Editor’s Note:

Military and civilian service professions, such as the Australian Defence Force (ADF) and emergency services, as well as elite sports professions, require a certain level of physical fitness, discipline and performance. The intensive training undertaken by those in high performance occupations may not always prepare them for the potential psychological impacts (VVCS, 2016; Bartlett & Mitchell, 2015).

This month we give an overview of the research on eating disorders in ex-serving military personnel, and take a closer look at appropriate self-care and support pathways for Veterans, Australian Defence personnel and other elite professionals. We also discuss the risks and warning signs associated with eating disorders, to better assist health care providers, coaches and others working alongside people currently or previously involved in high performance occupations to appropriately identify and respond to symptoms.

If you are interested in collaborating with the NEDC, we encourage you to join and become an NEDC member.

Contents:

1. Eating Disorders in ex-serving Military Personnel
2. Veterans, ADF Personnel and Family Support Pathways
3. Resource: Physical Fitness and High Level Performance

This article was contributed by a Mental Health Advisor from the Department of Veterans' Affairs.

Eating disorders comprise a group of psychological conditions characterised by disordered food and body related cognitions, difficulties with self-regulation, and disordered eating behaviours (American Psychiatric Association [APA], 2013; Hay et al., 2014). Eating disorders present serious psychological and physical disability and have high rates of mortality (Bartlett and Mitchell, 2015).

There is limited research, particularly in Australia, exploring eating disorders in military populations, perhaps due to the misconception that eating disorders only affect females, and such concerns are not relevant in a male dominated environment. However, international research suggests that both male and female veterans do experience eating disorders (Bartlett & Mitchell, 2015). The rate of eating disorders in veterans is comparable to prevalence estimates of eating disorders in the general population (Mitchell, Rasmusson, Bartlett & Gerber, 2014). Such rates may be aligned with an increase in younger service members and female service members (Bartlett & Mitchell, 2015; Mitchell et al., 2014).

The research to date indicates increased exposure to stress and trauma to be linked to the development of disordered eating and eating disorders in both civilian and military cohorts (Brewerton, 2007; Forman-Hoffman et al., 2012; Rayworth, Wise, & Harlow, 2004). Additional evidence suggests that disordered eating behaviour may be a coping strategy to manage psychiatric symptoms, including negative affect (Jacobson et al., 2009; Forman-Hoffman et al., 2012; Maguan et al., 2012; Heatherton et al., 1991), with those veterans experiencing symptoms of post-traumatic stress disorder (PTSD) and depression more likely to meet criteria for binge eating disorder (Hoerster et al., 2015).

Bartlett and Mitchell (2015) conducted a review of the literature on eating disorders across military and veteran populations and found having comorbid mental disorders was linked, in both male and female veterans, to a higher incidence of eating disorders (Maguen, et al., 2012). There is also evidence to suggest that comorbid mental health conditions associated with an eating disorder diagnosis differ between men and women, with men experiencing mood disorders and substance abuse or dependence disorders and women experiencing mood disorders and personality disorders (Striegel-Moore, et al., 1999: Striegel-Moore, et al., 1999).

The military presents an environment that prides itself of discipline and high standards of physical fitness. The comparable prevelance of eating disorders in veterans to the general population (Mitchell et al., 2014) and the high rate of US veterans who are overweight and obese (Vieweg et al., 2007), highlights the risk that disordered eating behaviours may persist or develop following discharge from service as veterans attempt to lose or control their weight and cope with changes in lifestyle and routine.

National research in Australia focusing on lifetime prevalence of eating disorders among members who have left the military is yet to be undertaken. This could be a future direction for research to help inform targeted interventions and effective management of eating disorders for both current and ex-serving military personnel.

If you, or someone in your care is experiencing difficulties with an eating disorder, or other mental health concern, there are a number of resources available to support veteran and military personnel. These are discussed in the next article, ‘Veterans, ADF Personnel and Family Support Pathways’.

References:

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author

Bartlett, B. A., & Mitchell, K. S. (2015). Eating disorders in military and veteran men and women. International Journal of Eating Disorders, 48, 1057–1069

Brewerton, T. D. (2007). Eating disorders, trauma, and comorbidity: Focus on PTSD. Eating Disorders, 15, 285–304

Forman-Hoffman, V. L., Mengeling, M., Booth, B. M., Torner, J., & Sadler, A. G. (2012). Eating disorders, posttraumatic stress, and sexual trauma in women veterans. Military Medicine, 177, 1161–1168

Hay, P., Chinn, D., Forbes, D., Madden, S., Newton, R., Sugenor, L., Touyz, S. & Ward, W. (2014). Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of eating disorders. RANZCP.
https://www.ranzcp.org/Files/Resources/Publications/CPG/Clinician/Eating-Disorders-CPG.aspx

Heatherton, T. F., & Baumeister, R. F. (1991). Binge eating as escape from self-awareness. Psychol Bull, 110, 86–108

Hoerster, K. D., Jakupcak, M., Hanson, R., McFall, M., Reiber, G., … Hall, K. S. (2015). PTSD and depression symptoms are associated with binge eating among US Iraq and Afghanistan veterans. Eat Behav, 17, 115–118

