Military accession and disordered eating among women: clinical and policy recommendations.

Abstract

Eating disorder prevalence has steadily increased in the U.S. population. Between 1996 and 2006, there was a significant increase in rates of both diagnosis and hospitalization for adolescents and young adults—primarily women—with eating disorders. Health care professionals in the military have long been aware that new active duty accessions are at risk for problems related to eating, including serious medical disorders such as anorexia nervosa and bulimia nervosa, and that eating disorders in the military are consistently higher than in the civilian population. This article summarizes the literature bearing on the prevalence, risk factors, and context-specific triggers for eating disordered behavior among female service members. We suggest that stressors specific to military accession—when coupled with existing risk factors related to age, gender, family, and life experience—often exacerbate disordered eating. In essence, military induction itself may create the conditions for situation-induced eating impairment. We are concerned that the military could be far more effective in screening for and responding to disordered eating among new military personnel. In this commentary, we endeavor to bring fresh attention to the problem of disordered eating among new service members and offer a way forward for health care professionals and policy-makers with responsibility for military accessions. We begin by reviewing the revised diagnostic categories for eating disorders in the Diagnostic and Statistical Manual of Mental Disorders (5th edition: DSM-V), and provide a selective review of literature relevant to eating disorder risk factors and eating disorder risk during the military accession and indoctrination process. We conclude with numerous recommendations for military health care providers and policy-makers. Although men certainly struggle with eating disorders—particularly men engaged in certain sports associated with cutting weight—this article focuses exclusively on women. The new DSM-V—the definitive source for prevalence rates of mental disorders—states that for both anorexia nervosa and bulimia nervosa, women are diagnosed far more frequently than men—at a 10:1 female to male ratio. Because persons with eating disorders are far more likely to suffer comorbid mood and anxiety disorders, personality psychopathology, and higher risk for suicidal behavior, it is essential that military providers be vigilant for eating disorder symptoms among women in the accession phase of military service.