Written by: Jessica Taylor, LPC
Site Director at The Renfrew Center of Radnor
Joining the military to serve the nation is a choice fraught with emotions for the person enlisting and their loved ones. For those who may have an eating disorder, the decision to serve in the military may complicate their eating disorder symptoms. As Veterans Day approaches, we pause to consider mental health issues, including eating disorders, affecting both our veterans and our active servicemembers.
Eating disorders can vary in name, presentation, and severity. Despite this variety, all eating disorders at their core are disorders of emotion. No matter someone’s specific diagnosis, these illnesses often share the function of communicating emotional distress or avoiding it through eating disorder symptoms.
Someone living with an eating disorder may feel that their disorder serves an important psychological purpose, such as coping with difficult emotions or gaining a greater sense of control, autonomy, or identity. Managing emotions through food and eating, however, can lead to psychological and medical complications that are uncomfortable at best and, at worst, can be life-threatening.
Servicemembers & Eating Disorders: How Many Are Struggling?
It can be very difficult to gather accurate data on the prevalence of eating disorders in military populations. The Department of Defense’s research shows two different conclusions. One result indicated that members of the military have a comparable rate of eating disorders as in the civilian population. Other survey-based research has suggested that the number of servicemembers who meet criteria for an eating disorder may actually be higher than we think. As many as 1/3 or more of the military population surveyed for research into this topic reported behaviors consistent with an eating disorder, but only 2% of those surveyed had been formally diagnosed with one.
How Does the Military Screen for Eating Disorders?
When someone enlists in the military, they complete a battery of physical and psychological tests to assess their abilities. The Department of Defense has initiated an assessment that screens for eating disorders during recruitment where previously no screener had existed. These screeners can be used to qualify or disqualify a recruit from service in combination with their other assessments. The assessment allows for military leadership to track and treat the eating disorder if enlistment is approved. If someone is struggling with an eating disorder during the recruitment process, it is helpful to carefully examine their intentions of joining the military. Is the desire to join the military aligned with their American identity or patriotism or is it fueled by a desire to change their body in a disordered way?
Active Duty Eating Disorders
While actively serving, readiness for combat is essential. Servicemembers focus on keeping their physical health at peak performance to improve the likelihood of survival in warfare. For those with an eating disorder, the idea of peak performance can be clouded by poor perception of body image, potential malnourishment, and eating disorder symptoms. Basic training, deployment, and aspects of military culture can involve significant messaging around physical strength, mental perseverance, and the value of overriding a stress response even in intensely stressful circumstances. Without robust screening and support for servicemembers with eating disorders, these messages can exacerbate eating disorder symptoms. While screenings for some mental health disorders, like post-traumatic stress disorder, are a part of the yearly Periodic Health Assessment for active servicemembers, an eating disorder assessment is not yet included.
The transition from active servicemember to veteran can prompt questions of purpose and identity, especially if the person newly designated as a veteran found great meaning in their military service. Eating disorders often arise or intensify in severity during periods of loss or transition. Even those who previously never had an eating disorder may find themselves trying to cope with significant life changes by focusing on their body and manipulating eating behaviors. Fortunately, veterans have access to mental health resources for their ongoing care.
Eating Disorder Treatment for Military Personnel & Veterans
The Department of Defense has partnered with Tricare Insurance and has contracts across the country to provide the interdisciplinary support needed to effectively treat an eating disorder. An interdisciplinary treatment team might include an individual therapist, a family therapist, a registered dietician, a psychiatrist, and a primary care physician.
There are various levels of care for an eating disorder, and the recommendation one receives depends on many factors, including the severity of the eating disorder symptoms. The levels of care include:
- Outpatient treatment (OP)
- Intensive outpatient programs (IOP)
- Partial hospitalization programs (PHP)
- Residential treatment (RES)
- Inpatient hospitalization (IP)
Treatment programs at higher levels of care can provide the structure, supervision and support that’s often needed to break the symptom cycle. Eating disorders rarely travel alone, and effective treatment should also target any co-occurring issues, such as anxiety, depression, PTSD, and/or substance abuse.
Military Stressors & Eating Disorder Symptoms
Before deciding to enlist, people struggling with an eating disorder or disordered eating should consider the large number of stressors they may encounter in the military that can impact them physically, psychologically, and behaviorally. These stressors include intense exercise and physical training, a culture of persevering through mental and physical pain, limited contact with and separation from supports, frequent tracking of weight and shape metrics, regulated food options and portion sizes, and psychological stress throughout training, deployments, combat, and even post-discharge.
When thinking of our veterans this year, we invite those struggling with an eating disorder to consider how their time in the military could impact their symptoms. We encourage anyone struggling to maintain a healthy relationship with food or their body to connect with a professional team to accurately assess the nature of these feelings.
Military service can be an honorable act of citizenship for many, but for those at risk of an eating disorder there is cause for careful reflection. If you or someone you know is at the crossroads of an eating disorder and military service, or if you want to know more about how military service can interact with eating disorder symptoms, please connect with a Renfrew professional today.
- Silas, S (2020) Department of Defense: Eating Disorders in the Military GAO-20-611R, Department of Defense: Eating Disorders in the Military
- Armed Forces Health Surveillance Branch, Diagnoses of Eating Disorders, Active Component Service Members, U.S. Armed Forces, 2013-2017, Medical Surveillance Monthly Report, (Silver Spring, MD: June 2018), p. 18.
- Bartlett BA, Mitchell KS. Eating disorders in military and veteran men and women: A systematic review. Int J Eat Disord. 2015 Dec;48(8):1057-69. doi: 10.1002/eat.22454. Epub 2015 Aug 27.PMID: 26310193 Review.
- Flatt RE, Norman E, Thornton LM, Fitzsimmons-Craft EE, Balantekin KN, Smolar L, Mysko C, Wilfley DE, Taylor CB, Bulik CM. Eating disorder behaviors and treatment seeking in self-identified military personnel and veterans: Results of the National Eating Disorders Association online screening. Eat Behav. 2021 Dec;43:101562. doi: 10.1016/j.eatbeh.2021.101562. Epub 2021 Sep 7.PMID: 34534875