Something rarely discussed in the military, whether in training, active duty, or among veterans, is mental health. There are many reasons for this: heavy stigma, fear of being unable to advance in their career, and fear of being rejected from the military before even starting. The military can also put personnel at higher risk for mental health problems, especially eating disorders. Eating disorders in the military are more common than we think, yet the lack of discussion of mental health prevents many individuals from getting treatment.
This article will cover:
- Why military personnel are at such a high risk for eating disorders
- Why it’s so hard to get eating disorder treatment in the military
- What is being done to combat barriers to eating disorder treatment in the military
Risks and Contributing Factors for Eating Disorders in the Military
Eating disorders are not often formally diagnosed in the military. However, anonymous self reports have allowed for better research as to the prevalence of eating disorder symptoms and diagnoses during and after military service.
In a large systematic review of eating disorder symptoms and diagnoses in the military, sample data determined:
- The risk for eating disorders in female and male cadets were 20-29%, and 2-7% respectively, although not enough research has been done on eating disorders in males
- 33.6% of active-duty females were considered “at-risk” for developing an eating disorder (male risk was not reported)
- 1.6% of active duty females met diagnostic criteria for anorexia, and 9.7% for bulimia
- 2.5% of active duty men met diagnostic criteria for anorexia, and 6.8% for bulimia
- 3.3% of women and 2.6% of men had developed an eating disorder by the 1-5 year follow-up of the initial study
EDNOS and BED were not specifically covered in these studies. However, more federal funding is being allotted for eating disorder research in the military, and these eating disorder traits will be studied in the future.
The anonymity of self-reporting has hugely influenced these numbers as compared to face-to-face interviews and medical record reviews.
THE MILITARY PLACES A LOT OF FOCUS ON BODY WEIGHT, SHAPE AND LEVEL OF FITNESS.
Of course it makes sense that you have to be physically strong to be in the military: you’re doing demanding physical activity for what is essentially your entire military career. However, the military places very stringent height, weight and body fat percentage requirements for all personnel.
You may have a higher weight limit if you are a new recruit, but you must trim down during active duty to meet weight requirements. The military believes that a targeted weight range is an indicator of good health. Your allotted weight range is based off of BMI, but this is not a good indicator of one’s fitness levels. If you do not meet weight requirements, you may receive a “weight waiver” if your body fat percentage is no more than 2% above standard body-fat composition requirements for enlistment.
Throughout a military member’s career, they are periodically weighed and measured for body-fat. Those found to be above their “body-fat limits” are subjected to a mandatory weight loss program. Those who fail to maintain “required body-fat standards” are subject to “administrative sanctions which can include reprimands, denial of promotions, administrative demotion in rank, and even administrative discharge,” according to the Army’s official website.
Such a high level of pressure put on military personnel to maintain a very specific weight and body-fat composition are naturally going to feel a need to use disordered eating and exercise behaviors to maintain. This is especially true around fitness testing and measurement periods, when huge spikes in purging behaviors, including vomiting, diet pill and laxative abuse have been detected in many scientific studies. Behaviors are used for the sole purpose of making weight.
THERE IS A HIGH PREVALENCE OF TRAUMATIC EXPERIENCES IN THE MILITARY, WHICH CAN CONTRIBUTE TO AN EATING DISORDER.
There is a strong correlation between trauma and eating disorders. Causes of military trauma vary, from active combat, to seeing dead bodies, to sexual trauma, among many others. According to a national screening by the U.S. Department of Veterans Affairs, 1 in 4 women and 1 in 100 men have experienced sexual trauma in the military. 11-30% of veterans end up with PTSD, with variations in measurement occurring with which war they fought in.
Barriers of Eating Disorder Treatment in the Military
There are many barriers to acknowledging and seeking help for eating disorders in the military. One of the most difficult ones, though, is stigma, both perceived public stigma and self-stigma.
The prevailing culture in the military is that you are supposed to be strong. This, again, makes sense: you are protecting your country, so you are probably someone strong and capable. So those who seek help for mental illness often fear that they will be perceived as lesser. They also fear for their careers, as public stigma can hold someone back from advancement, or be cause for discharge altogether. However, having an eating disorder, or even symptoms, does not make one weak. It’s just not something discussed, so it’s not well understood.
Even mental health counselors within the military do not understand why someone would engage in harmful eating disorder behaviors. Their focus is more on anxiety and trauma, not eating disorders.
Also, in military culture, there is the idea that you are supposed to be able to handle your problems on your own. Those in the military are trained to be able to quickly react to situations and be self-sufficient, while also able to follow orders. This culture, though, leads a military member to perceive themselves as weak if they have a problem they can’t handle on their own, and become less willing to seek help. This is known as self-stigma. They may also feel like treatment may not be useful or effective, and often drop out of treatment almost immediately.
Due to stigma and shame, active military members experiencing trauma often do not come forward, either. That stigma and shame exists among veterans as well, causing mental health problems to become prolonged and intensified.
Rethinking Mental Health in the Military
Eating disorders are serious illnesses that can compromise a person physically and mentally. Eating disorders do not make room for the intense mental stress and physical responsibilities of military personnel, so it’s very important that those suffering are able to seek care as soon as possible.
Legislation is in the works to expand access to eating disorder treatment at all levels. The 2021 National Defense Authorization Act would provide measures for encouraging the Department of Defense (DoD) to cover residential treatment centers for adults with eating disorders, and train leaders to recognize the signs of eating disorder behaviors. (Currently, DoD policies only cover residential treatment for members 21 years of age and under, except for special cases, and inpatient levels of treatment are typically reserved for those needing medical stabilization.)
Sufferers of eating disorders in the military may receive treatment at any of the 166 eating disorder treatment centers that have set up partnerships with the DoD. It can be difficult to get military members into these facilities due to limited space or the level of reimbursement the military provides to these treatment centers is inadequate for them. If it just isn’t feasible to go to one of these treatment facilities, the military’s treatment providers work hard to find another solution. Every level of care, except residential treatment, is available for everyone who needs it. A clinician can help decide what level of treatment is right for someone.
Eating disorders are screened for when entering into the military. But there has been a widespread “don’t ask, don’t tell” situation when it comes to mental health screenings in the recruitment process. The military is working to train clinicians on how to better spot eating disorder symptoms, during recruitment and periodic exams. They are also being trained on how to provide better treatment and access to care, and on how to talk about and de-stigmatize mental health conditions in general.
If you or someone you love is suffering from an eating disorder, take the first step today and talk to talk to someone about recovery or simply learn more about the eating disorder recovery programs we offer.
