Eating Disorders and Female Sexuality: Current Evidence-base and Future Implications

Leonidas, Carolina; Santos, Manoel Antônio dos

doi:10.1590/1413-82712020250109

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Papers • Psico-USF 25 (1) • Jan-Mar 2020 • https://doi.org/10.1590/1413-82712020250109 copy

Eating Disorders and Female Sexuality: Current Evidence-base and Future Implications

Transtornos Alimentares e Sexualidade Feminina: Evidências Atuais e Implicações Futuras

Trastornos Alimenticios y Sexualidad Femenina: Evidencias Actuales e Implicaciones Futuras

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

This study aimed to examine current scientific production regarding sexuality-related issues in the context of eating disorders (ED). Searches were performed on PubMed, LILACS, CINAHL and PsycINFO, including papers published between 2008 and 2018, using the following descriptors: eating disorders, femininity, sexuality and sexual behavior. Nineteen studies were selected. Findings were systematized into two main thematic categories and showed, in general, that femininity can be a risk factor to the development of ED. Studies indicated that endorsing a gender role that is socially considered discrepant from biological sex, despite feminine or masculine, is related to ED symptomatology. Moreover, body dissatisfaction is positively correlated to sexual dysfunction. Interventions targeting prevention of ED should include sexuality-related issues by approaching probable negative consequences of adhering to female gender role social requirements and stereotypes, especially those related to body weight and body shape.

