Eating disorders in the military population

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Eating disorders affect the military population, due in part to the environment. Combat trauma, sexual assault, and an emphasis on body weight and size create a perfect storm for people in the military to develop an eating disorder. In addition, many of these individuals may face barriers to receiving the treatment they need, due to stigma surrounding talking about mental health and eating disorders in the military.

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What is the prevalence of eating disorders in the military?

Exact rates of eating disorders in the military are unknown, due to stigma, eating disorders being undiagnosed or underdiagnosed, and underreporting. However, research from one study has revealed the following prevalence rates for various eating disorders in the military, as well as those at risk: (1)

  • Between 20% and 29.6% of female cadets were at risk for eating disorders
  • Nearly 34% of active-duty women scored in the at-risk range for eating disorders
  • Between 2% and 7% of male cadets were at risk of developing an eating disorder
  • Nearly 2% of active duty women had anorexia nervosa and nearly 10% had bulimia nervosa
  • Approximately 2.5% of active duty men had anorexia and nearly 7% had bulimia
  • Over 5% of women had an eating disorder predeployment and an additional 3.3% developed an eating disorder within 1-5 years
  • About 4% of men had an eating disorder predeployment and an extra 2.6% developed an eating disorder within 1-5 years

In addition to finding a high prevalence of full-blown eating disorders in the military, studies have found rates of eating disorder symptoms and behaviors in the military, including: (1)

  • About 3% of active duty females and up to 5.2% of female cadets engaged in self-induced vomiting
  • Between 4% and 9.7% of female military personnel used laxatives
  • Up to 18% of female cadets and active-duty women used diet pills
  • Nearly 4% of active duty men engaged in self-induced vomiting and diet pill use, while 3.4% used laxatives
  • Over 19% of female military personnel engaged in binge eating episodes
  • About 25% of male military members engaged in binge eating

Though eating disorder development is complex and involves a variety of biological, psychological, and sociological risk factors, there are some unique risk factors about military life that may increase the likelihood of someone developing an eating disorder.

Unique factors of military life that increase the risk of eating disorder development

Military life can be extremely grueling and physically and mentally challenging, with a strong emphasis on body weight and size.

For example, the Army lists height and weight requirements, dictating how much a soldier should weigh depending on their age, height, and sex. If they don’t meet these requirements, then they are subjected to a tape measure test, in which various body parts are measured to determine their body fat percentage (though we know this is both an inaccurate measure of health and harmful practice). 

These body measurements and requirements exemplify the military’s harmful ideas about body weight and size, such as weight being an indicator of health and fitness and body fat indicating a lack of discipline. The military also tends to want their personnel to present a “fit” and “lean” appearance.

This pressure to make weight and obtain a specific body type can lead to profound body dissatisfaction and vigilance related to weight.

Additionally, eating disorder symptoms may escalate during certain periods in the military, such as during fitness testing. Research has indicated that three times as many male sailors engaged in laxative use and self-induced vomiting leading up to fitness testing compared to non-fitness testing periods. (1) Another study supports this assertion—18% of male and female service members who completed the survey reported using diet pills, diuretics, and laxatives, while 5% reported self-induced vomiting as a means to lose weight before a fitness test. (1)

Additionally, sexual assault is extremely prevalent in the U.S. military, with over 20,000 active service members experiencing sexual assault in 2018. (2) And experiencing sexual trauma is a risk factor for eating disorder. One study found that women who’d experienced sexual abuse or sexual assault were more likely to experience mental health complications, such as posttraumatic stress disorder (PTSD) and eating disorders, such as bulimia. (3)

PTSD and eating disorders

People in the military are often exposed to traumatic events, such as combat and sexual assault, which can increase the risk of developing posttraumatic stress disorder (PTSD). And PTSD is a known risk factor for eating disorder development, with more severe PTSD symptoms associated with more severe eating disorder symptoms. In fact, one study found that between 9% and 24% of individuals with eating disorders have co-occurring PTSD, while another found rates as high as 52%. (4,5)

The exact connection between PTSD and eating disorders is not yet understood. But researchers do know that trauma can negatively affect a person’s nervous system functioning, which can lead to emotional regulation problems. When a person can’t effectively regulate their emotions, they may find other ways of coping with unwanted feelings, memories, or thoughts related to trauma. One common way of coping is engaging in disordered eating behaviors, which can help a person feel as if they are in control. 

