Eating Disorders among Active Service Members

An incidence similar to that of civilian populations, but many cases go reported.

Historically, one does not associate eating disorders with active duty military personnel or veterans. Yet eating disorders are not rare, and abnormal eating behaviors may in fact be common, among U.S. military members.

One factor that may well interfere with diagnosing eating disorders among military personnel can be traced to current Department of Defense (DOD) guidelines. The DOD policy states that a diagnosis of anorexia nervosa (AN), bulimia nervosa (BN), or an unspecified eating disorder (EDNOS) after 13 years of age is an automatic medical disqualification for acceptance into any of the service branches. In addition, service members who have an eating disorder that does not respond to treatment or that interferes with military duties may be discharged from the service. Results of previous studies have varied widely, but a 2001 Military Medicine study based on a survey of 3,000 active-duty women found more than 16% had a lifetime history of an eating disorder, and the eating disorder was associated with post-traumatic stress or sexual trauma (Military Med 2001; 166:53).

A review of medical diagnoses made among the Army, Air Force, Marine Corps, Navy, and Coast Guard from January 1, 2004 through December 2013 by the Armed Forces Health Surveillance Center, Silver Springs, MD, showed that a total of 3,527 service members had diagnoses of AN, BN, or EDNOS (MSMR. 2014; 21:8). The overall incidence was 2.5 cases per 10,000 person-years, and women had a rate 20 times greater than did men. Female service members accounted for 78% of all diagnosed eating disorders, even though women make up only 15% of active service members. Higher rates were also found among younger military persons, and among whites, non-Hispanics, and Marines, compared to their counterparts. The current report also indicated that Marine women suffered from bulimic behavior at more than 10 times the rate of civilians — 15.9% versus 1.5%. White female soldiers had bulimia at six times the rate of civilian women.

Approximately two-thirds of all incidence reports involved service members in specific job areas: repair/engineering, communications/intelligence, and healthcare. The report may be limited by several factors. One is that the outcomes were diagnoses recorded in the health records of service members. People with eating disorders may avoid seeking medical care, at least at first, because of embarrassment or because they don’t believe they have a problem. This generally common problem in assessing the prevalence of eating disorders may be more marked in the military, as service members with eating disorders may also avoid reporting them because discovery may endanger their future in the military.

It is worth noting that some VA hospitals have begun to establish eating disorder services, reflecting growing recognition of this issue.