Jacobson, I.G., Smith, T.C., Smith, B., Keel, P.K., Amoroso, P.J., … Wells, T.S. (2009). Disordered eating and weight changes after deployment: Longitudinal assessment of a large US military cohort. Am J Epidemiol, 169, 415–27

Maguen, S., Cohen, B., Cohen, G., Madden, E., Bertenthal, D., & Seal, K. (2012). Eating disorders and psychiatric comorbidity among Iraq and Afghanistan veterans. Womens Health Issues, 22, e403–e406

Mitchell, K. S., Rasmusson, A., Bartlett, B., & Gerber, M. R. (2014). Eating disorders and associated mental health comorbidities in female veterans. Psychiatry Res, 219, 589-591

Rayworth, B. B., Wise, L. A., & Harlow, B. L. (2004). Childhood abuse and risk of eating disorders in women. Epidemiology, 15, 271–278

Striegel-Moore, R. H., Garvin, V., Dohm, F. A., & Rosenheck, R. A. (1999). Eating disorders in a national sample of hospitalized female and male veterans: Detection rates and psychiatric comorbidity. Int J Eat Disord, 25, 405–414

Striegel-Moore, R. H., Garvin, V., Dohm, F. A., & Rosenheck, R. A. (1999). Psychiatric comorbidity of eating disorders in men: A national study of hospitalized veterans. Int J Eat Disord, 25, 399–404

Vieweg, W. V., Julius, D. A., Bates, J., Quinn, J. F., Fernandez, A., Hasnain, M., & Pandurangi, A. K. (2007). Posttraumatic stress disorder as a risk factor for obesity among male military veterans. Acta Psychiatrica Scandinavica, 116, 483–7

Back to Top

Between 2015 - 2016, over 20,000 Australian veterans and their families sought mental health support (DVA, 2016). Australian Defence Force (ADF) personnel undertake intensive training for operational duties, however it is recognised that such training does not always prepare the mind for the psychological impact of events that may be experienced or witnessed during combat (VVCS, 2016). The significant number of veterans seeking support indicates the need for awareness of services available for serving, ex-serving personnel and their families.

You may be working alongside someone currently or previously involved in the military or a family member who requires support or information. Health professionals, particularly GPs, have been identified as playing an important role in the mental health of veterans, ADF personnel and their families. Having knowledge of support pathways can assist with providing appropriate information and referrals to those affected.

With the advice of the Department of Veterans’ Affairs, we have provided links to useful websites and services that support the mental health and wellbeing of those who have served and their families.

Department of Veterans’ Affairs (DVA)

The Department of Veterans’ Affairs delivers government programs, support and information for war veterans, members of the Australian Defence Force, members of the Australian Federal Police and their dependants.

Veterans and Veterans Families Counselling Service (VVCS)

Counselling Service - 1800 011 046, 24/7 assistance
Veterans and Veterans Families Counselling Service (VVCS) provides free and confidential, nation-wide counselling and support for war and service-related mental health conditions, such as post-traumatic stress disorder (PTSD), anxiety, depression, sleep disturbance and anger.

Department of Defence (DoD)

All-hours Support Line (ASL) - 1800 628 036, 24/7 assistance
The Department of Defence provides a portal with information and links to online resources for ADF members and their families to learn more about mental health, resilience and wellbeing. DoD also provide a confidential phone service, All-hours Support Line (ASL), to help ADF members and their families access mental health services.

At Ease

At Ease is DVA’s online mental health information portal for serving and ex-serving personnel, families and health professionals. At Ease provides self-help tools and information to support mental health and wellbeing and is a gateway to websites and free mobile apps about stress, PTSD, alcohol management, resilience and suicide awareness and prevention. At Ease also offers links to a range of resources for health professionals, including GPs, for effective assessment and evidence-based treatment of veterans. Below are some of the tools referred to in At Ease:

• High Res: an eToolbox designed to help serving and ex-serving Australian Defence Force personnel and their families manage stress and build resilience.
• The Right Mix: a website involving tips, tools and strategies to assist with reducing the impact of drinking on one’s lifestyle
• Operation Life: a website and mobile app that teaches the warning signs of suicide and provides resources to help keep yourself and others safe.

Butterfly Foundation National Helpline

Helpline - 1800 334 673 (Monday – Friday 8am to 9pm AEST, excluding national holidays)
Butterfly’s National Helpline is a free and confidential service providing information, counselling and referral for eating disorders, disordered eating, body image concerns and related issues. This service is open to anyone, including sufferers, carers, family, friends, health professionals, educators and employers.

For additional information, organisations and services, visit http://www.dva.gov.au/contact/ex-service-organisations.

Reference

Department of Veterans’ Affairs. (2016). Department of Veterans’ Affairs Annual Report 2015 – 2016. (2016). Canberra. Retrieved from: http://www.dva.gov.au/about-dva/accountability-and-reporting/annual-reports/annual-reports-2015-16
 

Back to Top