By Shirley Vanderbilt
Originally published in Massage & Bodywork magazine, August/September 2001.
Eating disorders cross every ethnic, gender and age line and are increasing at an alarming rate. Whether by refusing to eat (anorexia nervosa) or binging and purging (bulimia nervosa), the victims deliberately deny their bodies of nutrition and deprive their souls of self-worth. Take a look at the statistics. In the United States, 7 million women and 1 million men suffer from eating disorders with 50 percent or less reporting cure.1 According to a recent survey, almost one-third of high school girls and 16 percent of high school boys exhibit symptoms of anorexia, bulimia or binge eating, and many are not receiving treatment.2 The death rate for serious cases of anorexia nervosa is estimated to be between 6 percent and 10 percent, with one citation reporting a rate of 25 percent for eating disorders in general.3 For those who survive anorexia, the majority will suffer irreversible bone loss,4 with men being most vulnerable.5 Bulimics can develop liver, kidney and bowel damage from binging and purging. Heart irregularities and sometimes cardiac arrest can result from both disorders. And while it is commonly accepted that anorexia nervosa is a disease of young, overachieving women, a Canadian study revealed more than 75 percent of deaths related to this condition occur in those over the age of 45.6
The cause of this modern-day epidemic has been attributed to many factors, not the least of which is our culture’s obsession with the “perfect body.” In an article from the Women’s Center Institute in New York, therapists noted, for girls particularly, “It is in the arena of eating and body image where the unconscious needs of the individual, including the need for recognition and selfhood, and the demands of the culture collide.”7 But it has also been suggested this obsession with body image is only one of perhaps many triggers of the disease rather than the cause. The actual, underlying etiology appears to go deeper.
Peggy Claude-Pierre, director and founder of the Montreux Clinic in Victoria, Canada, a residential program for eating disorders, coined the term Confirmed Negativity Condition (CNC) to describe the negative mindset that predisposes an individual to this illness. She states, “The eating disorder is the symptom; CNC is the affliction we must cure.”8 Those who develop CNC are in a constant battle of the mind, between positive and negative thoughts, with the negativity becoming increasingly dominant to the point of translating everything in the victim’s experience through the subjective negative.9
Throughout the literature, the eating disordered individual is described as a “pleaser.” They strive for perfection, not out of a sense of empowering themselves but as a duty to others. Taking on the responsibility for creating a perfect world, they are thwarted by the imperfection and chaos of reality, and thus label themselves as a worthless failure. “This leads to the manifestation of an eating disorder...expressed in the anorexic as an attempt at being the smallest and sickest and in the bulimic with ever more extreme binge/purge episodes,” says Claude-Pierre. The subtle reality of this mindset is that sufferers need to be the best at being the least deserving. Ultimately, they need to know: Are they the best at dying?”10
Eating disorders are extremely difficult to treat, primarily because the victims’ denial and covert behavior is an entrenched symptom of the disease. Among psychiatric illnesses, eating disorders account for the highest mortality rate,11 thus the success or failure of treatment becomes a life-or-death ultimatum.
Refining the Search and Rescue
From the medical perspective, study teams have focused on chemical imbalances and pharmacological Band-aids to assuage the symptoms of eating disorders. Minimal success has been noted in treating symptoms of anxiety and low self-esteem with antidepressants.12 Scientists are currently researching the role of hormones in modulating hunger and saity in humans, after successfully identifying chemicals that influence these mechanisms in mice.13 Geneticists, basing their research on the discovery that those with eating disorders appear to have a disturbance in serotonin production, are hopeful of finding a group of genes that would account for the biological component contributing to disorder of mood and impulse control.14 At this point, discovering the cause doesn’t appear to be the “chicken or the egg” conundrum, but rather one of sorting out predisposing conditions and triggering factors. As in many other psychiatric disorders, evidence is leading to the interplay of physiological, psychological and environmental situations that both generate and reinforce the cycle of destruction in eating disorders.
