High Risk For Suicidal Behavior Research Articles

P.1.a.024 - Association of maternal emotional abuse with decreased serotonin transporter gene (SLC6A4) methylation

People with a mental disorder have a higher risk of suicidal behavior. Little research has examined the role of childhood trauma in suicide behavior, and even fewer studies have assessed the specific relevance of subtypes of childhood trauma and suicidal behavior in first-episode psychosis (FEP). The aims of the present study were: 1) to compare suicide behavior between FEP and HC; 2) to study the relationship between the five types of ChT and suicide risk in FEP controlling for confounding sociodemographic, clinical, and psychosocial variables. 95 patients diagnosed with FEP and 92 healthy control (HC) were recruited as a part of the PROFEP study. ChT was evaluated using The Childhood Trauma Questionnaire-Short Form (CTQ) and suicide behavior through The Suicide Risk Scale of Plutchik (SRSP). Our results showed that patients with FEP presented more suicide behavior (ideation, attempt, and suicide risk) than HC. Emotional abuse was the most relevant type of ChT in suicide ideation and suicide risk. After controlling for other relevant variables, perceived stress seemed to play an important role in suicide ideations, suicide attempt, and suicide risk. The results highlight the importance of assessing and considering in the clinical practice ChT and the perceived stress.

Quinolone antibiotic use increases risk of suicidal behavior

An analysis of the World Health Organization's (WHO's) adverse drug reactions database has found a significantly higher risk of suicidal behavior associated with use of quinolone antibiotics compared with other antibiotics. The frequently prescribed drug ciprofloxacin was most strongly associated with suicidal behavior among the quinolone class.

Pronounced prefronto-temporal cortical thinning in schizophrenia: Neuroanatomical correlate of suicidal behavior?

Schizophrenia is characterized by increased mortality for which suicidality is the decisive factor. An analysis of cortical thickness and folding to further elucidate neuroanatomical correlates of suicidality in schizophrenia has not yet been performed. We searched for relevant brain regions with such differences between patients with suicide-attempts, patients without any suicidal thoughts and healthy controls.37 schizophrenia patients (14 suicide-attempters and 23 non-suicidal) and 50 age- and gender-matched healthy controls were included. Suicidality was documented through clinical interview and chart review. All participants underwent T1-weighted MRI scans. Whole brain node-by-node cortical thickness and folding were estimated (FreeSurfer Software) and compared. Additionally a three group comparison for prefrontal regions-of-interest was performed in SPSS using a multifactorial GLM.Compared with the healthy controls patients showed a typical pattern of cortical thinning in prefronto-temporal regions and altered cortical folding in the right medial temporal cortex. Patients with suicidal behavior compared with non-suicidal patients demonstrated pronounced (p<0.05) cortical thinning in the right DLPFC and the superior temporal cortex. Comparing cortical thickness in suicidal patients with non-suicidal patients significant (p<0.05) cortical thinning was additionally found in the right superior and middle temporal, temporopolar and insular cortex.Our findings extend the evidence for neuroanatomical underpinnings of suicidal behaviour in schizophrenia. We identified cortical thinning in a network strongly involved in regulation of impulsivity, emotions and planning of behaviour in suicide attempters, which might lead to neuronal dysregulation in this network and consequently to a higher risk of suicidal behavior.

