Eating disorders and psychiatric comorbidity among Iraq and Afghanistan veterans.

San Francisco VA Medical Center, San Francisco, CA 94121, USA.
Women s Health Issues (Impact Factor: 1.61). 07/2012; 22(4):e403-6. DOI: 10.1016/j.whi.2012.04.005
Source: PubMed

ABSTRACT Individuals with mental health problems are at elevated risk for eating disorders. Veterans serving in support of the conflicts in Afghanistan and Iraq (OEF/OIF) have a high prevalence of deployment-related mental health problems, but little is known about their risk for eating disorders. Our aim was to determine rates of eating disorder diagnoses among OEF/OIF veterans with mental health problems, particularly among those with comorbid mental health problems.
This retrospective, cross-sectional analysis of nationwide VA healthcare facilities used descriptive statistics and regression analyses to determine eating disorder rates in OEF/OIF veterans who were new users of VA healthcare from October 7, 2001 to December 31, 2010 (N = 593,739).
Although the prevalence of eating disorder diagnoses was 0.007% (n = 465) in women and <0.001% (n = 192) in men, veterans diagnosed with mental health problems were significantly more likely to have an eating disorder than those without mental health diagnoses. Eating disorders were significantly more common in women with depression, posttraumatic stress disorder, and alcohol and/or drug use disorders than in women veterans without these mental health disorders. Among men, the associations between eating disorder diagnoses and comorbid mental health diagnoses closely paralleled those observed in women.
Rates of eating disorders are significantly higher among returning veterans with comorbid mental health problems compared with those without mental health diagnoses. Further research should examine methods to improve detection and treatment of eating disorders in this population.

