Eating disorders and disordered eating in servicemen and women: A narrative review

Abstract

Objective Eating disorders (EDs) are mental illnesses impacting all aspects of an individual's life. Recent research has examined EDs and disordered‐eating behaviors in the military, a population subject to body composition standards, fitness requirements, and extreme stress. The purpose of this narrative review was to investigate ED and disordered‐eating prevalence and their risk factors in ROTC (reserve officers’ training corps), active‐duty, and veteran servicemembers. The secondary purpose was to provide policy recommendations to reduce the burden of these conditions in the military. Methods PubMed and PsycINFO were reviewed for relevant articles. All studies including data on EDs or disordered eating in U.S. active‐duty, ROTC, or veteran populations were considered. Results Results revealed a high burden of EDs and disordered eating with bulimic‐ and binge‐type behaviors being the most common. Servicemembers exposed to trauma, including military sexual assault, and those with comorbidities like PTSD showed a higher prevalence. Body composition and fitness testing were also associated with a higher risk. Qualitative studies suggest these conditions serve as coping mechanisms for aspects of military life. Conclusions The high prevalence of EDs and disordered eating in the military points toward the importance of identification, treatment, and prevention. Policy change is necessary to protect servicemembers.

Eating Disorder Risk and Common Mental Disorders in British Servicewomen: A Cross-Sectional Observational Study

“…Alternatively, older women could be a healthy survivor cohort, and younger women with common mental disorders may be more likely to leave the military. A specific body composition is not a prerequisite to successful military performance, but body mass standards and the effects of heavier body mass on military job performance may increase disordered eating behaviors and dieting behaviors in those with heavier body mass (9,11,13).…”

“…Therefore, our data could be explained by the observation that older age was also associated with a lower risk, and heavier body mass was associated with a higher risk, of symptoms of anxiety, depression, and/or stress. Older age has previously been associated with a lower risk of eating disorders in US servicewomen and servicewomen (9,11) and a lower risk of common mental disorders in the UK general population (50,51) and UK military population (27,29), and heavier body mass has previously been associated with a higher risk of eating disorders in US servicemen, servicewomen, and female veterans (10,11). Older women may be at lower risk of common mental disorders because of being in senior ranks and completing fewer physically demanding military activities; however, these factors were controlled for in our analyses.…”

“…Higher ranks were associated with a lower risk of symptoms of anxiety, depression, and stress, and higher perceived resilience, in agreement with previous studies of common mental disorders in UK servicemen and servicewomen (27–29). Enforced feeding behaviors in military environments such as military training and deployments (11,13) and exposure to combat (9) may contribute to disordered eating behaviors, but number of deployments, length of service, being a regular or reserve, or job role was not associated with risk of eating disorders. Similarly, these factors were not related to other common mental disorders in agreement with previous studies exploring regular or reserve status (27), employment in a combat role (29,30), and deployment history (28,29) in men and women.…”

“…Common mental disorders were assessed using the 7-item Generalized Anxiety Disorder Assessment (GAD-7) (38), the 9-item Patient Health Questionnaire (PHQ-9) (39), the Perceived Stress Scale (40), and 10-item Connor-Davidson Resilience Scale (CD-RISC-10) (41). Anxiety and depression were scored according to severity using the respective GAD-7 (minimal (0-4), mild (5-9), moderate (10)(11)(12)(13)(14), severe (15)(16)(17)(18)(19)(20)(21)) and PHQ-9 scores (minimal (0-4), mild (5-9), moderate (10)(11)(12)(13)(14), moderately severe (15)(16)(17)(18)(19), severe (20)(21)(22)(23)(24)(25)(26)(27)). A participant was defined as having symptoms of anxiety if they scored ≥10 on the GAD-7 (38) and depression if they scored ≥10 on the PHQ-9 (39).…”

The food security and the eating behavior of the civilian population during the military conflict in Ukraine: a preliminary research

“…Studies conducted among military personnel show that experiencing war is one of the most stressful events in their lives and is associated with the subsequent occurrence of increased anxiety, depression and post-traumatic stress disorder (Fel et al, 2022;Fiedler et al, 2006). In numerous studies (Falvey et al, 2021;Gaviria and Ammerman, 2022;McNulty, 1997aMcNulty, , 1997b, the occurrence of eating disorders in military personnel is noted, namely, anorexia nervosa, bulimia nervosa and another category of eating disorders known as not otherwise specified. Female military personnel who served in combat were 1.8 times more likely to report eating disorders (McNulty, 1997b).…”