Reformed Perspectives Magazine, Volume 7, Number 16, April 17 to April 23, 2005

Reflective Review of Sexual Anorexia 1 by Patrick Carnes

By Derek R. Iannelli-Smith

Patrick Carnes' book Sexual Anorexia explores problems with sexuality experienced by Christian clergy. Carnes approaches clerical sin as an outsider and from a non-biblical perspective. This review addresses a variety of shortcomings in Carnes' thinking, but also recognizes that some benefit may be derived from his work.

Definition of Sexual Anorexia

According to Carnes,

Sexual anorexia is an obsessive state in which the physical, mental, and emotional task of avoiding sex dominates one's life. Like self-starvation with food or compulsive dieting or hoarding with money, deprivation with sex can make one feel powerful and defended against all hurts. As with any other altered state of consciousness, such as those brought on by chemical use, compulsive gambling or eating, or any other addiction process, the preoccupation with the avoidance of sex can seem to obliterate one's life problems. The obsession can then become a way to cope with all stress and all life difficulties. Yet, as with other addictions and compulsions, the costs are great. In this case, sex becomes a furtive enemy to be continually kept at bay, even at the price of annihilating a part of oneself. 2

Why Does the Clergy Fail Sexually?

Carnes states under the subtitle of "Sex as Sleaze," that

Religious traditions have, in fact, been part of this split way of understanding sexuality. The ideas of sex as sin outside of the marriage and sex as duty inside the marriage have gone far to undermine the acceptance of sexual pleasure as normal or healthy. 3

Biblically however, we realize that the "frigidity" of "religion" has nothing to do with the clergy failing sexually. It is clear that God's design for sexuality is quite healthy and normal within the confines of marriage. For instance, in the Old Testament God gave direction for healthy and normal sexuality in the book of Leviticus. 4 Reviewing the Song of Solomon, one comes very close to blushing with the beauty and romance suggested by this highly erotic and biblical text! There are also many New Testament texts that address healthy and normal sexuality. 5 If there were one pivotal selection of Scripture to point to why clergy fail sexually, I would quote,

But each one is tempted when he is carried away and enticed by his own lust. Then when lust has conceived, it gives birth to sin; and when sin is accomplished, it brings forth death. Do not be deceived, my beloved brethren. Every good thing given and every perfect gift is from above, coming down from the Father of lights, with whom there is no variation or shifting shadow. 6

What Does Clergy Need to Do to Break the Addiction?

Carnes states, "The healing journey starts with admitting there is a problem. Remember that denial is core to the impaired thinking process." 7 He then goes on to recommend therapists, 12-step groups and even his own material, while giving support to the medical/disease model regarding this behavior.

Although I agree that the first step is admitting the "addict" has a problem, the term addiction continues to bother me in that it implies "helplessness." I picture helpless humans sucked into a bug light representing their addiction. We laugh at this analogy, but I frequently ask disciples/counselees if a gun was held to their head the first time they participated in feeding their lust. Without fail, the answer is no. A choice was made and a continual choice is made to participate in sinful behavior, whether it be "sexual addiction" or "sexual anorexia."

Last year John Stossel did a great commentary titled Is Addiction a Choice? 8 in which a secular investigative report was done on these very topics. The results were quite humorous in that, after watching the report, it was easy to infer that even secular people are fed up with the blame-shifting. There is no medical evidence to suggest that a diagnosis of "addiction" can be applied to sexual addiction or sexual anorexia. With drugs and mind altering chemicals, there is some evidence to suggest that after use they do affect the body. However, self-control is still commanded by Scripture. It is hard to imagine someone standing before God with the excuse, "Gee, God, I was addicted. You understand, don't you?" I like Welch's statement on this as well,

Scripture, indeed, emphasizes that sin has many things in common with a disease. For example, it affects our entire being, it is painful, it leads to death and it is absolutely tragic. Yet there are also ways in which sin is not like a disease. It is something we do rather than catch, we confess it rather than treat it, the disease is in our hearts rather than our bodies, and only the forgiveness and cleansing found in the blood of the Great Physician is sufficient to bring thorough healing. 9

Why is Sexual Acting Out by These Men is an Addiction?

