Sexuality, embodiment and attachment style in anorexia nervosa



Recent studies hypothesized that sexual dysfunctions represent not just complications of eating disorders (EDs), rather they should be attributed to the core psychopathology of these disorders. Therefore, disorders of the embodiment and insecure attachment may play a role in maintaining an abnormal sexual functioning, given their known relations with core ED features. The aim of the study was to investigate the relationship between sexual dysfunctions and both disorders of the embodiment and attachment style in people with anorexia nervosa (AN).


111 adult women with AN and 120 healthy subjects completed the Symptom Checklist-90, Eating Disorder Examination Questionnaire, Identity and Eating Disorders, Attachment Style Questionnaire and the Childhood Trauma Questionnaire-Short Form.


Patients reported worse scores than controls in all areas assessed. In patients, low sexual desire was found to be associated with general and ED-specific psychopathology, and with disorders of embodiment and attachment style. Sexual dysfunctions had no associations with traumatic experiences. Dietary restriction showed an association with low sexual desire through embodiment disorder and Discomfort with Closeness, as confirmed by the serial mediation model.


The present study suggests that disorders of embodiment maintained by pathological eating behaviours have a key role in the development of sexual dysfunctions in EDs, through the compromise of intimacy.

Level of evidence

Level III, cross-sectional study with comparisons between cases and controls.

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All authors contributed to the study conception and design, material preparation, data collection and analysis, and to drafting and revising the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Giovanni Castellini.

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Informed consent was obtained from all individual participants included in the study.

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All procedures were in accordance with the ethical standards of the institutional research committee (Ethical Committee Area Vasta Centro, reference number OSS.14.162) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Cassioli, E., Rossi, E., Castellini, G. et al. Sexuality, embodiment and attachment style in anorexia nervosa. Eat Weight Disord 25, 1671–1680 (2020).

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  • Embodiment
  • Anorexia nervosa
  • Attachment style
  • Sexual dysfunctions