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Tilstra-Ferrell EL, Braden A, Russin S. Military sexual trauma, combat trauma, and disordered eating among United States veterans: An exploration of underlying mechanisms. MILITARY PSYCHOLOGY 2024:1-12. [PMID: 38781487 DOI: 10.1080/08995605.2024.2336639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 03/22/2024] [Indexed: 05/25/2024]
Abstract
Military sexual trauma (MST) and combat trauma (CT) survivors experience disproportionate risk for disordered eating. A survey of MST, CT, disordered eating, trauma-related self-blame, emotion regulation challenges, body dissatisfaction, and dissociation among military personnel with a history of military-related trauma was conducted. These survey-based cross-sectional data were analyzed via parallel mediation analyses and Analyses of Covariance (ANCOVA). Six parallel mediation analyses were conducted examining trauma-related self-blame, emotion regulation challenges, body dissatisfaction, and dissociation as mediators linking MST and CT, separately, with purging, restricting, and bingeing. ANCOVAs were also performed to examine differences in levels of bingeing, restriction, and purging among people exposed to MST, CT, both MST and CT, and neither. MST and CT exposure was indirectly related to bingeing via emotion regulation challenges. MST and CT was also indirectly related to both restriction and purging via emotion regulation challenges and trauma-related self-blame. Dissociation and body dissatisfaction were not significant mediators in any model. Participants endorsed high levels of disordered eating. Individuals exposed to both MST and CT reported greater bingeing, restricting, and purging than individuals exposed to either CT, MST, or neither. Findings highlight the nuanced symptoms that may increase risk for disordered eating among MST and/or CT survivors. Future treatment research should explore how addressing emotion regulation and trauma-related self-blame among individuals with MST and/or CT may help address disordered eating. Implications and future directions for this area of research are discussed.
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Affiliation(s)
| | - Abby Braden
- Department of Psychology, Bowling Green State University (BGSU), Ohio
| | - Sarah Russin
- Department of Psychology, Bowling Green State University (BGSU), Ohio
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Hill NG, Abber SR, Keel PK. The role of sexual assault history and PTSD in responses to food intake among women with bulimic-spectrum eating disorders. Eat Disord 2024; 32:266-282. [PMID: 38093449 PMCID: PMC11116069 DOI: 10.1080/10640266.2023.2293597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/24/2024]
Abstract
Sexual abuse or assault (SA) history is associated with eating disorder severity and psychiatric comorbidity, including post-traumatic stress disorder (PTSD). Beyond persistent alterations in mood and cognitions characterizing PTSD, PTSD due to SA may contribute to greater increases in negative affect and body image concerns following food intake in bulimic syndromes (BN-S). To test this, participants (n = 172) with BN-S who reported PTSD due to SA, PTSD due to other forms of trauma, or neither completed clinical interviews and momentary reports of negative affect and shape/weight preoccupation before and after food intake. Participants with PTSD, regardless of trauma source, reported higher purging frequency whereas PTSD due to SA was associated with more frequent loss of control eating. For one task, changes in negative affect following food intake differed across the three groups. Negative affect decreased significantly in participants with PTSD without SA whereas nonsignificant increases were observed in those with PTSD with SA. Results of the present study suggest that source of trauma in PTSD may impact likelihood that eating regulates affect and provide insight into ways current treatments may be adapted to better target purging in BN-S comorbid with PTSD.
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Affiliation(s)
| | - Sophie R. Abber
- Department of Psychology, Florida State University, Tallahassee, FL 32304
| | - Pamela K. Keel
- Department of Psychology, Florida State University, Tallahassee, FL 32304
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3
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Reinhardt KM, McCaughey VK, Vento SA, Street AE. In Their Own Words: Women Veterans Identify the Personal Consequences of Military Sexual Trauma Victimization. Violence Against Women 2024; 30:722-742. [PMID: 36617939 DOI: 10.1177/10778012221147909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
This qualitative study provides a platform for women veterans to inform our perspective of their experienced impacts following military sexual trauma (MST). We engaged 23 women veterans in semistructured interviews and used a grounded theory-informed thematic analytic approach, to interpret women's experiences. Women described negative impacts of their MST experiences across psychological, behavioral, and occupational domains. Less frequently, women discussed experiences of posttraumatic growth. These results aid our understanding of the complexities of women's posttrauma experiences and suggest that holistic intervention frameworks focused on a range of potential intervention targets are warranted in helping women veterans recover from MST.