Substance Abuse Related Predictors in Soldiers’ Suicidal Attempt

Background: Military populations are at high risk for suicidal behavior. There are several well-known predictors for suicide and a few studies have evaluated the effect of substance abuse patterns on suicide in military environments. Objectives: This study was designed to determine substance abuse related factors that predict suicidal attempts in soldiers by concerning confounding factors. The importance of determining these risk factors is that they allow us to identify high-risk people, who should receive intensive monitoring and attempts should be made to reduce modifiable predictors. Patients and Methods: Through a cross sectional research, 3960 soldiers were selected by cluster sampling from army service garrisons in 12 regions of Iran during 2010. Data were gathered by demographic and military environment information, Texas Christian University (TCU) drug screen II and the Addiction Severity Index (ASI). The dependent variable was suicidal attempt during the military service course and the independent variables were demographic (age, education, job prior to service course and life situation), substance abuse related (the age at first substance abuse experience, alcohol abuse, tobacco abuse, ecstasy abuse, analgesics abuse, opium abuse, marijuana abuse, multi drug abuse and history of drug intoxication (subgroup analysis)), psychosocial (history of anxiety disorder, depression, obsessive compulsive disorder, personality disorder, child abuse, HIV risk behavior, physical fight) and military service-related factors (service place satisfaction, bad relationship with commanders, always having feelings of loneliness, combat situation, distance from home). Information was decoded in the SPSS 21 software and a backward logistic regression analysis was performed. Results: The majority of soldiers with mean age of 21.8 (SD = 2.4) years were single (82.1%), employed (54.5%) and had a low level of education or were illiterate (71.1%). In total, 296 (7.5%) soldiers had suicidal attempts in their military service course. Predictors of suicidal attempt were education level of under diploma, age of under 18, being abused during childhood, having a history of human immunodeficiency virus (HIV) high risk behavior, anxiety disorder, depression disorder and service place dissatisfaction. By controlling known confounders, substance abuse-related predictors of suicidal attempt were first experience of substance abuse before the age of 15 (OR = 1.48, P = 0.023), abusing opium (OR = 3.92, P = 0.000), alcohol (OR = 1.39, P = 0.023) and multi substance abuse (OR = 1.37, P = 0.029). Conclusions: By intensive monitoring of the situation of substance abuse among soldiers, commanders can reduce modifiable predictors of suicidal attempt.

Depression and epilepsy: comorbidities, pathogenesis, principles of therapy

Numerous trials of last years confirm the bilateral link between depression and epilepsy with mutual complication of both diseases. Depression increases the risk of the first unprovoked paroxysm, worsens the compliance of epileptic patients, leads to decrease of the response both to therapeutic and surgical treatment and to increase of side effects of antiepileptic drugs. Depression is associated with high risk of suicidal behavior and reduces the quality of life level. Depression in epileptic patients is characterized by atypical clinical course in most cases what makes its diagnostics difficult and becomes the reason of the absence of the necessary pharmacologic and psychotherapeutic treatment. All of the above creates significant economical burden for the community because the epileptic patient with comorbid depression visits the physicians 2-4 times more often.

Unpacking Sleep and Suicide in Older Adults in a Combined Online Sample.

Duration of insomnia symptoms and nightmares are related to suicidal risk in young adults independent of current symptoms of insomnia, nightmares, anxiety, depression, and PTSD. However, this relation has yet to be examined among older adults, despite older adults being at higher risk of suicidal behavior. Further, the current study aims to replicate previous research among younger adults showing that insomnia symptoms and nightmares are associated with suicide risk independent of the interpersonal psychological theory of suicide (IPTS). The present study utilized 167 participants age 55 and older obtained by combining two independent mTurk data collections of adults in the United States. In the current sample, duration of nightmares was associated with suicide risk in older adults independent of symptoms of current insomnia and nightmares, duration of insomnia, and symptoms of PTSD, anhedonia, and the IPTS. Our findings suggest that the duration of nightmares (i.e., how long someone has been experiencing nightmares) predict substantial variance in suicide risk among older adults in addition to the risk factors typically examined. Thus, assessment of sleep dysfunction is important when assessing suicide risk among older adults.

Blunted HPA Axis Activity in Suicide Attempters Compared to those at High Risk for Suicidal Behavior.