Additionally, eating disorders and PTSD may share similar genetic factors that can increase the chance of developing both of these mental health disorders.

Treatment for Eating Disorders in Military Personnel

Military personnel with eating disorders require specialized care, especially if the individual has co-occurring PTSD or other mental health disorders. Treatment may help patients understand the ways in which military life has affected their mental health and eating disorder development, including their body dissatisfaction, body image, and their self-worth being tied to making weight, passing tape tests, or excelling at fitness tests. 

While every treatment program and treatment plan is different and will depend on the patient’s unique needs and challenges, there are some specific therapies that are commonly used to treat PTSD and eating disorders, such as:

  • Prolonged exposure therapy: Helps patients to gradually approach memories, situations, and emotions related to their trauma, which teaches them they don’t need to avoid these memories or cues in the future
  • Cognitive processing therapy: Teaches patients how to change unhelpful beliefs related to their traumatic experience, which can help mitigate the long-lasting effects of trauma
  • Eye movement desensitization and reprocessing: Relieves stress and distress related to traumatic memories
  • Cognitive behavioral therapy: Helps the patient to understand the connection between behaviors, emotions, and thoughts to help change their behaviors related to disordered eating
  • Interpersonal psychotherapy: Teaches patients to understand their eating disorder as it relates to relationships, as well as addresses interpersonal difficulties, like social withdrawal
  • Acceptance and commitment therapy: Encourages patients to assert their values, create goals related to those values, accept both negative and positive emotions, and commit to engaging in positive change 

Treatment can occur in several settings, including inpatient, outpatient, partial hospitalization, and virtual care. Inpatient care is the most intensive and involves round-the-clock treatment and care, which can often be helpful in early recovery, since patients are less likely to encounter triggers or stressors. However, other options, including virtual eating disorder treatment, can be beneficial as well, especially if a patient is unable to commit to inpatient due to obligations or travel. 

At Within Health, we provide highly specialized comprehensive and integrated care, including nutritional counseling, individual, group, and family therapy, support groups, medical care, and even follow-up support through our alumni network. 

If you suspect you or someone you love may have an eating disorder, it’s important to seek help from healthcare professionals who specialize in eating disorders as soon as possible. Eating disorders do not go away on their own without treatment and are often easier to treat the earlier they are detected.

Disclaimer about "overeating": Within Health hesitatingly uses the word "overeating" because it is the term currently associated with this condition in society, however, we believe it inherently overlooks the various psychological aspects of this condition which are often interconnected with internalized diet culture, and a restrictive mindset about food. For the remainder of this piece, we will therefore be putting "overeating" in quotations to recognize that the diagnosis itself pathologizes behavior that is potentially hardwired and adaptive to a restrictive mindset.

Resources

  1. Bodell, L., Forney, K. J., Keel, P., Gutierrez, P., & Joiner, T. E. (2014). Consequences of Making Weight: A Review of Eating Disorder Symptoms and Diagnoses in the United States Military. Clinical psychology : a publication of the Division of Clinical Psychology of the American Psychological Association, 21(4), 398–409. https://doi.org/10.1111/cpsp.12082
  2. Military sexual assault fact sheet: Protect our defenders. Protect Our Defenders |. (2022, October 26). Retrieved November 18, 2022, from https://www.protectourdefenders.com/factsheet/ 
  3. Brewerton T. D. (2007). Eating disorders, trauma, and comorbidity: focus on PTSD. Eating disorders, 15(4), 285–304. https://doi.org/10.1080/10640260701454311
  4. Parnassia Psychiatric Institute (n.d.). Eating disorders and posttraumatic stress disorder: Current opinion in psychiatry. LWW. Retrieved November 18, 2022, from https://journals.lww.com/co-psychiatry/Abstract/2019/11000/Eating_disorders_and_posttraumatic_stress_disorder.8.aspx
  5. Reyes-Rodríguez, M. L., Von Holle, A., Ulman, T. F., Thornton, L. M., Klump, K. L., Brandt, H., Crawford, S., Fichter, M. M., Halmi, K. A., Huber, T., Johnson, C., Jones, I., Kaplan, A. S., Mitchell, J. E., Strober, M., Treasure, J., Woodside, D. B., Berrettini, W. H., Kaye, W. H., & Bulik, C. M. (2011). Posttraumatic stress disorder in anorexia nervosa. Psychosomatic medicine, 73(6), 491–497. https://doi.org/10.1097/PSY.0b013e31822232bb

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