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Affiliation(s)
| | - Virginia K McCaughey
- Suffolk University and National Center for PTSD at VA Boston Healthcare System, Boston, MA, USA
| | | | - Amy E Street
- National Center for PTSD at VA Boston Healthcare System and Boston University School of Medicine, Boston, MA, USA
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Braun TD, Bhuptani PH, O’Keefe B, Abrantes AM, Marsh E, Holzhauer CG. Mindful self-compassion for veteran women with a history of military sexual trauma: feasibility, acceptability, potential benefits, and considerations. Eur J Psychotraumatol 2024; 15:2301205. [PMID: 38349003 PMCID: PMC10866049 DOI: 10.1080/20008066.2023.2301205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 12/08/2023] [Indexed: 02/15/2024] Open
Abstract
Background: Military sexual trauma (MST) is reported by up to 74% of women veterans in the United States and is a driver of poor behavioural and physical health. Self-compassion is a transdiagnostic, protective factor linked with improved posttraumatic stress disorder (PTSD), depression, and health behaviours. Thus, Mindful Self-Compassion training (MSC) may help ameliorate MST-related impacts. However, MSC can also temporarily increase distress (i.e. backdraft). Delivering it with elective trauma-informed yoga (TIY), which regulates acute distress, may help address this issue.Objective: This VA quality improvement project examined feasibility, acceptability, and reported benefits and challenges of a manualized 8-week MSC including within non-randomized subgroups: MSC (n = 4) and MSC+ elective TIY classes (MSC+; n = 4).Methods: Nine women veterans with a history of MST at a Vet Center in the Northeastern U.S.A. enrolled; eight completed, excluding one MSC+ participant. Measures included attrition (n = 9), attendance (n = 8), weekly (n = 8) and posttreatment acceptability (n = 6), validated symptom severity assessments (n = 7), and an exit interview (n = 8).Results: Among completers, MSC attendance was excellent (89%) and higher among in MSC+ vs. MSC (94% vs. 84% sessions completed). On average across the two groups, depressive and PTSD symptom severity decreased by 21% and 30%, respectively. In exit interviews, participants across groups described improved coping with distress and psychiatric symptoms, reduced stress, and improved self-care and health behaviours. Although women in both groups reported backdraft during the programme, MSC+ also reported healthier coping and improved emotional processing.Conclusion: The results of this programme evaluation infer MSC may be feasible, acceptable, and beneficial for women survivors of MST in one Vet Center in the Northeastern USA. Further, temporary elevations in MSC-related distress may be ameliorated with adjunctive TIY. Given requests of women veterans in the USA. for additional complementary and integrative health treatment options, formal research on these approaches is warranted.
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Affiliation(s)
- Tosca D. Braun
- Alpert Medical School of Brown University, Providence, RI, USA
- Butler Hospital, Providence, RI, USA
- VA Central Western Massachusetts, Leeds, MA, USA
| | - Prachi H. Bhuptani
- Alpert Medical School of Brown University, Providence, RI, USA
- Rhode Island Hospital, Providence, RI, USA
| | | | - Ana M. Abrantes
- Alpert Medical School of Brown University, Providence, RI, USA
- Butler Hospital, Providence, RI, USA
| | | | - Cathryn Glanton Holzhauer
- VA Central Western Massachusetts, Leeds, MA, USA
- University of Connecticut School of Medicine, Farmington, CT, USA
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5
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Zhao Z, Serier KN, Smith BN, Vogt D, Kehle-Forbes S, Mitchell KS. Gender similarities and differences in associations between weight discrimination, shape/weight concerns, and eating disorder symptoms among post-9/11 veterans. Eat Behav 2023; 51:101818. [PMID: 37741082 DOI: 10.1016/j.eatbeh.2023.101818] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 09/13/2023] [Accepted: 09/13/2023] [Indexed: 09/25/2023]
Abstract
OBJECTIVE Weight discrimination, defined as mistreatment of people based on body weight, is associated with body image concerns and eating disorder (ED) symptoms. Military veterans are particularly vulnerable to developing ED symptoms, which may be due to experiences of weight discrimination resulting from the military's strict weight and fitness requirements. However, no previous study has examined these associations among veterans. We investigated relationships between weight discrimination during and after military service and shape/weight concerns and ED symptoms in post-9/11 veterans. Based on evidence for gender differences in weight discrimination, body image, and ED symptoms, we also examined whether gender moderated these associations. METHOD Participants were randomly selected from the population of post-9/11 U.S. veterans who had been discharged from the military within the previous 18 months. A total of 1494 veterans completed the Everyday Discrimination Scale, Eating Disorders Examination-Questionnaire, and the Eating Disorder Diagnostic Scale-5. RESULT Women were more likely to report weight discrimination and had higher levels of ED symptoms and shape/weight concerns than men. Weight discrimination in and after leaving the military were positively associated with shape/weight concerns and ED symptoms in the full sample and among men and women. Gender moderated the association between weight discrimination after leaving the military and shape/weight concerns such that the association was stronger among men. DISCUSSION Both male and female veterans may be vulnerable to developing ED symptoms, in part due to weight discrimination experienced during and after military service. Our findings emphasize the need to address weight discrimination and its consequences in veterans.
