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Recognizing Eating Disorders in Veterans with PTSD
Eating disorders are serious diseases that affect both body and mind. An eating disorder can be anorexia nervosa, bulimia nervosa, or binge eating disorder.
Regardless of the eating disorder individuals will often feel shame, guilt, embarrassment about their disorder and keep it as secretive as possible.
A VA-funded study that looked at female veterans of war trauma stated that depression and post-traumatic stress disorder (PTSD) can trigger disordered eating [1].
This study was published in early 2017 and also found that trauma was associated with disordered eating and was connected to negative feelings and emotions, as well as thoughts of panic, fear, and anxiety [1].
Trauma and Disordered Eating Connection
Women who had been exposed to trauma reported eating more or less and that there is a relationship between trauma, and disordered eating is a cycle [1].
This sequence starts with PTSD symptoms which can induce negative thinking and then turn to eating disorders symptoms to manage the PTSD symptoms.
Further studies show that 31% of soldiers and 20% of soldiers are between 20-29 years of age. Of these numbers, almost 40% reported a psychiatric disability with PTSD being the most frequent diagnosis [2].
In a further study that looked at hospitalized veterans, 25% of women were diagnosed with eating disorders and PTSD [2].
A 2007 study showed that various types of traumas could be connected to eating disorders, such as neglect, sexual assault or harassment, emotional trauma, all which are also seen in situations of war.
Trauma can create a disruption in the nervous system which can make it difficult for a person to manage their emotions. This can lead a person to turn to an eating disorder or other addiction to help manage the trauma.
There are some theories that eating disorders and PTSD are linked, but do one or the other cause each other?
Identifying Eating Disorders and PTSD in Veterans
Both eating disorders and trauma have high rates of dissociation due to trying to distance self from painful experiences, thoughts, emotions, or memories that come with PTSD.
Psychological symbols such as purging can be seen as a way to get rid of unwanted feelings/thoughts and binging can be looked like a way to fill a void within oneself [3].
Both lack of eating and binge eating are signs of eating disorders within veterans. Using food or lack of it, to cope with stressful situations or past events is a part of the disease.
Recognizing that eating disorders are about dealing and controlling, rather than just food, is essential when working with a veteran.
Typically when someone is struggling with co-occurring disorders, the symptoms of both will ebb and flow in severity and symptom struggle. Often if the eating disorder is under control than the PTSD symptoms will be out of control, and vice versa.
Typically PTSD and eating disorders may go together but are not always at the same level of symptomatology at the same time.
What Types of Eating Disorders are There?
Anorexia Nervosa (AN) is a type of eating disorder. This form is usually defined as when a person will significantly restrict calories and liquid with the goal to lose weight. It is often driven by thoughts of being fat or a fear of becoming fat. Typically in females, they will cease to have their menstrual cycle for at least three months or more, consecutively.
Those with anorexia nervosa will also engage in compensating behaviors such as over-exercising to ‘get rid’ of the food or liquid they have ingested.
Often men and women who struggle with AN will be under 85% if their ideal body image weight. They may show signs of obsessive thoughts and behaviors around food, healthy eating, calories in foods, and other unusual behaviors.
They may begin to slowly cut food groups from their diets and only have a list of ‘safe’ foods with which they feel comfortable.
With significant malnutrition, the risk develops for further co-morbid issues such as anxiety and depression, as well as physical complaints such as bone weakness, being cold most of the time, fatigue and GI distress.
Bulimia Nervosa (BN) is the second type of an eating disorder that is when a person will go through cycles of binging and purging mixed with restriction or ‘normal’ eating.
A person who binges and purges at least three times a week for three months or more is considered to have BN. Many times these individuals will keep their disorder and symptoms secret and hid food eaten in various ways.
Binge Eating Disorder (BED) is when an individual will binge but have no compensating behaviors to rid himself of the food.
PTSD is a disorder that an individual will struggle with symptoms of when they have witnessed or been a part of trauma. The trauma can be emotional or physical and it causes dissociation, flashbacks to the event, anxiety, distress, depression, and anger.
Recognizing eating disorders and PTSD in a veteran may be difficult at first, but when you know some of the signs to look for it can be easier to spot.
Knowing that regardless of the disorder, your loved one or friend, may not act him/herself, or become more isolated, have frequent anger outbursts or irritability and show signs of depression.
Remember that your loved one is struggling with symptoms that are beyond being able to treat himself, and seeking treatment is recommended. With proper therapy and support, an eating disorder and PTSD can be managed and recovery is possible.
About the Author: Libby Lyons is a Licensed Clinical Social Worker and Certified Eating Disorder Specialist (CEDS). Libby has been practicing in the field of eating disorders, addictions, depression, anxiety and other comorbid issues in various agencies. Libby has previously worked as a contractor for the United States Air Force Domestic Violence Program, Saint Louis University Student Health and Counseling, Saint Louis Behavioral Medicine Institute Eating Disorders Program, and has been in Private Practice.
Libby currently works as a counselor at Fontbonne University and is a Adjunct Professor at Saint Louis University, and is a contributing author for Addiction Hope and Eating Disorder Hope. Libby lives in the St. Louis area with her husband and two daughters. She enjoys spending time with her family, running, and watching movies.
References:
[1] Richman, M. (2017, February 2). Office of Research & Development. Retrieved August 13, 2017, from https://www.research.va.gov/currents/0217-1.cfm[2] Nieves, J., Pace, A., Stack, K., & Cohen, M. (2015). A Case of Post-Traumatic Stress Disorder Presenting With Anorexia Nervosa Restrictive Type. Retrieved August 13, 2017, from http://militarymedicine.amsus.org/doi/pdf/10.7205/MILMED-D-14-00244
Published in Military Medicine
[3] Eating Disorders, Trauma, and PTSD. (2017, June 26). Retrieved August 13, 2017, from https://www.nationaleatingdisorders.org/blog/eating-disorders-trauma-ptsd-recovery
The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer discussion of various issues by different concerned individuals.
We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.
Published on November 10, 2017.
Reviewed By: Jacquelyn Ekern, MS, LPC on November 10, 2017.
Published on EatingDisorderHope.com
Baxter Ekern is the President of Eating Disorder Hope. He is responsible for the management and operations of Eating Disorder Hope. Baxter has been lending his services to Eating Disorder Hope for several years but came on board as the full-time president in November 2016.
