Eating Disorders in Veterans: Prevalence, Comorbidity, Risk, and Health Care Use
Abstract
Eating disorders (EDs), including anorexia nervosa, bulimia nervosa, and binge eating disorder, are deadly conditions that can be difficult to detect and treat. Although many people think they are rare conditions, they affect 10%-13% of women in their lifetimes. EDs are typically not screened for or treated within the Department of Veterans Affairs (VA) healthcare system, possibly because many people believe that since Veterans are mostly male, they are not affected by these disorders. However, 25%-33% of ED cases occur in men. Veterans also may be more vulnerable to developing EDs, as they have high rates of other mental health conditions, such as post-traumatic stress disorder (PSTD), depression, anxiety, and substance use disorders, and report high rates of trauma, including military sexual trauma (MST) and combat trauma, which are associated with EDs. Rates of EDs are increasing in the military, and our previous studies have found that there are high rates in both male and female Veterans. People with EDs use healthcare services frequently, possibly because EDs can have medical consequences, such as dental and gastrointestinal problems. Despite this, in non-Veteran healthcare settings, EDs often go undetected. The ED would need to be quite severe for a provider to notice the symptoms or the patient would need to explicitly tell the provider about the issue. Many people with EDs may be reluctant to tell providers, possibly because they do not know there are effective treatments available or how or where to access treatment. They also may be ambivalent about getting treatment or have concerns about stigma around seeking treatment. Veterans with EDs are likely making extensive use of healthcare services, but the VA may not be detecting and treating EDs in Veterans. We do not know exactly how many Veterans are affected by EDs. This proposal addresses several Fiscal Year 2017 Peer Reviewed Medical Research Program Areas for Encouragement, including the prevalence of diagnosable EDs and other clinically significant disordered eating, associations between ED symptoms and military-unique behaviors and conditions (specifically, difficulty meeting military weight and fitness requirements, MST, and combat exposure) and treatment patterns of individuals with EDs. We will recruit a large cohort of post-9/11 Veterans who separated from Service within the past year, which will allow us to assess military-specific variables soon after their military Service. All participants will complete a mailed survey, and we will select participants who screen positive for EDs, and a sample of participants with no mental health conditions, for an interview. Interviews will be used to make diagnoses and assess risk and maintaining factors for EDs. We will investigate the proportion of male and female Veterans with EDs, and we will also examine how many Veterans with post-traumatic stress disorder (PTSD), depression, anxiety, and alcohol/substance use disorders also have EDs. For Veterans with more than one disorder, we will assess which came first. We also will ask Veterans with EDs about the healthcare services they used while in the Service and since separating and what services they would like in order to address eating and weight issues. We will investigate whether they perceive barriers to mental health treatment in general and ED treatment, specifically, such as not knowing where to find an appointment or feeling that their loved ones would not be supportive. We will investigate whether military variables (difficulty meeting military weight and fitness requirements, MST, and combat exposure) are related to the development of EDs. Finally, we will investigate whether two short ED measures are efficient at screening for EDs in male and female Veterans. Our findings have the potential to help many Veterans with EDs. Knowing how many Veterans have EDs will help policymakers decide how to fund research and treatment servi
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Oct 29, 2018
- Source ID
- W81XWH1810698
Entities
People
- Zafra Cooper
Organizations
- United States Army
- Yale University