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Affiliation(s)
- Ziyu Zhao
- National Center for PTSD at VA Boston Healthcare System, United States of America; Department of Psychological & Brain Science, Boston University, United States of America
| | - Kelsey N Serier
- National Center for PTSD at VA Boston Healthcare System, United States of America; Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, United States of America
| | - Brian N Smith
- National Center for PTSD at VA Boston Healthcare System, United States of America; Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, United States of America
| | - Dawne Vogt
- National Center for PTSD at VA Boston Healthcare System, United States of America; Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, United States of America
| | - Shannon Kehle-Forbes
- National Center for PTSD at VA Boston Healthcare System, United States of America; Minneapolis VA Healthcare System, United States of America; Department of Medicine, University of Minnesota, United States of America
| | - Karen S Mitchell
- National Center for PTSD at VA Boston Healthcare System, United States of America; Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, United States of America.
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Zelkowitz RL, Sienkiewicz ME, Vogt DS, Smith BN, Mitchell KS. Gender differences in direct and indirect associations of trauma types with disordered eating in a national U.S. veteran sample. PSYCHOLOGICAL TRAUMA : THEORY, RESEARCH, PRACTICE AND POLICY 2023; 15:1280-1287. [PMID: 36074630 PMCID: PMC10283316 DOI: 10.1037/tra0001353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Disordered eating (DE) in military veterans has been linked to trauma exposure, but the mechanisms underlying this association remain unclear. The current study documented the direct associations of DE with multiple trauma types in a gender-balanced sample of veterans and examined indirect associations of trauma and DE via self-reported PTSD symptoms and concerns about shape and weight. METHOD Participants included 1,187 veterans (50% women, 46% men, 4% another) from multiple service eras. Sampling weights were applied to enhance representativeness to the national veteran population. RESULTS Gender-stratified, weighted models revealed associations of premilitary, warfare, and postseparation trauma with DE in men and associations of premilitary, military sexual (MST), and postseparation trauma with DE in women. Monte Carlo estimation of indirect effects showed support for indirect associations of premilitary, warfare, and postseparation-related trauma/stressor exposure with DE via PTSD symptoms among men; postseparation stressors were also indirectly associated with DE via shape and weight concerns. Among women, each trauma type was indirectly associated with DE via shape and weight concerns but not PTSD symptoms. When trauma exposures were examined concurrently, MST and postseparation trauma exposure were uniquely associated with DE via shape and weight concerns among women. Only the indirect association of postseparation trauma/stressor exposure with DE via shape and weight concerns was significant among men. CONCLUSIONS Findings support the need for gender-specific interventions that target different mechanisms contributing to DE symptoms among veterans. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Rachel L. Zelkowitz
- Women’s Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Massachusetts, USA
- Department of Psychiatry, Boston University School of Medicine, Massachusetts, USA
| | - Megan E. Sienkiewicz
- Women’s Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Massachusetts, USA
| | - Dawne S. Vogt
- Women’s Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Massachusetts, USA
- Department of Psychiatry, Boston University School of Medicine, Massachusetts, USA
| | - Brian N. Smith
- Women’s Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Massachusetts, USA
- Department of Psychiatry, Boston University School of Medicine, Massachusetts, USA