Keywords:
eating disorders; sexuality; femininity

Authors and year of publication	Study design and EL	Population	Measures
Green et al., (2008Green, M. A., Davids, C. M., Skaggs, A. K., Riopel, C. M., & Hallengren, J. J. (2008). Femininity and eating disorders. Eating Disorders, 16(4), 283-293. DOI: 10.1080/10640260802115829 https://doi.org/10.1080/1064026080211582... )	Non-experimental, descriptive, correlational (EL 4)	86 female college students aged 17-23	Eating Disorder Examination-Questionnaire (EDE-Q) and Conformity to Feminine Norms Inventory (CFNI).
Pinheiro et al., (2010Pinheiro, A. P., Raney, T. J., Thornton, L. M., Fichter, M. M., Berretini, W. H., Goldman, D., Halmi, K. A., Kaplan, A. S., Strober, M., Treasure, J., Woodside, D. B., Kaye, W. H., & Bulik, C. M. (2010). Sexual functioning in women with eating disorders. International Journal of Eating Disorders, 43(2), 123-129. DOI: 10.1002/eat.20671 https://doi.org/10.1002/eat.20671... )	Quasi experimental (EL 3)	242 women from the multisite international Price Foundation Genetic Studies of Eating Disorders: AN Affected Relative Pair Studies	Structured Interview for Anorexic and Bulimic Disorders-Psychopathology (SIAB-P), Temperament and Character Inventory (TCI), Frost Multidimentional Perfectionism Scale (MPS), State-Trait Anxiety Inventory (STAI) and Eating Disorder Inventory-2 (EDI-2).
Capitaine, Rodgers, & Chabrol (2011Capitaine, M., Rodgers, R. F., & Chabrol, H. (2011). Unwanted sexual experiences, depressive symptoms and disordered eating among college students. Eating Behaviors, 12(1), 86-89. DOI: 10.1016/j.eatbeh.2010.11.003. https://doi.org/10.1016/j.eatbeh.2010.11... )	Non-experimental, descriptive, correlational (EL 4)	122 college women	Eating Attitudes Test-26 (EAT-26), Centre for Epidemiological Studies - Depression Scale (CES-D), Sexual Experience Survey (SES) e Visual Analog Scale (VAS).
Woolhouse et al., (2012Woolhouse, M., Day, K., Rickett, B., & Milnes, K. (2012). “Cos girls aren’t supposed to eat like pigs are they?” Young women negotiating gendered discursive constructions of food and eating. Journal of Health Psychology, 17(1):46-56. DOI: 10.1177/1359105311406151 https://doi.org/10.1177/1359105311406151... )	Non-experimental, descriptive, correlational (EL 4)	37 young women aged 11-19	Semi-structured interview.
Castellini et al., (2013Castellini, G., Lo Sauro, C., Lelli, L., Godini, L., Vignozzi, L., Rellini, A. H., Faravelli, C.,Maggi, M., & Ricca, V. (2013). Childhood sexual abuse moderates the relationship between sexual functioning and eating disorder psychopathology in anorexia nervosa and bulimia nervosa: A 1-year follow-up study. Journal of Sexual Medicine, 10(9), 2190-2200. DOI: 10.1111/jsm.12232 https://doi.org/10.1111/jsm.12232... )	Quasi experimental, longitudinal (EL 3)	27 patients with AN and 31 with BN were assessed at baseline and at 1-year follow-up	Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders IV (SCI - DSM-IV), Female Sexual Function Index (FSFI), Eating Disorder Examination Questionnaire (EDEQ), Beck Depression Inventory (BDI), Spielberg’s State-Trait Anxiety Inventory (SSTAI), Symptom Checklist-90 and Childhood Experience of Care and Abuse Questionnaire (CECAQ).
Cella, Iannaccone, & Cotrufo (2013Cella, S., Iannaccone, M., & Cotrufo, P. (2013). Influence of gender role orientation (masculinity versus femininity) on body satisfaction and eating attitudes in homosexuals, heterosexuals and transsexuals. Eating and Weight Disorders, 15(2), 115-124. DOI: 10.1007/s40519-013-0017-z https://doi.org/10.1007/s40519-013-0017-... )	Non-experimental, descriptive, correlational (EL 4)	132 homosexuals, 178 heterosexuals and 15 transexuals (man to woman)	Sociodemographic script, Eating Disorders Inventory -2 (EDI-2), Body Uneasiness Test (BUT) and Bem Sex Role Inventory (BSRI).
Yean et al., (2013Yean, C., Benau, E. M., Dakanalis, A., Hormes, J. M., Perone, J., & Timko C. A. (2013). The relationship of sex and sexual orientation on self-esteem, body shape satisfaction, and eating disorder symptomatology. Frontiers in Psychology, 4. DOI: 10.3389/fpsyg.2013.00887 https://doi.org/10.3389/fpsyg.2013.00887... )	Non-experimental, descriptive, correlational (EL 4)	506 college students and 187 people from the community (246 men and 447 women)	Kinsey Heterosexual-Homosexual Likert-type Scale, Body Shape Questionnaire (BSQ), Eating Attitudes Test-26 (EAT-26), Drive for Thinness subscale of the Eating Disorder Inventory-II (DFT, EDI-II), Drive for Muscularity Scale (DFM), Rosenberg Self-Esteem Scale (RSES) and Sociocultural Attitudes Towards Appearance Scale-3 (SATAQ).
Collins et al., (2014Collins, B., Fischer, S., Stojek, M., & Becker, K. (2014). The relationship of thought suppression and recent rape to disordered eating in emerging adulthood. Journal of Adolescence, 37(2), 113-121. DOI: 10.1016/j.adolescence.2013.11.002 https://doi.org/10.1016/j.adolescence.20... )	Non-experimental, descriptive, correlational (EL 4)	319 female college students	Eating Disorder Examination Questionnaire (EDE-Q), White Bear Thought Suppression Inventory (WBSI), Sexual Experiences Survey (SES) and Childhood Trauma Questionnaire (CTQ).
Matthews-Ewald, Zulling, & Ward (2014Matthews-Ewald, M. R., Zullig, K. J., & Ward, R. M. (2014). Sexual orientation and disordered eating behaviors among self-identified male and female college students. Eating Behaviors, 15(3), 441-444. DOI: 10.1016/j.eatbeh.2014.05.002 https://doi.org/10.1016/j.eatbeh.2014.05... )	Non-experimental, descriptive, correlational (EL 4)	Sample from the American College Health Association National College Health Assessment (n=110,412)	American College Health Association National College Health Assessment (ACHA-NCHA).
