Eating disorders and associated mental health comorbidities in female veterans
Introduction
The issue of eating disorders (EDs) in veterans has recently received increasing attention due to several factors. First, a large proportion of service members in the current conflicts in Iraq and Afghanistan is younger than veterans from previous conflicts and may be more susceptible to EDs (Curry et al., 2014). Second, given the high rate of overweight and obesity among veterans (Vieweg et al., 2007), ED behaviors may persist or develop following discharge from service as veterans attempt to lose or control their weight. Third, approximately 75% of individuals with anorexia nervosa (AN) and bulimia nervosa (BN) are female (Hudson et al., 2007), and the number of female service members has increased markedly during the current conflicts. Fourth, exposure to potentially traumatic experiences may put male and female service members and veterans at increased risk for EDs (Forman-Hoffman et al., 2012, Mitchell et al., 2012), as disordered eating behaviors may be used to cope with negative affect (Heatherton and Baumeister, 1991).
In a sample of female veterans seeking outpatient treatment for trauma-related mental health conditions, 12.9% reported binge eating, 3.9% reported purging, and 8.2% reported extreme caloric restriction as a method of weight regulation (Rowe et al., 2009). In addition, a recent study found that 78.2% of a sample of male and female veterans seeking weight loss treatment reported clinically significant binge eating (Higgins et al., 2013). Two recent studies examined EDs in more general VA samples. One investigation of 1004 female veterans found that 4.7% had been diagnosed with an ED, and an additional 11.5% reported that they had ED symptoms (Forman-Hoffman et al., 2012). A second study administered the Structured Clinical Interview for the DSM-IV and found that 4.6% of female veterans (n=346) and 0.7% of male veterans (n=1354) of the current Iraq and Afghanistan conflicts had a lifetime history of any ED (Curry et al., 2014). Thus, EDs affect a considerable number of female veterans. Nevertheless, EDs remain understudied in this population. Further, VA has no national screening or treatment programs for EDs, underscoring the potential need for additional treatment implementation research.
The current investigation therefore sought to describe rates of EDs and their correlates in a sample of female veteran primary care patients. This sample represents a broader population of female veterans than those directly seeking inpatient or outpatient mental health care; in addition, primary care settings represent an important point for VA care entry generally, and provide opportunities for both early detection and coordinated medical and behavioral treatment of EDs that may present but remain undertreated in the context of more apparent trauma-related disorders such as PTSD or depression. We hypothesized that rates of ED diagnoses would be similar to those in the general population and that rates of psychiatric disorders would be greater among women with EDs than those without EDs.
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Participants
Data from the VA electronic medical record system were obtained from 492 female patients identified as having received services in the VA Boston Healthcare System primary care clinic between December 2007 and December 2009.
Procedures
The investigation was carried out in accordance with the latest version of the Declaration of Helsinki. Chart review procedures approved by the Institutional Review Board at VA Boston were used to obtain data for the following study variables.
Measures
Study variables included current
Results
The participants׳ mean age was 52.12 (S.D.=17.12). On an average, the participants were overweight (MBMI=29.22, S.D.=6.98; Range: 14.48–67.00). Approximately half (54.5%) were Caucasian, 18.7% were African–American, 1.4% were Hispanic/Latina, 1.8% were Asian, 1.0% were Native American/Pacific Islander, and 22.5% were unknown. Of the 492 participants, 2.8% had an ED diagnosis. The majority were diagnosed with eating disorder not otherwise specified, two had AN, and one had BN. Twenty-three
Discussion
In the current study, 2.8% of female veteran participants had a current ED diagnosis, supporting previous findings that EDs are at least as common among veterans as the general population (Forman-Hoffman et al., 2012). Of note, this may be an underestimate, given previous findings that EDs are unlikely to be diagnosed in hospital and clinic settings. Specifically, a previous study found that only half of BN cases had been detected in a primary care practice (Whitehouse et al., 1992). Patients
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Psychiatric Issues in Women Veterans
2023, Psychiatric Clinics of North AmericaRates and correlates of disordered eating among women veterans in primary care
2018, Eating BehaviorsCitation Excerpt :However, only one study to date (Mitchell et al., 2014) has specifically examined rates of eating disorder diagnoses among veterans who use primary care, suggesting a need for further study. The majority of research to date has explored rates of eating disorders via electronic medical record review (EMR; Maguen, Cohen, Cohen, et al., 2012; Maguen, Cohen, Ren, et al., 2012; Mitchell et al., 2014). While EMR-based studies are helpful in exploring national base rates, this methodology may underestimate the number of individuals with disordered eating, given the lack of national guidelines within the Veterans Healthcare Administration (VHA) to identify individuals with eating disorders.
Intimate partner violence and disordered eating among male and female veterans
2018, Psychiatry ResearchCitation Excerpt :Further, anorexia nervosa is associated with the highest mortality rate of any psychiatric disorder (Sullivan, 1995), underscoring the need to investigate these deadly conditions among veterans. Prevalence estimates of eating disorders among veterans based on hospital records and in-person interview assessments vary widely and range from 0.0007% and 4.8% for women, and < 0.001% and 3.7% for men (Litwack et al., 2014; Maguen et al., 2010, 2012; Mitchell et al., 2014; Striegel-Moore et al., 1999). It is important to note that the lower rates are based on hospital records which likely underestimate eating disorders (Whitehouse et al., 1992).
Military experience can influence Women's eating habits
2017, AppetiteCitation Excerpt :Finally, women reported that poor eating habits continued after military service, often because they remained under stress. Many of the experiences described by participants align with and add nuance to findings from past quantitative work demonstrating relationships between eating disorders and military sexual trauma or pressure to meet weight requirements (e.g., Bodell et al., 2014; Forman-Hoffman et al., 2012; Maguen et al., 2012; Mitchell, Porter, Boyko, & Field, 2016; Mitchell et al., 2014). Women in the present study also described significant distress due to weight- and eating-related judgements from peers and superiors.