| | - Karen S. Mitchell
- Women’s Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Massachusetts, USA
- Department of Psychiatry, Boston University School of Medicine, Massachusetts, USA
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Sandhu D, Dougherty EN, Haedt-Matt A. PTSD symptoms as a potential mediator of associations between military sexual assault and disordered eating. Eat Disord 2023; 31:285-299. [PMID: 36239705 DOI: 10.1080/10640266.2022.2133586] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Despite increasing rates of sexual assault in the military and high rates of disordered eating and post-traumatic stress disorder (PTSD) among veterans, little is known about how these constructs are related. This study examined whether PTSD symptoms mediate the relation between military sexual assault and disordered eating among female veterans. United States female veterans (N = 98) completed self-report measures assessing military sexual assault, PTSD, and disordered eating. Results indicated that military sexual assault was associated with higher PTSD symptoms and disordered eating. PTSD symptoms did not mediate the relation between military sexual assault and overall levels of disordered eating. However, PTSD symptoms fully mediated the relation between military sexual assault and the Bulimia and Food Preoccupation subscale of the Eating Attitudes Test-26. Findings suggest that military sexual assault may contribute to the development of bulimia nervosa symptoms indirectly through PTSD symptoms. Thus, the findings do not support a global relationship between trauma and all facets of disordered eating, but demonstrate a relationship between PTSD and bulimia nervosa symptoms, with purging potentially functioning as an emotion regulation strategy. Future longitudinal studies are needed to establish temporal precedence of these associations.
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Affiliation(s)
- Danielle Sandhu
- Department of Psychology, Illinois Institute of Technology, Chicago, Illinois, USA
| | | | - Alissa Haedt-Matt
- Department of Psychology, Illinois Institute of Technology, Chicago, Illinois, USA
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8
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Gaviria D, Ammerman A. Eating disorders and disordered eating in servicemen and women: A narrative review. J Clin Psychol 2023; 79:316-373. [PMID: 35938917 DOI: 10.1002/jclp.23424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 06/09/2022] [Accepted: 07/14/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Eating disorders (EDs) are mental illnesses impacting all aspects of an individual's life. Recent research has examined EDs and disordered-eating behaviors in the military, a population subject to body composition standards, fitness requirements, and extreme stress. The purpose of this narrative review was to investigate ED and disordered-eating prevalence and their risk factors in ROTC (reserve officers' training corps), active-duty, and veteran servicemembers. The secondary purpose was to provide policy recommendations to reduce the burden of these conditions in the military. METHODS PubMed and PsycINFO were reviewed for relevant articles. All studies including data on EDs or disordered eating in U.S. active-duty, ROTC, or veteran populations were considered. RESULTS Results revealed a high burden of EDs and disordered eating with bulimic- and binge-type behaviors being the most common. Servicemembers exposed to trauma, including military sexual assault, and those with comorbidities like PTSD showed a higher prevalence. Body composition and fitness testing were also associated with a higher risk. Qualitative studies suggest these conditions serve as coping mechanisms for aspects of military life. CONCLUSIONS The high prevalence of EDs and disordered eating in the military points toward the importance of identification, treatment, and prevention. Policy change is necessary to protect servicemembers.
