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					                                                                    Vol. 13 No.1 Winter 2006
                      Anorexia Symptoms are Reduced by Massage Therapy
                                                              Anorexic individuals do not respond
        Anorexia nervosa is diagnosed as body         readily to treatment. Recent reviews on the
weight 15% below normal in individuals who are        status of treatments for eating disorders report
fearful of weight gain despite being underweight,     that encouraging findings on treatments for
disturbed over their body weight or shape, and,       bulimia have not been matched in parallel studies
among females, if there are disruptions in the        on anorexia, with the exception of one study
menstrual cycle resulting in amenorrhea. With         which found that the tricyclic antidepressant,
the rapid growth in cultural expectations that        cyproheptadine, was marginally associated with
women’s bodies should be very thin, concerns          decreases in anorexia symptoms. Psychotherapy
about body shape and eating emerge as early as        has had limited success with outpatients, and
adolescence and may contribute to the “almost         studies on inpatients suggest that anorexia is
epidemic rise” in the incidence of eating             often a chronic condition requiring repeated
disorders, now striking 1% of adolescent females      hospitalization. One study on a clinical
and resulting in death in 2 to 10% of cases.          population reported that almost one half of
        Women who have anorexia consistently          inpatients with a diagnosis of anorexia were
report comorbidity of eating and affective            readmitted to a psychiatry unit within five years,
disorders, and high depression and anxiety levels     and another study on a non-clinical population
are observed in these women. Eating disorders         reported that women’s scores on the Eating
also affect body image. For example one study         Disorder Inventory were highly stable over a
found that dysphoria significantly covaried with      one year period.
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
                                                      Photo by Tiffany Field
depression.
                                                                       touchpoints Vol .13 No.1, Page 1
Anorexic individuals also report a strong desire
for more tactile nurturance. Compared with a          Treatment Procedures
non-clinical sample, anorexics have reported
greater touch deprivation during their current                Massage Therapy. The massage therapy
lives as well as their childhood. These studies       subjects received a massage two days per week
suggest that the inclusion of positive touch          for 5 weeks, for a total of 10 massages. The
experiences such as massage therapy may be            massage covered the entire body, including 15
important for successful treatment. Studies have      minutes in a supine position and 15 minutes in a
shown that elderly individuals and hospitalized       prone position. It consisted of first exerting
depressed children showed decreased anxiety,          traction upon the neck with the patient in a
depression and stress hormones following              supine position, followed by smooth strokes
massage. Bulimic adolescents have also                across the forehead, jaw and face, and depressing
benefited from massage therapy. Massaged              the shoulders. The therapist then moved each
patients reported improved attitudes on the           arm one at a time and exerted traction, followed
Eating Disorder Inventory, including drive for        by massage of the hand and smooth strokes over
thinness,     bulimia,   body     dissatisfaction,    the length of the arm. The torso was gently
ineffectiveness, perfectionism, interpersonal         rocked, and then the same movements used with
distrust, interoceptive awareness and maturity        the arms were used with the legs and feet, one at
fears.     Additionally, they reported lower          a time. In a prone position the Achilles tendon
depression and anxiety levels and they exhibited      was stretched, and long strokes were made from
less anxious behavior and more positive affect.       the hip to the toes. The strokes on the back
Following a month of treatment, massaged              included lumbar stretching, strokes that connect
subjects showed lower cortisol, again suggesting      the back and arms, grasping top of shoulders and
reduced stress, and increased dopamine. The           squeezing, friction alongside the spine, sacral
present study investigated the effectiveness of       traction and long, soothing strokes from the head
massage therapy for women with anorexia               to the feet.
nervosa.
                                                      Assessment procedures
                     Method
Sample                                                Immediate effects measures (Pre/Post therapy
        Nineteen females currently undergoing         sessions)
treatment for anorexia were randomly assigned                 The     immediate     effects   measures
to a massage therapy or a standard treatment          included: (1) the State Anxiety Inventory (2) The
only control group. Participants’ body mass           Profile of Mood States Depression Scale (3)
index (BMI; weight in kg/square of height in          saliva cortisol
meters) suggested body weight at least 15%
below normal range. Six of the 10 participants in     Longer-Term effects measures (First Day/Last
the massage therapy group and 5 of the 9              Day)
subjects in the control group were in-patients at a           The longer-term effects measures
center for eating disorders. Outpatient subjects      included: (1) Eating Disorders Inventory (EDI);
were recruited from college treatment centers         (2) The Center for Epidemiological Studies
serving women with eating disorders. In- and          Depression Scale (CES-D) ratings of depression;
out-patients did not differ on the BMI, the EDI       (3) urine samples collected from the subjects
or demographic variables.       Subjects in the       prior to the end of the first and last day therapy
massage and control groups also did not differ on     sessions. An aliquot of urine was frozen and sent
BMI, EDI or the demographic variables.                to Duke University to be assayed for cortisol,
                                                      serotonin      (5HIAA),        creatinine,     and
                                                      catecholamines (dopamine, epinephrine and
                                                      norepinephrine).
                                                                     touchpoints Vol .13 No.1, Page 2
                                                    need for tactile nurturance. Continued research is
                                                    needed to determine the relationship between
                    Results                         body image and the need for tactile nurturance
                                                    among anorexic women receiving massage
Immediate Effects                                   therapy.
        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        Photo by Tiffany Field
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
                                                                     touchpoints Vol .13 No.1, Page 3
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