I had the privilege of completing my training as a psychologist at the VA in Long Beach, CA. During this time I spent two years working with Veterans from all walks of life ranging in age from 20 to 90. Some had served in WWII, others in Vietnam, and still others in the more recent conflicts in Iraq and Afghanistan. I treated Veterans for PTSD, depression, anxiety, and insomnia. I provided support to Veterans as they navigated recovery from life-changing experiences such as spinal cord injuries, stroke, and vision loss. I advocated for Veterans who were coping with prolonged hospitalization and listened as some Veterans came to terms with the end of life.
Eating disorders are one of many significant mental health problems Veterans face and they often go overlooked. This is perhaps because eating disorders are typically thought of as a problem that occurs only among women (though the number of female Veterans is growing every day), or perhaps because of the myriad of other physical and mental health problems many Veterans are coping with. This is unfortunate given all we know about the seriousness of eating disorders and their associated health problems.
Eating disorders occur at least as commonly among Veterans as they do in the general population, with some studies suggesting slightly higher rates. Eating disorders occur in female and male Veterans. Unlike the general population, some studies show similar rates of eating disordered behaviors among active duty men and women. This may be related to required compliance with weight standards, measurements, and fitness assessments in the military.
Eating disorders appear to be especially common among those military personnel or Veterans who are also struggling with depression, PTSD, and substance use, each problem heightening the severity of the other. It is likely that some Veterans enter the military having already developed an eating disorder, while some Veterans experience significant stressors, especially combat exposure, that (along with a predisposition or vulnerability to developing an eating disorder) may serve to increase risk for developing an eating disorder.
Veterans face unique challenges in receiving care, particularly for a specialized problem like an eating disorder. Mental health stigma is common in the military, often interfering with active duty service members seeking help. Many are fearful that seeking help or disclosing mental health problems may somehow get back to their superiors, may make them appear weak or unfit, or may put their job in jeopardy. This stigma continues to affect Veterans following their service time with many going untreated, despite the availability of mental health care via VA or other resources such as vet centers and recent efforts of the VA and department of defense to destigmatize mental health care and increase utilization.
For those who do seek help, it may be difficult to find mental health providers who specialize in eating disorders within VA, which may affect the quality of treatment. Alternatively, Veterans may be referred to outside locations that do specialize in eating disorders but don’t have a good understanding of the unique experiences, challenges and stressors Veterans face, which can negatively impact attendance and compliance with treatment. Veterans may be more likely to present to primary care for physical problems related to an eating disorder, but are not likely to be asked about eating problems, and are not likely to disclose spontaneously. All considered, Veterans would benefit from regular screening for eating disorders in primary care and in mental health clinics, especially if they have been diagnosed with PTSD, depression, or substance abuse.
This Veteran’s day, I’ll bring to mind the Veterans I worked with, and I’ll reflect with gratitude on the sacrifices all Veterans have made. I am a better clinician and a better person because of my time at the VA. I continue to hope for reduced stigma and access to good, evidenced-based treatment for Veterans struggling with eating and other mental health disorders.
Veterans in crisis can call the Veterans Crisis Line 24/7 at 1-800-273-8255 (press 1) for confidential support. Confidential chat and a resource locator for mental health services are also available at veteranscrisisline.net
Dr. Carcieri is a staff psychologist at Eating Disorder Therapy LA.