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Affiliation(s)
- David Gaviria
- Department of Nutrition, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Alice Ammerman
- Center for Health Promotion and Disease Prevention, Department of Nutrition, Schools of Public Health and Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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9
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Convertino AD, Morland LA, Blashill AJ. Trauma exposure and eating disorders: Results from a United States nationally representative sample. Int J Eat Disord 2022; 55:1079-1089. [PMID: 35719053 PMCID: PMC9545485 DOI: 10.1002/eat.23757] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 05/27/2022] [Accepted: 05/27/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Sexual assault, child abuse, and combat have been linked to eating disorders (EDs). However, noninterpersonal trauma is relatively understudied, and therefore it is unknown whether noninterpersonal trauma is associated with EDs. Furthermore, most previous studies do not account for multiple trauma exposures, or the relative association of traumatic events with EDs in the same statistical model. METHOD Multinomial regression was used to examine the association of lifetime ED diagnosis (anorexia nervosa [AN], bulimia nervosa [BN], binge eating disorder [BED]) with trauma type (sexual interpersonal, other interpersonal, war/combat, and noninterpersonal) in a nationally representative dataset of US adults in bivariate and multivariable (i.e., with all trauma types) models. RESULTS Sexual interpersonal trauma was significantly positively associated with AN and BED in bivariate and multivariable models. In the multivariable model, only BED was found to be equally associated with sexual interpersonal, other interpersonal, and noninterpersonal trauma. DISCUSSION These results indicate a strong positive association between sexual trauma and EDs, even when controlling for experiences of other trauma events. Future research should examine longitudinal mediators between trauma and EDs, especially sexual trauma, to identify what factors may explain this relationship. PUBLIC SIGNIFICANCE STATEMENT Individuals with eating disorders often experience traumatic events but it is unclear whether specific trauma types are more or less common in this population. This study found that only events such as rape and sexual assault are associated with anorexia nervosa, but that most trauma types are associated with binge eating disorder. Therefore, the relationship between trauma and binge eating disorder may function differently than other eating disorders.
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Affiliation(s)
- Alexandra D. Convertino
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical PsychologySan DiegoCalifornia
| | - Leslie A. Morland
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical PsychologySan DiegoCalifornia,Department of PsychiatryUniversity of CaliforniaSan DiegoCaliforniaUSA,Veterans Affairs San Diego Healthcare SystemSan DiegoCaliforniaUSA,National Center for PTSD–Pacific Islands DivisionHonoluluHawaiiUSA
| | - Aaron J. Blashill
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical PsychologySan DiegoCalifornia,Department of PsychologySan Diego State UniversitySan DiegoCaliforniaUSA
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Touma DA, Quinn ME, Freeman VE, Meyer EG. Eating Disorders in U.S. Active Duty Military Members and Veterans: A Systematic Review. Mil Med 2022; 188:usac180. [PMID: 35788384 DOI: 10.1093/milmed/usac180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 05/30/2022] [Accepted: 06/08/2022] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Feeding and eating disorders can be difficult to treat and frequently co-occur with other mental health conditions. The last systematic review of eating disorders in a military and veteran population was published in 2015. An updated review is warranted to re-examine the current literature on eating disorders in the active duty and veteran populations. MATERIALS AND METHODS A systematic review that described the prevalence, co-occurrence of other disorders and/or events, and health care utilization of U.S. active duty members and veterans was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Databases and Medical Subject Headings (MeSH) terms used are listed in Appendix A. Each category of the literature was extracted and graded using the Oxford Centre for Evidence-Based Medicine Levels of Evidence. RESULTS Twenty-one studies revealed prevalence estimates with varying rates based on demographic information. Trauma exposure is consistently associated with eating disorder development. Individuals diagnosed with eating disorders had greater health care utilization. CONCLUSIONS Research on eating disorders in the military and veteran populations has expanded in recent years. Limitations of the evidence included in this review stem from the use of self-reported questionnaires, changes to medical record systems, and limited generalizability to the overall population of patients with eating disorders. Further research should investigate the impact of demographic factors and trauma exposure on the development of an eating disorder within the military and veteran populations.
