Vol. 28 / No. 4 — Eating Disorders Review
Victims who report abuse face widespread social and professional retaliation.
Military sexual trauma (MST) has been defined as psychological trauma resulting from a physical sexual assault occurring while the victim is serving on active duty or in active military training (Veterans Benefits, 2011). The Department of Veterans Affairs suggests that 25% of women and 1% of men serving in the military have experienced MST at some time during their service (Veterans Administration, 2016).
In their recent study, Rebecca K. Blais, PhD, and colleagues at VA centers in Salt Lake City and Logan, UT, San Francisco, and Philadelphia, reported that a group of veterans with positive screenings for MST had nearly twice the likelihood of other veterans of developing an eating disorder. One year after the initial screening, the researchers also found that at one-year follow-up, the increased likelihood of an eating disorder connected to a diagnosis of MST was stronger among male veterans than among female veterans (Int J Eat Disord. 2017; doi:10.1002/eat.2270).
Still largely unexplored territory
Limited work has examined the link between MST and ED risk, and whether this risk varies by gender. Previous reports have linked MST, female gender, and EDs, but in some instances this association was limited to female veterans with comorbid posttraumatic stress disorder (PTSD).
On the other hand, the authors note that male veterans with a history of MST may be at increased risk for eating disorders due to stressors secondary to masculinity and rape myth stereotypes (Int J Adolesc Med & Health. 2013; 25:269). In addition, male veterans may be less likely to seek or to receive mental health treatment (Women’s’ Health Issues. 2012; 22:e61). Many veterans, male and female alike, are extremely reticent to report such assaults, and often with good reason. As the Rand Corporation reported in a study commissioned by the Department of Defense, 62% of veterans who had complained of MST experienced either social or professional retaliation, including loss of promotions and harassment, along with physical attacks from their peers.
In their recent study, Dr. Blais and colleagues studied a large representative cohort of male and female veterans who had served in operations Enduring Freedom and Iraqi Freedom. Two cohorts were used, one that involved a 1-year follow-up and one using a 5-year follow-up. Military sexual trauma was screened with the VHA MST screener, which uses two questions to determine if sexual trauma has occurred. All mental health disorders were identified with ICD-9 codes retrieved from clinical data.
A snapshot of veterans affected by MST and EDs
Three percent of the 18,488 veterans screened reported experiencing MST. Female veterans, veterans who had never married, younger non-Black veterans, veterans on active duty in the Navy/Coast Guard and the Air Force who had positive screenings for MST were more likely to be diagnosed with an ED. Other risk factors included higher rates of comorbid PTSD, depressive disorders, alcohol-related disorders, and substance-related disorders.
The authors noted that the incidence of MST and eating disorders among veterans are an understudied public health concern and share many of the same psychiatric distress patterns with PTSD, depression, substance misuse, and homelessness. The researchers also reported that male veterans are more vulnerable to psychiatric distress and dysfunction than previously thought. These findings echo an earlier study that showed that males with a history of MST had higher levels of suicidal ideation and planning, PTSD, and poorer perceived health than did female veterans (Psychiatry Res. 2015; 227:246).
Gaining a better understanding of the relationship between MST and the development of an eating disorder may help researchers and clinicians improve awareness of the problem. Increased awareness may then lead to improved screening. Better screening strategies and earlier intervention can be powerful nonmilitary weapons to bring this often-hidden problem into the light.