Eating Disorders in the Military

Review by Millie Plotkin

Williams, V. F., Stahlman, S., & Taubman, S. B. (2018). Diagnoses of eating disorders, active component service members, U.S. Armed Forces, 2013-2017. MSMR: Medical Surveillance Monthly Report, 25(6), 18-25.

In this report on the years 2013-2017, 1788 active service members were diagnosed with current first-time eating disorders, for a crude overall incident rate of 2.7 per 10,000 person-years. These numbers were obtained both through hospitalization and outpatient records. Nearly half (46.6%) were diagnosed as “other/unspecified eating disorder”, followed closely by 41.8% with bulimia nervosa. Only 11.9% were diagnosed with anorexia nervosa. It is important to note that this survey only included new diagnoses during these years, not people who previously been identified. The article explains that a change from ICD-9 to ICD-10 allows for Binge Eating Disorder as a separate diagnosis, therefore future surveys will capture those members diagnosed with BED.

As in the civilian population, women accounted for the majority of those with an eating disorder diagnosis: 67.5%. Incidence rates were highest among younger service members, those age 29 or below. Among women, rates were highest among non-Hispanic whites, however in men, Hispanic and other/unknown races showed higher rates. In women, Marine Corps members had the highest rate of any branch, and in men Army was the highest, but only slightly more than Marines.

Why is this important?

Members of the U.S. military experience many risks for eating disorders, including strict weight and fitness standards. They may turn to disordered behaviors such as restrictive eating, vomiting, and laxatives in order to meet these weight requirements. In addition, there are high rates of post-traumatic stress disorder. Previous studies have shown that military sexual trauma among female service members may be a higher contributor to PTSD and eating disorders than combat trauma. However, the stigma against people with mental illness and fear of discharge from military service leads to underreporting, and therefore the numbers in this study probably do not show the true extent of eating disorder prevalence.

Service members and their families often have difficultly accessing treatment for eating disorders. Although Tricare, the health care benefits service of the U.S. Armed Forces, eliminated annual treatment limits at the end of 2016, they do not cover free-standing treatment centers. This often prevents those in need from taking advantage of the full range of levels of care. Mental health advocates must continue working to improve access as well as prevention efforts for the armed forces.