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Affiliation(s)
- Danielle A Touma
- Department of Psychiatry, Uniformed Services University, Bethesda, MD 20814, USA
| | - Meghan E Quinn
- Department of Psychiatry, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Vanessa E Freeman
- Department of Psychiatry, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Eric G Meyer
- Department of Psychiatry, Uniformed Services University, Bethesda, MD 20814, USA
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Walter KH, Levine JA, Madra NJ, Beltran JL, Glassman LH, Thomsen CJ. Gender differences in disorders comorbid with posttraumatic stress disorder among U.S. Sailors and Marines. J Trauma Stress 2022; 35:988-998. [PMID: 35218250 PMCID: PMC9306964 DOI: 10.1002/jts.22807] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 01/04/2022] [Accepted: 01/09/2022] [Indexed: 01/24/2023]
Abstract
Psychological comorbidity, the co-occurrence of mental health disorders, is more often the rule than the exception among individuals with posttraumatic stress disorder (PTSD). Research shows that prevalence estimates for specific psychological disorders differ by gender; however, little is known about whether these patterns persist in the presence of a comorbid PTSD diagnosis. This study examined gender differences in prevalence estimates for conditions comorbid with PTSD using medical records for 523,626 active duty U.S. Sailors and Marines who entered the military over an 8-year period. Using chi-square tests of independence, we detected statistically significant gender differences for specific comorbid conditions in the subsample of 9,447 service members with a PTSD diagnosis. Women were more likely than men to have PTSD with comorbid adjustment, OR = 1.35; depressive, OR = 1.71; and generalized anxiety or other anxiety disorders, OR = 1.16, with the largest effects for eating, OR = 12.60, and personality disorders, OR = 2.97. In contrast, women were less likely than men to have a diagnosis of PTSD with comorbid alcohol use, OR = 0.69, and drug use disorders, OR = 0.72, with the largest effects for insomnia, OR = 0.42, and traumatic brain injury, OR = 0.17. No significant gender differences emerged for comorbid bipolar, obsessive-compulsive, panic/phobic, psychotic, or somatoform/dissociative disorders, ps = .029-.314. The results show gender differences in conditions comorbid with PTSD generally align with internalizing and externalizing dimensions. Differences in comorbidities with PTSD between women and men could have implications for treatment development and delivery.
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Affiliation(s)
- Kristen H. Walter
- Health and Behavioral SciencesNaval Health Research CenterSan DiegoCaliforniaUSA
| | - Jordan A. Levine
- Health and Behavioral SciencesNaval Health Research CenterSan DiegoCaliforniaUSA,LeidosRestonVirginiaUSA
| | - Naju J. Madra
- Health and Behavioral SciencesNaval Health Research CenterSan DiegoCaliforniaUSA,LeidosRestonVirginiaUSA
| | - Jessica L. Beltran
- Health and Behavioral SciencesNaval Health Research CenterSan DiegoCaliforniaUSA,LeidosRestonVirginiaUSA
| | - Lisa H. Glassman
- Health and Behavioral SciencesNaval Health Research CenterSan DiegoCaliforniaUSA,LeidosRestonVirginiaUSA
| | - Cynthia J. Thomsen
- Health and Behavioral SciencesNaval Health Research CenterSan DiegoCaliforniaUSA
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12
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Serier KN, Smith BN, Cooper Z, Vogt D, Mitchell KS. Disordered eating in sexual minority post-9/11 United States veterans. Int J Eat Disord 2022; 55:470-480. [PMID: 35092637 DOI: 10.1002/eat.23680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 01/12/2022] [Accepted: 01/12/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE It is well documented that sexual minority individuals are more likely to report disordered eating (DE) than those identifying as heterosexual. Although DE is prevalent in veterans, investigation of potential disparities in DE among sexual minority veterans is limited. This study examined rates of DE in post-9/11 United States (U.S.) veterans identifying as sexual minorities and explored their association with discrimination because of marginalized identities. METHODS A national sample of recently separated post-9/11 U.S. veterans were recruited. Women (N = 805; heterosexual [n = 656]; lesbian [n = 51]; bisexual [n = 98]) and men (N = 558; heterosexual [n = 540]; gay [n = 11]; bisexual [n = 7]) completed a survey assessing eating behaviors, mental health, and military experiences. Weighted correlational and regression analyses were conducted. Analyses in men were exploratory. RESULTS DE was prevalent across gender and sexual orientation identity groups. Women identifying as bisexual and men identifying as gay reported higher rates of DE and consequent impairment compared to veterans who identified as heterosexual. There were no differences in DE between heterosexual and lesbian female veterans, but lesbian women reported lower DE-related impairment. Experiencing any discrimination in the military was positively related to DE. DISCUSSION This study found evidence of disparities in DE among sexual minority U.S. military veterans. While the factors contributing to these differences, such as the role of discrimination, are not completely understood, DE is a health concern for sexual minority veterans and requires continued investigation. PUBLIC SIGNIFICANCE Sexual minority individuals experience disparities in disordered eating; yet, this has not been explored in military veterans. This study found that disordered eating is a significant health concerns for veteran women and men, especially among those identifying as sexual minorities. More research is needed to explore why these disparities exist, such as the role of minority stress, in order to address the unique healthcare needs of these veterans.
