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Anorexia Symptoms are Reduced by Massage Therapy Anorexia Nervosa is diagnosed as body weight 15% below normal in individuals who are fearful of weight gain despite being underweight, disturbed over their body weight or shape, and, among females, if there are disruptions in the menstrual cycle resulting in amenorrhea. With the rapid growth in cultural expectations that women’s bodies should be very thin, concerns about body shape and eating emerge as early as adolescence and may contribute to the “almost epidemic rise” in the incidence of eating disorders, now striking 1% of adolescent females and resulting in death in 2 to 10% of cases. Women who have anorexia consistently report comorbidity of eating and affective disorders, and high depression and anxiety levels are observed in these women. Eating disorders also affect body image. For example one study found that dysphoria significantly covaried with women’s negative evaluations of their bodies and in another study, mood and eating symptoms were linked to body-image concerns, perfectionism, impulsivity, self-criticism and perceptions of anorexic families as incohesive. Due to limited food intake, anorexic individuals can experience biochemical changes including electrolyte imbalances as well as renal and liver dysfunction. The energy requirements of the body can shift into a catabolic state in which energy is released through the breakdown of materials in the body, including muscle and other structural proteins, to provide glucose. The production of glucose from alternative substrate sources has been associated with increased cortisol levels, with higher cortisol levels being associated with lower body weight and depression. Anorexic individuals do not respond readily to treatment. Recent reviews on the status of treatments for eating disorders report that encouraging findings on treatments for bulimia have not been matched in parallel studies on anorexia, with the exception of one study which found that the tricyclic antidepressant, cyproheptadine, was marginally associated with decreases in anorexia symptoms. Psychotherapy has had limited success with outpatients, and studies on inpatients suggest that anorexia is often a chronic condition requiring repeated hospitalization. One study on a clinical population reported that almost one half of inpatients with a diagnosis of anorexia were readmitted to a psychiatry unit within five years, and another study on a non-clinical population reported that women’s scores on the Eating Disorder Inventory were highly stable over a one year period. Anorexic individuals also report a strong desire for more tactile nurturance. Compared with a non-clinical sample, anorexics have reported greater touch deprivation during their current lives as well as their childhood. These studies suggest that the inclusion of positive touch experiences such as massage therapy may be important for successful treatment. Studies have shown that elderly individuals and hospitalized depressed children showed decreased anxiety, depression and stress hormones following massage. Bulimic adolescents have also benefited from massage therapy. Massaged patients reported improved attitudes on the Eating Disorder Inventory, including drive for thinness, bulimia, body dissatisfaction, ineffectiveness, perfectionism, interpersonal distrust, interoceptive awareness and maturity fears. Additionally, they reported lower depression and anxiety levels and they exhibited less anxious behavior and more positive affect. Following a month of treatment, massaged subjects showed lower cortisol, again suggesting reduced stress, and increased dopamine. The present study investigated the effectiveness of massage therapy for women with anorexia nervosa. MethodSample Nineteen females currently undergoing treatment for anorexia were randomly assigned to a massage therapy or a standard treatment only control group. Participants’ body mass index (BMI; weight in kg/square of height in meters) suggested body weight at least 15% below normal range. Six of the 10 participants in the massage therapy group and 5 of the 9 subjects in the control group were in-patients at a center for eating disorders. Outpatient subjects were recruited from college treatment centers serving women with eating disorders. In- and out-patients did not differ on the BMI, the EDI or demographic variables. Subjects in the massage and control groups also did not differ on BMI, EDI or the demographic variables. Treatment Procedures Massage Therapy. The massage therapy subjects received a massage two days per week for 5 weeks, for a total of 10 massages. The massage covered the entire body, including 15 min in a supine position and 15 minutes in a prone position. It consisted of first exerting traction upon the neck with the patient in a supine position, followed by smooth strokes across the forehead, jaw and face, and depressing the shoulders. The therapist then moved each arm one at a time and exerted traction, followed by massage of the hand and smooth strokes over the length of the arm. The torso was gently rocked, and then the same movements used with the arms were used with the legs and feet, one at a time. In a prone position the Achilles tendon was stretched, and long strokes were made from the hip to the toes. The strokes on the back included lumbar stretching, strokes that connect the back and arms, grasping top of shoulders and squeezing, friction alongside the spine, sacral traction and long, soothing strokes from the head to the feet. Assessment procedures Immediate effects measures (Pre/Post therapy sessions) The immediate effects measures included: (1) the State Anxiety Inventory (2) The Profile of Mood States Depression Scale (3) saliva cortisol Longer-Term effects measures (First Day/Last Day) The longer-term effects measures included: (1) Eating Disorders Inventory (EDI); (2) The Center for Epidemiological Studies Depression Scale (CES-D) ratings of depression; (3) urine samples collected from the subjects prior to the end of the first and last day therapy sessions. An aliquot of urine was frozen and sent to Duke University to be assayed for cortisol, serotonin (5HIAA), creatinine, and catecholamines (dopamine, epinephrine and norepinephrine). Results Immediate Effects Group analyses revealed that the massage group score on the STAI and the POMS and cortisol levels decreased, suggesting an immediate reduction in anxiety and stress hormone levels and an improved mood following the massage sessions. Longer-Term Effects Analyses of the longer-term measures revealed that after the 5-week treatment period the massage group showed decreased EDI scores. Dopamine also increased in the massage group following the five-week treatment period. Discussion The anorexic women in this study reported decreased anxiety and improved mood immediately following the massage therapy sessions. In parallel with the self-report data, decreases in saliva cortisol levels further suggested reduced stress. These findings support previous reports on the benefits of massage therapy for bulimic women. The increased dopamine levels and the increased norepinephrine levels were unexpected and certainly warrant further research. By the last day of the study, massaged women reported less body dissatisfaction on the Eating Disorder Inventory. That the EDI scores of subjects in the control group were unchanged, despite being in standard treatment, supports reports on the stability of EDI responses and confirms observations that anorexia does not respond readily to traditional therapies. The massage therapy may have been more successful because of the desire for tactile nurturance in anorexic women. Further studies are needed to explore associations between body satisfaction, the need for tactile nurturance, and massage therapy. By helping women feel more comfortable with their bodies, massage therapy may have facilitated close physical contacts in intimate relationships, thereby satisfying the need for tactile nurturance. Continued research is needed to determine the relationship between body image and the need for tactile nurturance among anorexic women receiving massage therapy. Touchpoints Touch Research Institutes Department of Pediatrics (D-820) University of Miami School of Medicine P.O. Box 016820 Miami, FL 33101 |