Studies looking at the relationship of the hypothalamic-pituitary-adrenal (HPA) axis to suicidal behavior and its risk factors, such as depression, childhood abuse, and impulsive aggression, report inconsistent results. These studies also do not always differentiate between subjects who go on to attempt suicide, suicidal subjects who never attempted suicide, and non-suicidal subjects with psychiatric disorders. In this study, we examined cortisol responses to an experimental stressor, the Trier Social Stress Test (TSST), in 208 offspring of parents with mood disorder. Offspring suicide attempters showed lower total cortisol output (β=-0.47, 95% CI (-0.83, -0.11), p=0.01) compared with offspring with suicide-related behavior (SRB) but never attempted, non-suicidal offspring, and a healthy control group. The result remained significant even after controlling for sex, age, race, ethnicity, site, socio-economic status, and hour of the day when the TSST was conducted. Suicide attempters also showed lower baseline cortisol before the TSST (β=-0.45, 95% CI (-0.74, -0.17), p=0.002). However, there were no significant differences between the groups on cortisol reactivity to stress (β=4.5, 95% CI (-12.9, 22), p=0.61). Although subjects with suicide attempt and SRB have similar clinical and psychosocial characteristics, this is the first study to differentiate them biologically on HPA axis indices. Blunted HPA axis activity may increase risk for suicide attempt among individuals with psychopathology by reducing their ability to respond adaptively to ongoing stressors. These results may help better identify subjects at high risk for suicidal behavior for targeted prevention and intervention efforts.

Differences in Assessment of Suicidal Tendencies in Men and Women: A Pilot Study

Suicidal behaviors in psychiatric patients are one of the main challenges in current clinical practice. The aim of this study was to investigate the gender differences in suicide risk for psychiatric patients in Poland and the influence of life satisfaction in different stages of life on suicidal tendencies. A descriptive–exploratory approach to inquiry was used for this study. Sixty patients aged 16–67 (45% males and 55% females) answered the demographic–descriptive questionnaire, the Suicide Behaviors Questionnaire-Revised (SBQ-R) and the Cantril Self-Anchoring Striving Scale (CSASS). The results suggest that women turned out to show higher risk of suicidal behavior than men (p<0.001). Moreover, women displayed strong negative correlation between suicide risk and the anticipated life satisfaction in the future (rho=−0.542), while men displayed negative correlation between suicide risk and the pre-illness level of functioning (rho=−0.638). The findings suggest that different therapeutic approaches for each gender should be applied in suicide prevention process.

Factors Associated with Recurrent Suicidal Ideation among Racially and Ethnically Diverse College Students with a History of Suicide Attempt: The Role of Mindfulness

Although one-third of enrolled U.S. undergraduate college students are non-White, little is known about risk factors for suicidal behavior among racial and ethnic minority students. Thus, we set out to determine psychosocial factors associated with recurrent suicidal ideation among racially and ethnically diverse college students with a history of suicide attempt. From 2012–2013, 1,734 racially and ethnically diverse college students completed an on-line survey of suicidal behavior and associated factors.Depression, hopelessness, rejection sensitivity, and mindfulness, as well as past-year discrimination, ethnic identification, and acculturative stress were measured using well-validated self-report instruments. The Beck Scale for Suicide Ideation was used to assess current suicidal ideation. A subsample of 118 college students who self-reported a past suicide attempt were selected for the current analysis. Logistic regression analysis was used to test associations between risk factors and the presence of suicidal ideation, and linear regression analysis was used to test factors associated with suicidal ideation severity among those who reported current suicidal ideation.Depression was significantly related to both the presence and severity of current suicidal ideation. Mindfulness, and in particular awareness of present moment experience, was also inversely associated with ideation severity.We found depression and mindlessness were associated with suicidal ideation severity among a sample of diverse college students at high risk for suicidal behavior due to a past suicide attempt. Factors unique to the minority experience, such as acculturative stress, were not associated with current suicidal ideation. Implications for suicide prevention are discussed.

The suicide prevention effect of lithium: more than 20years of evidence-a narrative review.

The management and treatment of patients with suicidal behavior is one of the most challenging tasks for health-care professionals. Patients with affective disorders are at high risk for suicidal behavior, therefore, should be a target for prevention. Numerous international studies of lithium use have documented anti-suicidal effects since the 1970s. Despite the unambiguous evidence of lithium’s anti-suicidal effects and recommendations in national and international guidelines for its use in acute and maintenance therapy of affective disorders, the use of lithium is still underrepresented. The following article provides a comprehensive review of studies investigating the anti-suicidal effect of lithium in patients with affective disorders.

Re-examination of classic risk factors for suicidal behavior in the psychiatric population.