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Affiliation(s)
- Kelsey N Serier
- National Center for PTSD at VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Brian N Smith
- National Center for PTSD at VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Zafra Cooper
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Dawne Vogt
- National Center for PTSD at VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Karen S Mitchell
- National Center for PTSD at VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
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13
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Nelson JD, Cuellar AE, Cheskin LJ, Fischer S. Eating Disorders and Posttraumatic Stress Disorder: A Network Analysis of the Comorbidity. Behav Ther 2022; 53:310-322. [PMID: 35227406 DOI: 10.1016/j.beth.2021.09.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 09/10/2021] [Accepted: 09/18/2021] [Indexed: 11/02/2022]
Abstract
Eating disorders (EDs) and posttraumatic stress disorder (PTSD) commonly co-occur, but the mechanisms driving this co-occurrence are not well understood. The current study explored the relationships between symptoms of ED and PTSD in a sample of male and female undergraduate students in order to identify pathways that may maintain the comorbidity. Network analysis was conducted in a sample of 344 first-year undergraduates to visualize partial correlations between each symptom in the comorbidity. Core symptoms, bridge symptoms, and direct pathways between ED and PTSD symptoms were identified. The PTSD symptoms negative emotions (strength = 1.13) and negative beliefs (strength = 1.11) were the strongest symptoms in the network. The strongest bridge nodes were the ED symptoms restriction (bridge strength = 3.32) and binge eating (bridge strength = 2.63). The strongest edges between ED and PTSD nodes were between binge eating and concentration (part r = .16), restriction and sleep (part r = .14), and binge eating and positive emotions (part r = .11). Findings suggest that PTSD symptoms related to negative alterations in cognitions and mood may be highly influential in the ED-PTSD network due to their relatedness to all other symptoms. The pathway between binge eating and inability to experience positive emotions suggest that the comorbidity may be partially maintained through an affect regulation function of binge eating.
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14
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Flatt RE, Norman E, Thornton LM, Fitzsimmons-Craft EE, Balantekin KN, Smolar L, Mysko C, Wilfley DE, Taylor CB, Bulik CM. Eating disorder behaviors and treatment seeking in self-identified military personnel and veterans: Results of the National Eating Disorders Association online screening. Eat Behav 2021; 43:101562. [PMID: 34534875 PMCID: PMC8952181 DOI: 10.1016/j.eatbeh.2021.101562] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 08/12/2021] [Accepted: 09/01/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To characterize disordered eating behaviors, eating disorder (ED) risk and diagnosis, and treatment seeking behaviors in active-duty military personnel/veterans compared with civilians. METHOD Self-selecting participants (n = 113,388; 1744 were military personnel/veterans) 18+ years old completed the National Eating Disorders Association's online screen. Engagement in and frequencies of disordered eating behaviors were compared across military/veteran and civilian groups and were stratified by gender. ED risk and diagnosis and treatment seeking behaviors were also compared. RESULTS Individuals in the military/veteran group were more likely to engage in diuretic/laxative use and excessive exercise compared with civilians. Compared with civilians, the military/veteran group had a lower percentage who screened "at risk for an ED" and a higher percentage who screened for "no risk". Females in the military/veteran group were more likely to engage in diuretic/laxative use, excessive exercise, and fasting compared with female civilians; males in the military/veteran group were more likely to engage in excessive exercise and less likely to engage in vomiting than male civilians. Of the self-identified military personnel/veterans who screened positive for any ED, 86% had never received treatment, which did not differ significantly from civilians. Notably, 56.7% of those (54.1% of military/veteran group; 56.7% of civilians) who completed an optional item on intention to seek treatment (n = 5312) indicated they would not seek treatment. CONCLUSIONS Disordered eating and ED profiles, but not treatment seeking, may differ between military personnel/veterans and civilians who complete an online ED screen. Future work should emphasize treatment options and connecting respondents directly to tailored resources.
