Bulimic Adolescents Benefit from Massage Therapy
Field, Tiffany, Schanberg, Saul, Kuhn, Cynthia, Field, Tory, Fierro, Karen, Henteleff, Tanja, Mueller, Cynthia, Yando, Regina, Shaw, Seana, Burman, Iris, Adolescence
Twenty-four female adolescent bulimic inpatients were randomly assigned to a massage therapy or a standard treatment (control) group. Results indicated that the massaged patients showed immediate reductions (both self-report and behavior observation) in anxiety and depression. In addition, by the last day of the therapy, they had lower depression scores, lower cortisol (stress) levels, higher dopamine levels, and showed improvement on several other psychological and behavioral measures. These findings suggest that massage therapy is effective as an adjunct treatment for bulimia.
Bulimia nervosa was originally thought to be a derivative of anorexia, but it is now recognized as a disorder of its own. A diagnosis of bulimia requires the following symptoms: (1) recurrent episodes of binge eating; (2) a feeling of lack of control over eating behavior during the binges; (3) regularly engaging in self-induced vomiting, use of laxatives or diuretics, strict dieting or fasting, or vigorous exercise in order to prevent weight gain; (4) an average of two or more binge-eating episodes a week for at least three months; and (5) persistent over-concern with body shape/weight (American Psychiatric Association, 1987).
The exact etiology of bulimia nervosa has not yet been determined, but the behaviors and symptoms presented by the majority of patients suggest a combination of psychological, social, and physiological factors. Depressed affect is so commonly seen that some believe bulimia is simply a type of affective disorder. According to Edelstein, Haskew, and Kramer (1989), 20-30% of patients with bulimia meet the diagnostic criteria for depression. Bulimic patients who vomit show lower urinary serotonin (Kaye, Ebert, & Gwirtsman, 1984), and elevated plasma norepinephrine (Robinson, Checkley, & Russell, 1985; Smythe, Bradshaw, & Vining, 1983).
Some have suggested that bulimics are difficult to medicate because they do not keep the medication in their systems long enough to absorb it. Nevertheless, significant decreases in bulimic and depressive symptoms have been demonstrated for tricyclic antidepressants, serotonergic agents, and MAO inhibitors. Investigators have found that some bulimic patients who are not depressed respond to antidepressant medication, and some who do suffer from depression may binge less while remaining depressed (Brotman, Herzog, & Woods, 1984; Walsh, Stewart, Roose, Gladis, & Glassman, 1984). Some of the relief experienced by bulimic patients may be due to lowered anxiety and suppressed appetite caused by tricyclic antidepressants rather than to the activity of the antidepressant itself (Pope & Hudson, 1986).
These treatment approaches, however, have not been sufficient on their own. To be successful, treatment must alleviate depressive symptoms and alter any neuroendocrinological abnormalities. Massage therapy has proven effective in these areas, namely reducing depression and cortisol (Field, Morrow, Valdeon, Larson, Kuhn, & Schanberg, 1992). For example, massage has been found to lower both self-reported and observed anxiety and depression as well as salivary cortisol levels in a sample of depressed adolescents (Field et al., 1992).
Given these positive findings, it was hypothesized that massage therapy would similarly be effective in decreasing depression, anxiety, and cortisol levels with a sample of eating-disorder patients. In addition, massage therapy was expected to reduce several other psychological and behavioral traits common in these patients.
Psychotherapy and pharmacotherapy have been somewhat effective, although the majority of patients have continuing eating problems (Garfinkel, Moldofsky, & Garner, 1977; Hsu, 1986). The present study sought to determine whether massage therapy is an effective adjunct.
The subjects were 24 adolescent female bulimic inpatients at a residential treatment center. …