. Background: For decades we have understood the risk factors for suicide in the general population but have fallen short in understanding what distinguishes the risk for suicide among patients with serious psychiatric conditions. Aims: This prompted us to investigate risk factors for suicidal behavior among psychiatric inpatients. Method: We reviewed all psychiatric hospital admissions (2008–2011) to a centralized psychiatric hospital in Ontario, Canada. Using multivariable logistic regression we evaluated the association between potential risk factors and lifetime history of suicidal behavior, and constructed a model and clinical risk score to predict a history of this behavior. Results: The final risk prediction model for suicidal behavior among psychiatric patients (n = 2,597) included age (in three categories: 60–69 [OR = 0.74, 95% CI = 0.73–0.76], 70–79 [OR = 0.45, 95% CI = 0.44–0.46], 80+ [OR = 0.31, 95% CI = 0.30–.31]), substance use disorder (OR = 1.30, 95% CI = 1.27–1.32), mood disorder (OR = 1.49, 95% CI = 1.47–1.52), personality disorder (OR = 2.30, 95% CI = 2.25–2.36), psychiatric disorders due to general medical condition (OR = 0.52, 95% CI = 0.50–0.55), and schizophrenia (OR = 0.42, 95% CI = 0.41–0.43). The risk score constructed from the risk prediction model ranges from −9 (lowest risk, 0% predicted probability of suicidal behavior) to +5 (highest risk, 97% predicted probability). Conclusion: Risk estimation may help guide intensive screening and treatment efforts of psychiatric patients with high risk of suicidal behavior.

Suicide ideation among oncologic patients in a Spanish ward

Oncologic patients are exposed to a higher risk of suicidal behaviors than the general population. In this study, we aim to examine the severity of suicidal ideation in a sample of oncologic patients considering different psychological and clinical features. We interviewed 202 inpatients receiving curative or palliative treatment in a medical oncology ward of a Spanish hospital during the period 2012–2014. A complete assessment of psychosocial factors, cancer diagnoses (lung, colon rectum, and genitourinary system), and suicidal behaviors were made during admission, including validated questionnaires about depression, anxiety, personality, quality of life, body image, life threatening events, hopelessness, and suicidal ideation. The characteristics of inpatients with high and low suicidal ideation were retrospectively compared. A logistic regression model was constructed to examine the relationship between the significant factors retained after the univariate analyses. One of every four patients (n = 51; 25.24%) presented high scores of suicidal ideation. Logistic regression analyses retained depression (OR = 3.55; 95% CI = 1.25–11.68; p = .016), hopelessness (OR = 8.78; 95% CI = 3.44–25.88; p ≤ .001), personality (OR = .44; 95% CI = .2–.96; p = .038), and advanced age (OR = 2.60; 95% CI = 1.18–5.98; p = .016) as the main risk factors for high suicidal ideation. Suicidal ideation was frequent among oncologic patients. These patients should receive closer monitoring, especially, when old, retired, or severely depressed.

Magnetic resonance imaging markers of suicide attempt and suicide risk in adolescents.

More than 36,000 people in the United States die from suicide annually, and suicide is the third leading cause of death in adolescence. Adolescence is a time of high risk for suicidal behavior, as well as a time that intervention and treatment may have the greatest impact because of structural brain changes and significant psychosocial development during this period. Functional and structural neuroimaging studies in adults who have attempted suicide suggest distinct gray matter volume abnormalities in cortical regions, as well as prefrontal cortical and dorsal anterior cingulate gyrus neural circuitry differences compared with affective and healthy adult controls. Recent functional neuroimaging studies in adolescents with a history of suicide attempt suggest differences in the attention and salience networks compared with adolescents with depression and no history of suicide attempt and healthy controls when viewing angry faces. In contrast, no abnormalities are seen in these areas in the absence of emotional stimuli. These networks may represent promising targets for future neuroimaging studies to identify markers of risk for future suicide attempt in adolescents.

