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: 2.33). 07/2012; 22(4):e403-6. DOI: 10.1016/j.whi.2012.04.005
Source: PubMed


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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    • "Ils rapportent parfois durant leur enfance un climat familial distant, des comportements auto-agressifs, de l'anxiété et une inhibition [44], ou encore des abus sexuels [22]. En population spécifique de vétérans de guerre, le risque de développer un TCA est 11 fois plus élevé quand il y a un diagnostic de dépression, six fois plus élevé avec un diagnostic de stress post-traumatique et cinq fois plus élevé avec un diagnostic de trouble anxieux ou une consommation de drogue [18]. "
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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.
    Full-text · Article · Sep 2014 · Journal de Thérapie Comportementale et Cognitive
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    • "Gender differences in ED comorbidities among veterans have also gone largely unexamined. The two exceptions to this are Maguen et al. [12], who identified similar patterns of comorbidities among male and female veterans, and Striegel-Moore et al. [19], who found that female veterans with EDs were more likely to be diagnosed with a mood or personality disorder, and male veterans with EDs were more likely to be diagnosed with a psychotic disorder. However, as noted above, these studies did not utilize a standard ED diagnostic interview, which raises concerns about the accuracy of the findings reported. "
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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 US military veterans who screened positive for trauma histories and/or a probable Diagnostic and Statistical Manual of Mental Disorders 4th Edition (DSM-IV) posttraumatic stress disorder (PTSD) diagnosis (n=499). Symptoms of PTSD were assessed using the Clinician-Administered PTSD Scale, and symptoms of EDs, mood, and substance use disorders were assessed using the Structured Clinical Interview for the DSM-IV. 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.
    Full-text · Article · Jul 2014 · General hospital psychiatry
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    • "Military experience influenced post-service eating behavior and increased mean body mass index (BMI) [25], suggesting that EDNOS may cause a tendency to become overweight or obese in these subjects. Moreover, comorbid mental health problems have been reported to increase ED rates among returning veterans from Iraq and Afghanistan conflicts [26]. Although war stress may be perceived even more intensively by civilians, few studies have approached the consequences of war on eating behavior in this population. "
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    ABSTRACT: Objective: Traumatic life events are important risk factors for eating disorders (ED). War has been associated, in military populations, with an increased post-service incidence of ED and an increased mean body mass index. We hypothesize that a modification of eating behavior (EB) related to stress during wartime may increase the risk of developing an ED later on among civilians exposed to war stress during adulthood. Methods: This descriptive cross-sectional study was performed in a group of 303 undergraduate young adult students of both sexes from Lebanon, 6 months after the July 2006 war. Modification of EB during wartime, sociodemographic and other potential risk factors were assessed retrospectively. Students were then screened for ED using the SCOFF questionnaire. Results: SCOFF was positive in 31.4% of the students, with a mean value 41.6% higher among subjects who reported an altered EB during the war. Among subjects with a positive SCOFF screening, 71% had experienced a change of EB during wartime. Alteration of EB during war was related to an odds ratio for a positive SCOFF screening of 2.6 (95% CI 1.54-4.34) and 1.8 (95% CI 1.01-3.21) for non-adjusted and adjusted analysis, respectively. Conclusions: Modification of EB related to stress during wartime is associated with an increased risk of eating disorders. Early detection and treatment of eating disorders may be improved by routinely evaluation of EB modification in patients with a past history of war exposure.
    Full-text · Article · Apr 2013 · General hospital psychiatry
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