For several decades, eating disorder clinics and inpatient programs have focused on a variety of psychological approaches, primarily individual, family and group therapy, cognitive-behavioral training and support groups. Some modalities address symptoms, others dig deep into the cause. Only recently have these programs begun to experience a modicum of success, with a minority of experts reporting significant recovery rates. Even after cessation of eating disorder behavior, the patient may still require years of counseling and nurturing to achieve wholeness of body and mind.
Although psychotherapy remains in the forefront of treatment, the use of adjunctive therapies can enhance the process and provide stepping stones for restoration to normalcy. At the Montreux Clinic, which reports a high success rate, the patient’s need for comfort and reassurance is addressed through soothing words and touch, and massage therapy.15 Recent touch research reveals this approach may not only be good for the eating-disordered soul, but for the body’s distorted chemical state as well.
The Touch Connection
In 1995, researchers at the University of Michigan Medical School published two studies suggesting a connection between eating disorders and touch deprivation. A preliminary non-clinical survey of 176 shoppers showed a “direct correlation between a current desire to get more tactile nurturance” and a drive for thinness as measured by the Eating Disorder Inventory (EDI).16 A second study compared perceived touch deprivation scores for 59 women with eating disorders and scores from a non-clinical randomly selected group of 140 women. Analysis revealed “the eating disorder group reported greater body image concerns and perceived greater touch deprivation, both during their childhood and their current life, than the non-clinical group.”17 In both studies, authors noted according to developmental literature, touching, holding and hugging play an important role in a child’s formation of body image.18,19
Studies on massage for chronic illnesses and emotional disturbance have shown a positive impact on anxiety level, depressed mood and biochemical imbalances, all of which are highly prevalent in cases of eating disorders.20,21 Putting these results to the test with eating disorders, researchers at Touch Research Institute (TRI) in Miami, Fla., designed projects to address the symptoms of these diseases. The first study focused on massage as an adjunct treatment in bulimia. The sample of 24 adolescent female bulimics assigned to the massage and control groups all received standard inpatient treatment during the study. Publishing their findings in 1998, the team reported the five-week, twice-weekly regimen of massage produced long-term results of lower cortisol (stress) levels, higher dopamine levels and lower depression scores. Short-term effects were measured on the first and last day of treatment, with the massage group showing lower anxiety and less depressed mood.The massage group also had improved scores on the EDI which may indicate an increased awareness of body (considered by some experts a critical factor “for resolving body dissonance”).22
The success of the bulimia study provided a foundation for testing the same adjunct treatment in cases of clinically diagnosed anorexia nervosa. Nineteen women were recruited from inpatient and outpatient treatment centers for the five-week study. The experimental group received Swedish massage administered in 30-minute, twice-weekly sessions. Measurements for analysis included the EDI, saliva cortisol samples, anxiety, mood and depression scales, and urine samples for dopamine, cortisol and catecholamine levels. As with the bulimia group, standard treatment was continuous for all patients throughout the study.23
Results of the anorexia study paralleled that of bulimia, with decreased anxiety, lower cortisol levels and improved mood being reported. While there was no weight gain in either group, improved EDI responses in the massage group suggested when combining massage with standard care “more appropriate eating behaviors might begin to emerge.”24
Dr. Sybil Hart, TRI researcher and psychologist, said in an interview from her office at Texas Tech University that it’s still unclear whether or not massage will facilitate weight gain. “Because of improvement,” she said, “we have reason to believe things like weight would also change if massage was administered longer or more intensely. Keep in mind these women were already in treatment. The control group was also getting care, but the individuals receiving psychiatric treatment and massage were doing better.”
The study team concluded massage, by attenuating anxiety and mood symptoms, negative body image and biochemical abnormalities of anorexia nervosa, “may be effective for healing mind and body issues” in this disorder.25 According to Hart, the massage group not only reacted with physical relief, but also seemed to be deeply moved emotionally.
“Right after treatment,” said Hart, “the patients were very relaxed, and very appreciative.” She noted this time period, when the patient is most receptive, could serve as an excellent opportunity for intervention, such as providing therapy or a meal.
“I’d be happy to see this (study) done more intensively and longer,” said Hart. “I believe if we did, we would get a positive outcome. What we tapped into was not merely our body as something we look at, but our body as something we live inside. We need to touch and be touched.”