Suicide Among Lgbt Individuals

Introduction Mental disorders constitute the most important risk factor for suicidal behaviour. Studies have found that LGBT (lesbian, gay, bisexual, and transgender) individuals are at increased risk for mental health problems, as a consequence of a hostile stressful environment. There as been a historical pathologisation of sexual orientation and gender identity, however, lately there have been significant changes in medical understanding about this theme. Objectives/Aims The authors aim to determine the possibility of increased suicidal ideation/suicidal behaviour among LGBT individuals. Methods Review of the literature using the terms LGBT, lesbian, gay, bissexual, transgender, sexual orientation, gender identity, suicide, suicidal ideation, suicidal behaviour. Results Studies provide evidence that individuals in a sexual or gender minority are at greater risk for suicidal thoughts and behaviours. There is evidence of elevated rates of reported suicide attempts in LGBT compared to heterosexual adolescents and adults, worldwide. Individuals reporting a bisexual orientation had an increased risk of suicide attempts and ideation compared with their homosexual and heterosexual peers. Mental disorders do not appear to entirely explain elevated rates of suicide attempts in these individuals. Social stigma, prejudice and discrimination associated with this individual are important factors. Conclusions Health professionals should be alert to the higher risk of suicidal behaviour in lesbian, gay, bisexual and transgender people. Further research is needed in order to prevent suicide in these populations.

Anxiety sensitivity cognitive concerns predict suicide risk

Anxiety sensitivity (AS) cognitive concerns, which reflects fears of mental incapacitation, have been previously associated with suicidal ideation and behavior. The first study aim was to replicate and extend upon previous research by investigating whether AS cognitive concerns can discriminate between those at low risk versus high risk for suicidal behavior. Secondly, we aimed to test the incremental predictive power of AS cognitive concerns above and beyond known suicide risk factors (i.e., thwarted belongingness and insomnia). The sample consisted of 106 individuals (75% meeting current criteria for an Axis I disorder) recruited from the community. Results revealed that AS cognitive concerns were a robust predictor of elevated suicide risk after covarying for negative affect, whereas AS social and physical concerns were not. Those with high, relative to low, AS cognitive scores were 3.67 times more likely to be in the high suicide risk group. Moreover, AS cognitive concerns significantly predicted elevated suicide risk above and beyond relevant suicide risk factors. Results of this study add to a growing body of the literature demonstrating a relationship between AS cognitive concerns and increased suicidality. Incorporating AS cognitive concerns amelioration protocols into existing interventions for suicidal behavior may be beneficial.

Are LGBT Populations at a Higher Risk for Suicidal Behaviors in Australia? Research Findings and Implications

The aim of this article is to review the Australian literature about suicidality in minority sexual identity and/or behavior groups in order to determine the evidence base for their reported higher vulnerability to suicidal behaviors than heterosexual and non-transgendered individuals in the Australian context, as well as to identify the factors that are predictive of suicidal behaviors in these groups in Australia. A literature search for all available years (until the end of 2012) was conducted using the databases Scopus, Medline, and Proquest for articles published in English in peer-reviewed academic journals. All peer-reviewed publications that provided empirical evidence for prevalence and predictive factors of suicidal behaviors among LGBT individuals (or a subset thereof) in Australia were included. Reference lists were also scrutinized to identify “gray” literature for inclusion. The results revealed that there is only limited research from Australia. Nevertheless, although no population-based studies have been published, research indicates that sexual minorities are indeed at a higher risk for suicidal behaviors. In order to further the understanding of suicidal behaviors and potential prevention among LGBT groups in the Australia, further research is needed, particularly on fatal suicidal behaviors.

Effects of Sexual Intercourse on Suicidal Behaviors among Adolescents in South Korea