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    ABSTRACT: Objective: Eating disorder (ED) symptoms have gone mostly unexamined among veterans. The current study assessed rates of bulimia nervosa (BN) and binge eating disorder (BED) symptoms and diagnoses and their associations with common comorbidities among male and female veterans. Method: Participants were U.S. military veterans who screened positive for trauma histories and/or a probable DSM-IV PTSD diagnosis (n = 499). Symptoms of PTSD were assessed using the Clinician Administered PTSD Scale (CAPS), and symptoms of EDs, mood, and substance use disorders were assessed using the Structured Clinical Interview for the DSM-IV(SCID). Results: Lifetime rates of BN and BED diagnoses were comparable to civilian populations and a considerable range of lifetime and current BN and BED symptoms were identified. In multivariate models, PTSD and depression severity were most consistently associated with BN and BED symptom severity, with depression most strongly associated with EDs for women. Conclusions: Findings highlight the importance of screening for ED symptoms among male and female veterans, particularly those that present with PTSD and depression symptomatology. Future examinations of the temporal order of such relationships and the degree to which ED symptoms and associated symptoms impact veteran functioning are warranted.
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    ABSTRACT: We conducted a systematic literature review on substance misuse, abuse, and dependence in women veterans, including National Guard/reserve members. We identified 837 articles published between 1980 and 2013. Of 56 included studies, 32 reported rates of alcohol misuse, binge drinking, or other unhealthy alcohol use not meeting diagnostic criteria for abuse or dependence, and 33 reported rates of drug misuse or diagnosed alcohol or drug use disorders. Rates ranged from 4% to 37% for alcohol misuse and from 7% to 25% for binge drinking; among Veterans Health Administration (VA) health-care system outpatients, rates ranged from 3% to 16% for substance use disorder. Studies comparing women veterans and civilians reported no clear differences in binge or heavy drinking. Substance misuse rates were generally lower among women veterans than men veterans. Substance misuse was associated with higher rates of trauma, psychiatric and medical conditions, and increased mortality and suicide rates. Most studies included only VA patients, and many used only VA medical record data; therefore, the reported substance misuse rates likely do not reflect true prevalence. Rates also varied by assessment method, source of data, and the subgroups studied. Further efforts to develop epidemiologically valid prevalence estimates are needed to capture the true health burden of substance misuse in women veterans, particularly those not using VA care. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health 2015. This work is written by (a) US Government employee(s) and is in the public domain in the US.
    Epidemiologic Reviews 01/2015; · 7.33 Impact Factor
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    ABSTRACT: Les troubles du comportement alimentaire (TCA) chez les hommes ont souvent été occultés par leur prévalence plus importante chez les femmes. Cependant, la recherche témoigne d’un regain d’intérêt pour cette thématique. L’objectif de cet article est de réaliser une synthèse des différentes études actuelles. Une revue de la littérature a été menée sur les bases de données PsycINFO, MEDLINE et ScienceDirect, et 34 études publiées entre 2009 et 2014 ont été analysées. Les résultats rapportent une fréquence des troubles alimentaires comprise entre 2,7 et 13,3 %. Les facteurs de risque observés incluent l’insatisfaction corporelle et notamment l’insatisfaction envers la masse graisseuse et la masse musculaire, l’exercice physique compulsif et compensatoire, les difficultés de régulation des émotions, les difficultés de flexibilité cognitive, l’adhésion aux stéréotypes et l’influence des relations interpersonnelles. Une importance particulière est attribuée à l’orientation sexuelle. Une seule étude concerne l’efficacité d’un traitement des patients boulimiques avec des résultats concluant jusqu’à une année post-traitement. Cette revue de la littérature confirme l’existence de facteurs de risque communs aux deux sexes et souligne certaines particularités des TCA chez les hommes. Elle évoque également la nécessité de mener des études sur les traitements. Aims: Male eating disorders are often overshadowed by the higher incidence of such disorders in the female population. Over the last 10 years, there has been renewed interest in research on this topic, although few studies of male eating disorders have been carried out in France. The aim of this article is to summarize current research in this field. A literature review was conducted on the databases of PsycINFO, MEDLINE and ScienceDirect. Articles on samples of males suffering from obesity were excluded due to the specific nature of eating disorders in this population. In the case of articles containing samples of men and women, only data linked to the male sample was analyzed wherever possible. The results of 34 studies published between 2009 and 2014 were analyzed. Results: The results of studies using self-assessments which define the risk thresholds showed a frequency of eating disorders between 2.7 and 13.3% (Hilbert and Tuschen-Caffier, 2004; Gadalla, 2009; Paulson and Rutledge, 2014) 0060, 0065 and 0070. The frequency of subclinical disorders, in other words eating problems which do not fit all the diagnostic criteria of eating disorders, was 11.8% (Valls et al., in press) [17]. However, few studies indicated the frequency of eating disorders due to the use of self-assessments which do not contain a threshold score. The risk factors observed concerned dissatisfaction with body shape, notably the distinction between dissatisfaction with fat mass and dissatisfaction with muscle mass. However, no study has investigated eating disorders and the associations between dissatisfaction with fat mass and dissatisfaction with muscle mass. Frequent physical exercise was associated with the risk of developing eating disorders. This association was stronger when compulsive (four times greater risk) and compensatory (three times greater risk) dimensions of physical exercise were taken into consideration, regardless of sex (Sanftner, 2011) [25]. In addition, inappropriate eating behaviors alleviated emotional dysfunction such as difficulties in controlling emotions and intolerance of negative mood. Self-silencing, i.e. the denial or minimization of one's own emotions to prioritize others’ needs, was a strong predictor of eating disorders in American students (Dakanalis et al., 2014) [28]. Although men suffering from eating disorders have less cognitions associated to the body than women, cognitive behavioral characteristics were highlighted as risk factors, for example weak cognitive flexibility (inability to adapt to change, rigidity) and central coherence (focusing to details) which could be associated to inappropriate behavior aimed at increasing muscle (Brennan et al., 2011) [22]. Sociocultural factors such as adherence to masculine stereotypes which are associated with a pursuit of weight loss (Baillie and Copeland, 2013) [31], and interpersonal difficulties associated with bulimic behavior (Lavander and Anderson, 2010) [27] were also important. Particular importance was given to sexual orientation. The homosexual population had a significantly higher tendency towards the pursuit of weight loss and was more sensitive to media message, to body objectification and to identity conflicts related to sex (Carper et al., 2010; Dakanalis et al., 2012; Ålgars et al., 2010) 0175, 0190 and 0195. As in the case of women, studies showed an association between high depressive symptomatology and eating disorders (Valls et al., in press; Griffiths et al., 2014) 0085 and 0105. Finally, although there were studies focusing on possible treatments of male eating disorders, only one evaluated the efficiency of cognitive behavioral treatment of bulimic patients. The results of this study indicated a reduction in symptoms up to one year following treatment (Fernández-Aranda et al., 2009) [10]. Conclusion: Although this literature review was not exhaustive, it confirmed the existence of risk factors which are common to both sexes (for example dissatisfaction with weight, difficulties in controlling emotions and depression) and underlined certain peculiarities of male eating disorders (for example, distinction between dissatisfaction with fat mass and dissatisfaction with muscle mass). The importance of risk factors associated with the development of eating disorders in the homosexual population was highlighted. This article also evokes the lack of sensitivity and of information in society and amongst health professionals, as well as the need to carry out studies on the different types of treatment for men suffering from eating disorders.
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