Carnes suggests that "Both sexual anorexics and sex addicts feel powerless. In that sense, the involuntary feelings of aversion in the anorexic are not different from the unwanted feelings of arousal in the addict." 10 This powerlessness is a continual theme with secular writers due to their limited understanding of the doctrines of man and sin. Dr. Robert Smith states, "Many of these sexual dysfunctions are the result of the sheer lack of dealing with problems because of discomfort in talking about them." Ed Welch states defines addictions as disorder of worship and calls it idolatry,

In other words, Scripture permits us to broaden the definition of idolatry so that it includes anything on which we set our affections and indulge in as an excessive and sinful attachment. Therefore, the idols that we can see — such as a bottle — are certainly not the totality of the problem. Idolatry includes anything we worship: the lust for pleasure, respect, love, power, control, or freedom from pain. Furthermore, the problem is not outside of us, located in a liquor store or on the internet; the problem is within us. Alcohol and drugs are essentially satisfiers of deeper idols. The problem is not the idolatrous substance; it is the false worship of the heart. We renounce living for God's glory, and turn to objects of worship that we hope will give us what we want. The desired payoff? The purpose of all idolatry is to manipulate the idol for our own benefit. This means that we don't want to be ruled by idols. Instead, we want to use them. 11

What Light Does 1 Corinthians 10:13 Shed on Sexual Addiction?

No temptation has overtaken you but such as is common to man; and God is faithful, who will not allow you to be tempted beyond what you are able, but with the temptation will provide the way of escape also, so that you will be able to endure it. 12

Jay Adams, in his expositional booklet on this verse states,

Most Christians who need counseling have one thing in common. Every observant pastoral counselor has noticed this all-but-universal characteristic: their conversation is studded with the word "can't." This common trait may be explained in various ways. Some might suppose that it is indicative of a basic weakness or inability that underlies their other problems This explanation leads to the conclusion that these are people who constitutionally, or for some other reason, really can't do what God requires. That is, of course, an explanation that accepts the counselee's view that he is helpless. It also renders the counselor helpless, you will notice. But there is another explanation of this phenomenon: the biblical explanation is that men "cop out" on their responsibilities and fail to accomplish their tasks because of sin. 13

God provides five ways for us to endure temptation: prayer, trust, his word, accountability and focusing on Jesus Christ. I think that it is very important that the immediate context of this verse be brought into this discussion. For instance, 1 Corinthians 10:12 states, "Therefore let him who thinks he stands take heed that he does not fall." This brings forth the sobering reality that each of our prideful hearts can fall. In Welch's article mentioned above, he teaches us to be compassionate about "addictions," reminding us, for instance, of our own failures to keep our January 1 resolutions to loose weight. The addictive cycle has a lot in common with this struggle with sin. That God has provided a way of escape does not give us license to throw our hands up and ask God to deliver us. Rather, we must do the work of radical amputation (taking all temptations out of our lives), radical appropriation (putting off unbiblical behaviors and putting on biblical ones), and radical accountability.

1 Corinthians 10:14 is also highly instructive: "Therefore, my beloved, flee from idolatry." It can be a courageous thing to flee. Consider the example of Joseph in the Old Testament. Did it turn out well for him? No, he spent 14 years in prison for doing the right thing. We must tell our counselees/disciples that it is going to take work, and that there may be negative consequences.

What Can Carnes Teach the Christian Church about Sexual Addiction?

Works done by unregenerate men, although for the matter of them they may be things which God commands; and of good use both to themselves and others: yet, because they proceed not from an heart purified by faith; nor are done in a right manner, according to the Word; nor to a right end, the glory of God, they are therefore sinful, and cannot please God, or make a man meet to receive grace from God: and yet, their neglect of them is more sinful and displeasing unto God. 14

Despite the fact that the foregoing quote from the Westminster Confession of Faith may seem harsh regarding Carnes, I have no doubt that he assists and helps many people. However, he cannot truly help a Christian, just like a Christian cannot truly help a non-Christian; both provide band-aids. It is also important to remember that Christians bring glory to God while non-Christians do not. I do think that Carnes has astutely observed that the church may be prudish at times when it comes to discussing sex and sexual issues. Much gracious and biblical teaching should be done on this topic, and perhaps even more in pre-marital counseling sessions. However, I don't agree with Carnes methodology (12-steps, revisiting the past, disease model, genograms, exercises mentioned in his books, etc), as these are superfluous band-aids that never address the heart and specifically the idolatry in a person's life. Dr. Smith states it succinctly,

It is important to recognize that sex dysfunction is a marriage problem, not the husband's or wife's individual problem. Biblical sex by definition is a two-person relationship and responsibility. Both husband and wife must cooperate in solving problems. While dysfunction is a result of sexual habits of thinking and action, dysfunction itself may become a habit. These habits will need to be replaced by biblical ones. Retraining and relearning are a part of this. People with these problems do not need sex therapy; they need biblical counseling. Not only do biblical counselors deal with causes, they correctly use the Bible in solving problems, keeping biblical goals in mind. Biblical counseling provides both short-term and long-term accountability; changing habits takes time and requires accountability. Biblical counseling does not attempt to do band-aid work on a serious problem but provides the loving major surgery that leads to permanent change.