For the current article an examination was done as to whether engaging in sexual intercourse before or during adolescence has a negative impact on the suicidal behaviors of suicide ideation, suicide attempt, and suicide lethality and whether the impact varies according to the context of sexual intercourse and/or gender. Adolescents who experienced casual sex and romantic sex were compared to adolescents who retained their virginity. Data was from samples drawn from the three waves (2010~2012) of the Korea Youth Risk Behavior Web-Based Survey. Logistic models were used to adjust for a wide array of confounding variables. Any type of sexual intercourse increases risk of all suicidal behaviors. Sexual intercourse in a romantic relationship exhibits enhanced risk of suicidal behaviors compared to casual sex. Adjusting for experience of sexual violence, however, decreases risk of romantic sex substantially, turning some estimates statistically insignificant. In addition, risks for suicide lethality are greater for girls than boys. Romantic sex put adolescents at higher risk for suicidal behaviors than casual sex owing to prevalent sexual violence in the relationships. Girls suffer more substantively adverse outcomes than boys. These results suggest that adolescents will benefit from comprehensive education on sexuality and sexual behaviors regarding how to form and maintain a romantic relationship that is characterized by personal integrity and mutual respect. It is also important to help victims of sexual violence recover from traumatic events by providing emotional support and effective counseling.

Psychiatric diagnoses and risk of suicidal behaviour in young disability pensioners: prospective cohort studies of all 19-23 year olds in Sweden in 1995, 2000, and 2005, respectively.

ObjectiveIncreasing rates of disability pension (DP) have been observed among young adults. We studied specific psychiatric DP diagnoses and subsequent risk of suicidal behaviour in a series of three cohorts of young adult in Sweden.MethodIn a nationwide register study, we included all young adults who in 1995, 2000, and 2005, respectively, were 19–23 years old and lived in Sweden (n≈500,000 per cohort). Rates of DP and specific psychiatric DP diagnoses were recorded in each cohort. Hazard ratios (HRs) and 95% confidence intervals (CIs) for suicidal behaviour during the following five years, with the corresponding age group as reference, were calculated by Cox proportional hazard regression, adjusted for demographic variables and previous own and parental suicidal behaviour.ResultsThe overall proportion with DP in this age group increased from 0.92% in 1995 to 2.29% in 2005, with particularly large increases in psychiatric diagnoses such as hyperkinetic disorders, pervasive developmental disorders, and depression/anxiety. The overall proportion of young disability pensioners attempting suicide during the five-year follow-up increased from 2.21% in the 1995 cohort to 3.81% in the 2005 cohort. Within most psychiatric DP diagnoses, the risk of attempted suicide did not change significantly over time, whereas suicide attempts increased in the reference group. Accordingly, the HRs for suicide attempt decreased in some psychiatric DP diagnoses. The highest adjusted HRs were observed for depression/anxiety (16.41; CI: 9.06 to 29.74) and schizophrenia (9.37; 6.13 to 14.31) in the 1995 cohort. The rate of suicide among young disability pensioners during follow-up ranged from 0.19% in 1995 to 0.37% in 2005, mainly occurring in individuals with psychiatric diagnoses.ConclusionSuicidal behaviour has become more prevalent among young disability pensioners, which co-occurred with an increased tendency to grant DP in psychiatric diagnoses with a known high risk of suicidal behaviour. Preventive measures are warranted.

Comportamiento suicida de adolescentes con trastorno por déficit de atención e hiperactividad en Medellín (Colombia), 2011-2012

BackgroundSuicide is a public health problem. In Colombia, teenagers are considered a group at high risk for suicidal behavior. ObjectiveTo explore the possible association between suicidal behavior and attention deficit hyperactivity disorder in adolescents of Medellin. MethodologyObservational, cross-sectional, analytical study. The Composite International Diagnostic Interview was applied to a total of 447 adolescents and the sociodemographic, clinical, familiar, and life event variables of interest were analyzed. The descriptive analysis of qualitative variables are presented as absolute values and frequencies, and the age was described with median [interquartile range]. A logistic regression model was constructed with explanatory variables that showed statistical association. Data were analyzed with SPSS® software version 21.0. ResultsOf the total, 59.1% were female, and the median age was 16 [14-18] years. Suicidal behavior was presented in 31% of females and 23% of males. Attention deficit was present in 6.3% of adolescents. The logistic regression analysis showed that the variables that best explained the suicidal behavior of adolescents were: female sex, post-traumatic stress disorder, panic disorder, and cocaine use. ConclusionsThe diagnosis and early intervention of attention deficit hyperactivity disorder in children may be a useful strategy in the prevention of suicidal behavior in adolescents.

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

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.