PTSD, Veterans & Eating Disorders: Lessons for All of Us

The brave men and women who have fought for our country need to be honored in so many ways. But as a mental health professional, it is my experience that this is best accomplished by being kind, compassionate and non-judgmental. This is probably a good rule of thumb for our interactions with all people. You never know what a person has gone through in his/her life that has brought suffering, which is often a root cause of mental illness, substance abuse or other forms of addiction, including eating disorders.

With Veterans Day upon us, we owe it to the men and women who’ve done the difficult work of defending our country to try our best to understand the toll that their experiences have taken. In some very real ways, the difficulties they face when they return home to so-called “safety” are as daunting as the war zone they left behind. Depending on the war, estimates of the percentage of veterans who suffer Post Traumatic Stress Disorder (PTSD) range from 30% (Vietnam) to 10% (the Gulf War). Of these veterans with PTSD, 20% struggle with substance abuse – and a third of veterans who seek treatment for drug or alcohol addiction are also diagnosed with PTSD.

In the many years that I’ve worked in the mental health field, I’ve seen a positive shift in both our professional understanding of PTSD and also in public awareness about the problem. We still have far to go, but by now most people know about the connection between active military duty, PTSD and vulnerability to addictions as a way to escape or self soothe torturous feelings or memories.

Since I specialize in treating those with eating disorders, I’d like to suggest that we open our hearts and minds just a bit more and extend that same level of empathy for those whose PTSD manifests in an eating disorder – a group that is largely, though certainly not completely, female.

Much of what people know about PTSD has to do with men, whose traumas occurred in the context of war. PTSD may play out differently for women. For instance, it is often more likely to be the result of sexual assault than combat. (And sadly this happens here at home, too: The CDC reports that nearly one in five women in the US has been raped, and close to 10% of all American women have PTSD.) Even in the general population, outside of the military, women are not only far more vulnerable to PTSD than men (two or three times more likely) but they also tend to experience its effects differently. Yes, they are prone to develop mental illness and/or drug or alcohol addictions. But women with PTSD are also at high risk for developing an eating disorder – bulimia, most often, followed by binge eating disorder and, in much smaller numbers, anorexia as well.

A 2001 study published in Military Medicine reported that American servicewomen were between six and ten times more likely to develop bulimia than civilian women — and that fully 63% of all enlisted women had an “unspecified” eating disorder (this category includes binge eating disorder)

All of this squares with what we in the eating disorder treatment community know all too well – which is that eating disorders (like all forms of addiction) are complex, multifaceted and have next to nothing to do with willpower, self-control or a lack of discipline. I’ve written before about “fat shaming” (link to previous post) in this space and the damage that it does. Today my plea is different. Let’s honor our veterans and the battle many of them are still fighting by expanding our compassion and respect for everyone who is engaged in their own private battles, the ones we’ll never hear about. Everyone deserves kindness.