Gonçalves et al., (2016Gonçalves, S., Machado, B., Silva, C., Crosby, R. D., Lavender, J. M., Cao, L., & Machado, P. P. (2016). The moderating role of purging behaviour in the relationship between sexual/physical abuse and nonsuicidal injury in eating disorder patients. European Eating Disorders Review, 24(2), 164-168. DOI: 10.1002/erv.2415 https://doi.org/10.1002/erv.2415... )	Non-experimental, descriptive, correlational (EL 4)	177 women with ED aged 14-38	Semi-structured interview for the assessment of risk factor in ED, Eating Disorders Examination (EDE).
Churruca, Ussher, & Perz (2016Churruca, K., Ussher, J. M., & Perz, J. (2016). Just desserts? Exploring constructions of food in women’s experience of bulimia. Qualitative Health Research, 27(10), 1491-1506. DOI: 10.1177/1049732316672644 https://doi.org/10.1177/1049732316672644... )	Non-experimental, descriptive, correlational (EL 4)	15 women with bulimic behaviours	Semi-structured interviews.
Dunkley, Gorzalka, & Brotto (2016Dunkley, C. R., Gorzalka, B. B., & Brotto, L. A. (2016). Disordered eating and sexual insecurities in young women. The Canadian Journal of Human Sexuality, 25(2), 138-147. DOI: 10.3138/cjhs.252-A6 https://doi.org/10.3138/cjhs.252-A6... )	Non-experimental, descriptive, correlational (EL 4)	789 female college students aged over 19	Sexual Self-Efficacy Scale for Female Function (SSES-F), Cognitive Distractions During Sexual Activity Scale (CDDAS), Eating Disorders Inventory-3 (EDI-3), Revised Rigid Restraint Scale (RRRS) and Body Shape Questionnaire (BSQ).
Gordon et al., (2016Gordon, A. R., Austin, S. B., Krieger, N., White Hughto, J. M., & Reisner, S. L. (2016). “I have to constantly prove to myself, to people, that I fit the bill”: Perspectives on weight and shape control behaviors among low-income, ethnically diverse young transgender women. Social Science and Medicine, 165, 141-149. DOI: 10.1016/j.socscimed.2016.07.038 https://doi.org/10.1016/j.socscimed.2016... )	Non-experimental, descriptive, correlational (EL 4)	21 women aged 19-32	Interview guide.
Cerniglia et al., (2016Cerniglia, L., Cimino, S., Ballarotto, G., & Tambelli, R. (2016). Do parental traumatic experiences have a role in the psychological functioning of early adolescents with binge eating disorder? Eating and Weight Disorders, 21(4), 635-644. DOI: 10.1007/s40519-016-0354-9 https://doi.org/10.1007/s40519-016-0354-... )	Quasi experimental (EL 3)	202 adolescents aged 11-13 and their parents (n = 202 mothers; n = 202 fathers)	Youth Self-Report (YSR), the Response Evaluation Measure for Youth (REM-71), the Toronto Alexithymia Scale (TAS-20), the Symptom Checklist (SCL-90-R), and the Traumatic Experience Checklist (TEC).
Lampis et al., (2017Lampis, J., Cataudella, S., Busonera, A., De Simone, S., & Tommasi, M. (2017). The moderating effect of gender role on the relationships between gender and attitudes about body and eating in a sample of Italian adolescents. Eating and Weight Disorders, 24(1), 3-11. DOI: 10.1007/s40519-017-0372-2 https://doi.org/10.1007/s40519-017-0372-... )	Non-experimental, descriptive, correlational (EL 4)	920 adolescents aged 14-21	Sociodemographic questionnaire, the Bem Sex-Role Inventory (BSRI) and the Eating Disorders Inventory (EDI-2).
Mason, Lewis, & Heron (2017Mason, T. B., Lewis, R. J., & Heron, K. E. (2017). Indirect pathways connecting sexual orientation and weight discrimination to disordered eating among young adult lesbians. Psychology of Sexual Orientation and Gender Diversity, 4(2), 193-204. DOI: 10.1037/sgd0000220 https://doi.org/10.1037/sgd0000220... )	Non-experimental, descriptive, correlational (EL 4)	436 homossexual females aged 18-30	The SCOFF questionnaire), the Short Positive and Negative Affect Schedule (S-PANAS), the State Social Anxiety Questionnaire, the Multidimensional Scale of Perceived Social Support (MSPSS) and the Everyday Discrimination Scale (EDS).
Tolosa-Sola et al., (2017Tolosa-Sola, I., Gunnard, K., Giménez Munieza, C., Casals, L., Grau, A., & Farré, J. M. (2017). Body dissatisfaction and eating disorder symptomatology: Which factors interfere with sexuality in women with eating disorders? Journal of Health Psychology. Epub ahead of print March 1. DOI: 10.1177/1359105317695425. https://doi.org/10.1177/1359105317695425... )	Quasi experimental (EL 3)	27 women with ED and 24 controls	Semi-structured questionnaire to assess psychosexual history and demographic/clinical data, Symptom Checklist Revised (SCL-90-R), Personality Disorder Questionnaire-4 (PDQ-4), Eating Disorders Inventory-2 (EDI-2), Eating Attitudes Test-40 (EAT-40), Bulimic Investigatory Test Edinburgh (BITE) and Female Sexual Function.
Watson et al., (2017Watson, R. J., Adijei, J., Saewyc, E., Homma, Y., & Goodenow, C. (2017). Trends and disparities in disordered eating among heterosexual and sexual minority adolescents. International Journal of Eating Disorders, 50(1), 22-31. DOI: 10.1002/eat.22576 https://doi.org/10.1002/eat.22576... )	Quasi experimental, longitudinal (EL 3)	Data from the Massachusetts Youth Risk Behavior Survey (MYRB), from 1999 to 2013 (n = 26002)	Massachusetts Youth Risk Behavior Survey (MYRBS), assessing for age, sex, ethnicity, sexual orientation, use of diet pills to lose weight, fasting to lose weight and purging to lose weight.
Zullig, Matthews-Ewald, & Valois (2017Zullig, K. J., Matthews-Ewald, M. R., & Valois, R. F. (2017). Relationship between disordered eating and self-identified sexual minority youth in a sample of public high school adolescents. Eating and Weight Disorders: Studies on Anorexia, Bulimia and Obesity. 1-9. DOI: 10.1007/s40519-017-0389-6 https://doi.org/10.1007/s40519-017-0389-... )	Non-experimental, descriptive, correlational (EL 4)	Data from the Connecticut Youth Risk Behavior Survey was utilized (n = 2242)	Structured questionnaire, developed by authors.

Universidade de São Francisco, Programa de Pós-Graduação Stricto Sensu em Psicologia R. Waldemar César da Silveira, 105, Vl. Cura D'Ars (SWIFT), Campinas - São Paulo, CEP 13045-510, Telefone: (19)3779-3771 - Campinas - SP - Brazil
E-mail: revistapsico@usf.edu.br

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