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Anorexia Nervosa: Changes in Sexuality During Weight Restoration

From the Eating Disorder Unit, St. George’s Hospital Medical School, London, United Kingdom.

Address reprint requests to: Dr. John Farnill Morgan, Department of General Psychiatry, St. George’s Hospital Medical School, Cranmer Terrace, London SW17 0RE, United Kingdom. Email: jmorgan{at}sghms.ac.uk

OBJECTIVE: We examined changes in sexual drive during weight restoration in patients with anorexia nervosa.

METHODS: Eleven women with anorexia nervosa prospectively completed the Sexual Daydreaming Questionnaire (SDQ) and the Hospital Anxiety and Depression Scale (HADS) at five time points during inpatient treatment involving weight restoration. SDQ and HADS scores were recorded every 4 weeks until 8 weeks after subjects had reached the mean matched population weight (MMPW), which was monitored against body mass index (BMI). Histories were taken for purging, self-cutting, childhood sexual abuse, and number of sexual partners. Repeated-measures analysis of variance, regression analyses, and t tests were performed.

RESULTS: BMI and sexual daydreaming were closely associated (p < .001). BMI and depression also achieved a statistically significant association (p = .046), with "caseness" for anxiety disorder throughout. Higher levels of sexual drive at MMPW seemed to be associated with purging, self-cutting, and childhood sexual abuse but not at low weight. Levels of sexual drive did not reflect previous sexual behavior.

CONCLUSIONS: An increase in sexual drive accompanies weight restoration in patients with anorexia nervosa, which is consistent with psychological and physiological explanations of altered sexuality. Transient depression is also associated with weight gain. Changes in sexuality should be considered in both recovery and treatment failure.

Key Words: anorexia nervosa • eating disorders • sexuality • affect

Abbreviations: BMI = body mass index; MMPW = mean matched populationweight; SDQ = Sexual Daydreaming Questionnaire; HADS =Hospital Anxiety and Depression Scale; ANOVA = analysis ofvariance; CI = confidence interval.