Emotional intimacy and relationship boundaries can be complicated for those in eating disorder recovery.
The following factors may get in the way of eating disorder sufferers forming or maintaining emotionally intimate relationships: 
In addition, partners of eating disorder sufferers may feel: 
Struggles with emotional intimacy and relationship boundaries may be attributed to the following:
A history of trauma. Traumatic events, especially those involving violence between people, have been found to be significant risk factors for the development of eating disorders, particularly bulimia and binge eating disorders.
Posttraumatic stress disorder (PTSD), a serious mental health condition that can develop when someone has been exposed to one or more traumatic events, has a lifetime prevalence rate of 38% to 44% for those with bulimia.
When partial or subclinical forms of PTSD are considered, then well over half of individuals with bulimic symptoms have PTSD or significant PTSD symptoms. 
Experiencing trauma can create difficulties on one’s ability to maintain healthy or intimate relationships, including struggling with emotional intimacy and relationship boundaries.
Attachment styles. Attachment styles commonly observed in those with eating disorders tend to impact emotional intimacy and relationship boundaries.
For example, Ward and colleagues (2000) found certain attachment patterns led to certain unhealthy relational patterns. More specifically, they found that anxious attachment patterns led to care-seeking and avoidant patterns led to “extreme self-sufficiency.”
In another study, Broberg and colleagues (2001) found similar attachment patterns among women with anorexia and bulimia, which they linked to mistrust of others, minimal emotional disclosure, and discomfort and dissatisfaction with close relationships.
Lastly, Evans & Wertheim (2002) found that insecure attachment patterns were linked to mistrust, fear of abandonment, and closeness avoidance among women with eating disorders. [1, 4, 6, 7, 8]
Body image concerns. One of the symptoms of an eating disorder is having a negative body image.  These body image concerns can impact eating disorder sufferers’ sexual esteem, sexual satisfaction, and sexual desire. 
Furthermore, all of these factors appear to play a role in the avoidance of sexual activity.  In addition, given the physiological impact of eating disorders, things like hormonal shifts can cause a drop in energy, mood, libido, and sexual functioning. 
Given the impact of eating disorders on emotional intimacy and relationship boundaries, it’s important that relational therapeutic approaches along with family or couples counseling be considered as a part of treatment when indicated.
Lastly, it’s important to note that these studies mentioned in this blog focused on cisgender women and heterosexual relationships. More diverse research is needed in order to identify what emotional intimacy and relationship boundaries look like for eating disorder sufferers of differing identities and orientations.
1. Dick, C.H., Renes, S.L., Moroti, A., & Strange, A.T. (2013). Understanding and Assisting Couples Affected by an Eating Disorder The American Journal of Family Therapy, 43 (3), 232-244 : 10.1080/01926187.2012.677728
2. National Eating Disorder Association. Learn: Warning Signs and Symptoms. Retrieved from https://www.nationaleatingdisorders.org/learn/general-information/trauma on Sept 9, 2019.
3. National Eating Disorder Association. Cooccurring disorders and special issues: Trauma & PTSD. Retrieved from https://www.nationaleatingdisorders.org/warning-signs-and-symptoms on Sept 9, 2019.
4. Tasca GA, et al. (2011). Implications of attachment theory and research for the assessment and treatment of eating disorders. DOI: 10.1037/a0022423
5. La Rocque CL, et al. (2011). An evaluation of the relationship between body image and sexual avoidance. DOI: 10.1080/00224499.2010.499522
6. Ward A., Ramsay R., Turnbull S., Steele M., Steele H., Treasure J. (2001). Attachment in anorexia nervosa: a transgenerational perspective. Br J Med Psychol. 74(4) : 497-505.
7. Broberg, A. G., Hjalmers, I. and Nevonen, L. (2001), Eating disorders, attachment and interpersonal difficulties: a comparison between 18‐ to 24‐year‐old patients and normal controls. Eur. Eat. Disorders Rev., 9: 381-396. doi:10.1002/erv.421
8. Evans L. & Wertheim E.H. (2002). An examination of willingness to self-disclose in women with bulimic symptoms considering the context of disclosure and negative affect levels. Int J Eat Disord, 31(3):344-8.
About the Author:
Chelsea Fielder-Jenks is a Licensed Professional Counselor in private practice in Austin, Texas. Chelsea works with individuals, families, and groups primarily from a Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT) framework.
She has extensive experience working with adolescents, families, and adults who struggle with eating, substance use, and various co-occurring mental health disorders. You can learn more about Chelsea and her private practice at ThriveCounselingAustin.com.
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 a 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 September 20, 2019, on EatingDisorderHope.com
Reviewed & Approved on September 20, 2019, by Jacquelyn Ekern MS, LPC
The post Emotional Intimacy & Relationship Boundaries for Eating Disorder Recovery appeared first on Eating Disorder Hope.