What Can the Christian Church Teach Carnes about Healing from Sexual Addiction/Anorexia?

First and foremost, the church can teach Carnes that his theology is wrong with regard to such topics as the sovereignty of God, depravity of man, sin, and man's need for a savior. With a more scriptural theological perspective, one can see that the church does have ministries in place to deal with sexual addiction/anorexia. I am thinking specifically of such ministries as Christian Counselor Education Foundation and National Association of Nouthetic Counselors.

In my continued frustration with the way Carnes deals with the topics of sexuality, I interviewed my wife (who was sexually abused and who was tempted to be highly sexually anorexic) about her thoughts on Carnes's 12-steps, revisiting the past, genograms, etc. Her answer was riveting and biblical. She stated that despite what she had endured in the past, she understood that she was still obligated to respond biblically, and still responsible to obey God. In short, she recognized she was bound by God not to repay sin with sin, and not to use the sins inflicted against her as excuses to sin against others.

Carnes' understanding of Christian theology leaves much to be desired. He could certainly benefit from reading Dr. Robert Smith's book Biblical Principles of Sex, 15 as well as from learning the differences between Roman Catholicism and Evangelicalism. Further, a proper understanding of God's sovereignty might improve Carnes' theories dramatically. Adams summarizes the impact of theology in counseling in this way:

A counselor's theology, and his use of it in counseling, then, is neither a matter of indifference nor a question of insignificance. Rather, it is an issue of the most profound importance. Truth and godliness, the reality of God and the welfare of His people are inseparable. The godly man, who copes with life, is always the one who has appropriated God's truth for his life... All counseling that measures up to the biblical standard must fully acknowledge both the tragedy of sin and the fact of human responsibility; it must reckon with God's ultimate purpose to glorify Himself in His Son and in a people redeemed by His grace. While all things will turn out well, they do so not apart from but precisely because of the responsible action of the Son of God who came and actually dies for those who from all eternity had been ordained to eternal life. 16

With regard to the problem of the past, there is a movement today in Christian counseling to get the counselee to revisit his past and much talk about generational curses (cf. Exod. 34:7), but drawing out genograms to wallow in your family timeline of sins gives an unbiblical focus to sinful behavior. More importantly, Ezekiel 18 and John 9:1-3 demonstrate that this understanding of the "generational curse" motif is entirely misguided. A generational curse is not one that is revisited in the lives of subsequent generations, but one in which the curse on the sinner impacts the lives of his contemporary relatives because their lives are intertwined. I do not suggest that Carnes' theology could be improved by studying the misguided approach to generational curses.

However, there are some very good approaches to the problem of the past from which Carnes' might learn quite a bit. One of the best biblical presuppositional outlines regarding counseling and the problem of the past was written by John Bettler, and I am convinced it also relates to disciples/counselees who have are experiencing sexual "addiction" or "anorexia" and responding biblically. I will edit it from its original plural to personal as I am in total agreement,

  • 1. I believe that a counselee's personal past has a significant influence upon his development of his manner of life. I do not believe that the counselee is a helpless victim whose manner of life is determined by his past.
  • 2. I believe that a person creatively interacts with and interprets past events and incorporates his interpretation into his manner of life. I do not believe that a counselee so constructs his past that it has no necessary existence in history. Just as God acts and explains or interprets his actions, so the person interprets the actual events in his life.
  • 3. I believe that the Christian should seek to interpret his past as coming from God and for God's glory; the unbeliever will distort the event with an explanation that does not honor God's truth. He will resist the truth and endeavor to believe the lie.
  • 4. I believe that a counselee is not always aware of the assumptions, values, and habits which shape his manner of life. I do not believe there exists within the person an "unconscious," i.e., an unexplored and largely unexplorable entity which drives his behavior.
  • 5. I believe that exploration of a person's past may help to reveal to himself his manner of life. I do not believe that such exploration is always necessary to produce biblical change.
  • 6. I believe that change occurs in the present. It involves repentance for the distorted values and habits of a false manner of life, and the putting on of godly values and behavior patterns in the present. I do not believe that change occurs in the past through the reliving of past experiences or through emotional release of stored-up emotions (a process commonly called catharsis).
  • 7. I believe that God is sovereign over all the events of a person's life and works providentially through those events to make Christians more like Christ. 17

The main goal for discipling the person dealing with "addiction" or "anorexia" is to teach him to obey as outlined in Matthew 28:18-20. Simply pontificating from the pulpit and providing lists of do's and don'ts is far from helpful. No amount of 12-steps, revisiting the past or moral relativism will free the "addict" or "anorexic." Only when a heart change occurs does a life change occur:

It is time for us Christians to face up to our responsibility for holiness. Too often we say we are "defeated" by this or that sin. No, we are not defeated; we are simply disobedient! It might be well if we stopped using the terms "victory" and "defeat" to describe our progress in holiness. Rather we should use the terms "obedience" and "disobedience." When I say I am defeated by some sin, I am unconsciously slipping out from under my responsibility. I am saying something outside of me has defeated me. But when I say I am disobedient, that places the responsibility for my sin squarely on me. We may, in fact, be defeated, but the reason we are defeated is because we have chosen to disobey. We have chosen to entertain lustful thoughts, or to harbor resentment, or to shade the truth a little. We need to brace ourselves up, and to realize that we are responsible for our thoughts, attitudes, and actions. We need to reckon on the fact that we died to sin's reign, that it no longer has any dominion over us, that God has united us with the risen Christ in all His power, and has given us the Holy Spirit to work in us. Only as we accept our responsibility and appropriate God's provisions will we make any progress in our pursuit of holiness. 18


1. Carnes, Patrick. Sexual Anorexia — Overcoming Sexual Self-Hatred. Center City, Minn, Hazelden, 1997.


3. Patrick Carnes, Sexual Anorexia-Overcoming Sexual Self-Hatred. Center City, Minn, Hazelden, 1997: page 28.

4. Ironically with this reference, if one looks at Lev 18, it is between 17- Blood for Atonement and 19-Idolatry Forbidden both topics which need to be in the forefront of the Christian's mind.

5. SOME other references for healthy and normal sexuality can be found Pro 4:23-27, 5; Matt. 5:27—30, 15:19-20; John 8:31—36; Rom 6:15-23; 1 Cor 6:9-20; 2 Cor 7; Gal 5:16-18; Eph 5:3-17; Col. 3:5—7; 1 Thes 4:3-6; Heb 13:4; 2 Peter 2:4—10; Jude 6—7.

6. Jas 1:14. All Scripture quotes are from New American Standard Bible: 1995 Update. LaHabra, CA: The Lockman Foundation, 1995.

7. Carnes, "Sexual Anorexia-Overcoming Sexual Self-Hatred," page 78-79.

8. April 21, ABC News

9. Welch, "Addictions: New Ways of Seeing, New Ways of Walking Free," page 24.

10. Carnes, "Sexual Anorexia-Overcoming Sexual Self-Hatred," page 50.

11. Edward Welch, "Addictions: New Ways of Seeing, New Ways of Walking Free," Journal of Biblical Counseling, Vol. 19, No. 3, 2001: page 20.

12. 1 Cor. 10:13.

13. Jay Adams, "Christ and Your Problems," Phillipsburg, New Jersey, P&R Publishing, 1983 page 21-22.

14. The Westminster Confession of Faith, Chapter XVI, 7. Oak Harbor, WA: Logos Research Systems, Inc., 1996.

15. It can be downloaded for free at:

16. Jay E. Adams, "Counseling and the Sovereignty of God," The Journal of Biblical Counseling, Vol. XI, No. 2, Winter 1993: pages 4-9.

17. John F. Bettler, "Counseling and the Problem of the Past," The Journal of Biblical Counseling, Vol. XII, No. 2, 1994: page 23.

18. Bridges, Jerry, "The Pursuit of Holiness."


Adams, Jay E., "Counseling and the Sovereignty of God," The Journal of Biblical Counseling, Vol. XI, No. 2, Winter 1993: pages 4-9.

-------., "Christ and Your Problems," Phillipsburg, New Jersey, P&R Publishing, 1983.

Bettler, John F., "Counseling and the Problem of the Past," The Journal of Biblical Counseling, Vol. XII, No. 2, 1994: pages 5-23.

Carnes, Patrick. Sexual Anorexia-Overcoming Sexual Self-Hatred. Center City, Minn, Hazelden, 1997.

New American Standard Bible : 1995 Update, LaHabra, CA: The Lockman Foundation, 1995.

Smith, Robert D., "Dealing with Sexual Dysfunction", Journal of Pastoral Practice, Vol. 9, No. 1, 1987: pages 11-20.

Tripp, Paul David., "Strategies for Opening Blind Eyes: Data Gathering-Part 3," The Journal of Biblical Counseling, Vol. 15, No. 1, Fall 1996: pages 42-51.

Steve Viars, "The Evolution of Sexual Sin," The Biblical Counselor, (on the web:, Aug 2004: pages 1-2.

Welch, Edward, "Addictions: New Ways of Seeing, New Ways of Walking Free," Journal of Biblical Counseling, Vol. 19, No. 3, 2001: pages 19-30.