Why eating-disordered patients resist sex therapy: a response to Simpson and Ramberg

Patients with eating disorders struggle with a plethora of sexual dysfunctions and yet are found to resist sex therapy interventions that might be particularly helpful to them. This paper suggests that patients resist sex therapy interventions because they have fragile self-structures. Usually plagued by more than one additional DSM-III-R diagnosis, the eating-disordered patient's treatment is usually complex, and it is difficult for the patient to focus on one specific problematic area. Possessing punitive superego structures, they are also quite critical of their sexual responses. Tending to come from families that are rife with marital discord, they have few role models for an adaptive, mature partnership. Sexual and physical abuse may also contribute to the sexual aversion found in eating-disordered patients. As clinicians comprehend more fully the multifaceted areas of resistance to treatment, they will be able to help their eating-disordered patients traverse a therapeutic impasse. Further research studies will clarify additional areas of resistance that affect the sex therapy of eating-disordered patients.