The idea of including dance and movement in interventions for eating disorders may seem somewhat controversial; generally, exercise and physical activity are discouraged for individuals recovering from eating disorders. Including dance in therapeutic interventions might raise a few eyebrows given the links between appearance-oriented athletic endeavors such as ballet and gymnastics and the development of eating disorders.
However, some therapists and scholars interested in alternative therapies for eating disorders have suggested that certain forms of movement therapy may help individuals with eating disorders connect to their bodies in a different, more positive way.
In 2011, two such scholars from Portugal, Padrão & Coimbra, published a 6-month pilot intervention for individuals hospitalized for anorexia nervosa (AN) based around body movement.
Their aims were twofold:
- Find out more about the links between body movement and bodily experience in individuals with AN
- Observe the ways in which individuals with AN move and prefer to move.
Data consisted of observations of free movement and conversations that came up during and after the sessions. Their sample size consisted of only 7 young women hospitalized for anorexia.
I’ll admit that despite years of dance training and a keen interest in the potential of dance therapy in mental health treatment, I was skeptical of this study from the start. I thought a fair bit about the ethical implications of such a study: I’ve always been of the mindset that particularly for individuals whose disorders included a seriously disordered relationship with exercise, putting the brakes on all movement just seems intuitive.
The authors note that all patients involved in the study were medically cleared for light exercise and were monitored by doctors throughout the intervention. Sessions lasted for 75 minutes at a time, once per week.
Though it seems that the authors thought through the potential problems with engaging individuals hospitalized for AN in a movement-based intervention, I would have liked to see a deeper exploration of the potential psychological consequences of engaging in 75-minute-long movement sessions for those in early treatment/recovery. Still, the study presumably passed ethics, and so maybe there is more to the picture than is described in this particular article.
The researchers’ curiosity was driven by prior research indicating that individuals with AN may be less aware of and less able to express their emotions (sometimes called alexithymia, see Sifneos, 1973). They also discuss the relationship between anorexia and the need for control (Bruch, 1962 (full paper), 1973) and how this may play into the ways in which individuals with AN experience their bodies.The linkages between anorexia and low sexual interest were also of interest to researchers (see, for example, Morgan et al., 1995).
Bringing the discussion to the level of dance therapy, the authors explain where dance therapy may be effective in healing the relationships AN patients have with their bodies: developing comfort with touch (of self and from others), trust, safety, empathy, and loss of control. For example, dance therapists would challenge patients to explore, through movement, what it feels like to lose control.
They use Laban’s (1971) system of movements (a common, well-established approach in dance and movement therapy) to guide interventions that are intended to bridge the gap between body image and body sensation, which they suggest might be inhibited in anorexia.
Despite my hesitations about the study design and potential pitfalls, I was curious to find out about the results.
SUMMARY OF MAIN FINDINGS
So what did they find?
At the beginning of the study, they noted the following characteristics in their sample’s movements:
- Feeling uncomfortable with being touched
- Rigidity and restricted movement
- “Obsession” with lightness and lacking sense of the force of the body’s weight
- Initiation of movement from the ends of limbs
- Distorted sense of time
- Use of different parts of the body in isolation, rather than as a unified whole
- Shallow breathing
- Alternating desire and avoidance of “sensual movements”
- Dislike of movement/music bringing participants close to the ground
In terms of the way that participants made links between experiences and movement, researchers found the following:
- Participants described sensual movements as “looking good” on others, but being not ready or willing to use these movements themselves
- Participants brought up themes of childhood happiness was brought up and associated these with loss/the inability to return to a happier time
- Participants often used words denoting lightness (ex. “float,” “fly”)
- Participants described themselves/their identities as tied to their eating disorders
As the intervention progressed, the researchers noted changes in the ways the participants moved, as well as the ways that they discussed their bodies in relation to their movements. The authors make the claim that these findings help to support theories that link AN to difficulties identifying and responding to bodily sensations, situating control at the center of the disorder. While this may be true, I had difficulty linking these conclusions to the observations they describe.
The claim they make about observations of bodily movement in individuals with AN seem more plausible; their findings relating to rigidity, isolated movement of body parts, monotonous movements, and shallow breathing seem to relate to several other studies of movement profiles in individuals with anorexia. There also seem to be echoes in their findings relating to earlier research on difficulties of sensuality in eating disorder patients.
While the findings relating to the ways in which individuals with anorexia move are certainly interesting, it seems premature to make a claim for the effectiveness of dance therapy for these patients. I’d like to see more studies with larger groups of patients, including those diagnosed with other eating disorders. Further, in order to draw conclusions about what these movements mean, I think that more attention needs to be paid to how patients describe their experiences with dance therapy.
Going back to my initial concerns, I’m also curious about whether using movement in therapy brought up any urges for exercise.
Still, this study raises the possibility of therapies that go beyond the traditional, which is encouraging for those interested in alternative therapies and those who feel that traditional forms of therapy have been unhelpful. I’d certainly be interested to learn more.
Padrão, M., & Coimbra, J. (2011). The Anorectic Dance: Towards a New Understanding of Inner-Experience Through Psychotherapeutic Movement American Journal of Dance Therapy, 33 (2), 131-147 DOI: 10.1007/s10465-011-9113-7