loathing of body functions
- Obsessive self-doubt about sexual adequacy
- Rigid, judgmental attitudes about sex
- Excessive fear and preoccupation with sexual diseases
- Obsessive concern or worry about the sexual activity of others
- Shame and self-loathing over sexual experiences
- Depression about sexual adequacy and functioning
- Self-destructive behavior to limit, stop, or avoid sex
As listed on the IITAP website sexhelp.com
Very common, but not always the case, with Anorexics is a history of trauma and/or toxic relationships with one or more parent.
While the classic image of the Love Avoidant is the stereotypical “bachelor for life” persona, like Charlie Sheen’s character in Two and a Half Men. Love Avoidants seek to control the frequency and intensity of emotional connection with their partners. The goal of the Avoidant is to try and balance their conscious fear of being smothered with their unconscious fear of being abandoned. The result is a pattern of seeking closeness followed by a pulling away or distancing. This is common with Avoidants and serves to diminish the feelings of trust and security between the partners, blocking the healthy development of the relationship.
Pia Mellody, one of the leading authorities on Love Avoidance and Love Addiction, lists three characteristics of the Love Avoidant:
- Love Avoidants evade intensity within relationships by creating intensity in activities (usually addictions) outside the relationship
- Love Avoidants avoid being known in the relationship in order to protect themselves from engulfment and control by the other person
- Love Avoidants avoid intimate contact with their partners using a variety of “distancing techniques.”
Very common, but not always the case, with Love Avoidants is a history of intense relationships that don’t last and/or “on again-off again” relationship patterns.
Similar to the plight of the Love Avoidants who seek to balance the fears of being smothered and abandoned, Love Addicts fear struggle is between abandonment and unfamiliarity with healthy relationship. The fear of abandonment keeps the Love Addict in a relationship that is unhealthy, even abusive. The lack of familiarity with healthy relationship patterns produces high anxiety for Addicts when they come close to healthy relationships. The Addict often selects an unhealthy partner to avoid contact with this anxiety or panics and creates a hurtful event that demands a distancing response from their partner.
Pia Mellody describes major symptoms of Love Addicts:
- Love Addicts assign a disproportionate amount of time and attention on their partner.
- Love Addicts have unrealistic expectations for unconditional positive regard from their partner.
- Love Addicts neglect to care for themselves while in a relationship.
And just like their counterpart, the Love Avoidant, it is very common for the Love Addict to have a history of intense relationships that don’t last and/or “on again-off again” relationship patterns.
Probably the most common form of Intimacy Disorders is Sexual Addiction. Just as the Sexual Anorexic’s primary task is the avoiding sex, the Sex Addict represents the opposite side of the scale and is driven to consume sex.
IITAP defines and describes sexual addiction as:
Any sexually-related, compulsive behavior that interferes with normal living and causes severe stress on family, friends, loved ones, and one’s work environment. Sexual addiction has also been called hyper-sexuality, sexual dependency and sexual compulsivity. By any name, it is a compulsive behavior that completely dominates the addict’s life. Sexual addicts make sex a priority over family, friends, and work. Sex becomes the governing principle of an addict’s life. They are willing to sacrifice what they cherish most in order to preserve and continue their unhealthy behavior. No single behavior pattern defines sexual addiction. These behaviors can take control of addicts’ lives and become unmanageable. Common behaviors include, but are not limited to compulsive masturbation, compulsive heterosexual and homosexual relationships, pornography, prostitution, exhibitionism, voyeurism, indecent phone calls, and anonymous sexual encounters. Even the healthiest forms of human sexual expression can turn into self-defeating behaviors.
And just like their counterpart, the Anorexic, it is very common for the Sex Addict to have a history of trauma and/or toxic relationships with one or more parent.
What can you do if you think you have an Intimacy Disorder?
If you have experienced patterns similar to one of the disorders discussed, it is reasonable to seek the help of a mental health practitioner that is familiar with treating Intimacy Disorders. When selecting help ask the practitioner about their experience and training in treating these disorders. Do internet research to verify that your practitioner has good standing with an organization that focuses on ongoing research, training and treatment of sexual disorders, such as the oldest group dedicated to sexual health, SASH (Society for the Advancement of Sexual Health) started by Patrick Carnes or IITAP, developers of cutting edge research, training, and assessment tools, such as the 500+ question SDI-R (Sexual Dependence Inventory) also founded Patrick Carnes.
There is a good chance that treating your disorder will not be a brief process, especially if there has been prolonged exposure to trauma, including neglect. You might expect at least a dozen weekly sessions followed by ongoing less frequent visits to your therapist’s office over the following months or even years. Remember, Intimacy Disorders develop and strengthen over time, often with roots that can be traced back to childhood, so allow yourself time to work toward achieving a progressively more healthful and deep interpersonal relationship.
See you on the couch.