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Affiliation(s)
- Rachael E Flatt
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Elliott Norman
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Laura M Thornton
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | - Lauren Smolar
- National Eating Disorders Association, New York City, NY, USA
| | - Claire Mysko
- National Eating Disorders Association, New York City, NY, USA
| | - Denise E Wilfley
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - C Barr Taylor
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA; Center for m(2)Health, Palo Alto University, Palo Alto, CA, USA
| | - Cynthia M Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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15
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Forkus SR, Weiss NH, Goncharenko S, Mammay J, Church M, Contractor AA. Military Sexual Trauma and Risky Behaviors: A Systematic Review. TRAUMA, VIOLENCE & ABUSE 2021; 22:976-993. [PMID: 31920168 PMCID: PMC10193300 DOI: 10.1177/1524838019897338] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
INTRODUCTION Military sexual trauma (MST) is a serious and pervasive problem among military men and women. Recent findings have linked MST with various negative outcomes including risky, self-destructive, and health-compromising behaviors. OBJECTIVE The current review summarizes the existing literature on the association between MST and risky behaviors among military men and women who have served in the U.S. Armed Forces. METHOD We systematically searched five electronic databases (PubMed, EMBASE, PSYCINFO, PILOTS, and CINAHL Plus) using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS Of the initial 2,021 articles, 47 met the inclusion criteria. Reviewed studies revealed three patterns of findings: (1) largely studied and consistent (i.e., suicidal behaviors, disordered eating), (2) mixed and in need of future research (i.e., alcohol and drug use, smoking), and (3) underexamined (i.e., sexual behaviors, illegal/aggressive behaviors) or completely neglected (e.g., problematic technology use, gambling). DISCUSSION The current systematic review advances literature by providing strong support for an association between MST and a wide range of risky behaviors. Moreover, it highlights important areas for future research.
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16
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Pebole MM, VanVoorhees EE, Chaudhry N, Goldstein KM, Thompson J, Parker R, Caron KM, Hall KS. Patient-centered behavioral services for women veterans with mental health conditions. Transl Behav Med 2021; 11:1676-1681. [PMID: 34080638 DOI: 10.1093/tbm/ibab057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The Veterans Health Administration (VHA) is undergoing a transformational shift from disease-focused care to a Whole Health model that emphasizes physical, mental, emotional, and spiritual health and well-being. As this shift is occurring, women veterans using VHA services face challenges navigating a system that has historically served a primarily male demographic, without consistent consensus on which services require specialization by gender. A quality improvement project was conducted to solicit feedback on VHA behavioral and wellness programs from women veterans enrolled in VHA mental healthcare services. A multi-disciplinary work group of clinical researchers and healthcare providers developed a needs assessment survey to assess patient needs and preferences for behavioral health services. A convenience sample of female veterans using VHA mental healthcare services within a comprehensive Women's Health Clinic were invited to complete this anonymous survey. 107 women Veterans 18-65+ years old (65.3% African American; 5.9% LatinX; 54.2% aged under 55) completed the survey. Over 50% of patients endorsed relationships, physical activity, sleep/nightmares, pain management, anger, or spiritual/moral pain as top wellness priorities. Programatic preferences included location (located at the main VA Hospital) and gender composition (female only group formats). Schedule conflicts were the most frequently cited barriers. Results from this quality improvement project highlight considerations for tailoring the content and delivery of behavioral services for women veterans with mental health conditions.
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Affiliation(s)
- Michelle M Pebole
- Department of Kinesiology and Community Health, University of Illinois at Urbana Champaign, Champaign, IL, USA.,Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs Healthcare System, Durham, NC, USA
| | - Elizabeth E VanVoorhees
- Durham Veterans Affairs Medical Center, Durham, NC, USA.,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | | | - Karen M Goldstein
- Durham Veterans Affairs Medical Center, Durham, NC, USA.,Department of Medicine, Duke University, Durham, NC, USA
| | - Jillian Thompson
- Physical Medicine and Rehabilitation Service, Durham Veterans Affairs Healthcare System, Durham, NC, USA
| | - Ryan Parker
- Chaplain Service, Durham Veterans Affairs Healthcare System, Durham, NC, USA
| | - Kelly M Caron
- Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Katherine S Hall
- Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs Healthcare System, Durham, NC, USA.,Department of Medicine, Duke University, Durham, NC, USA
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17
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Sienkiewicz ME, Iverson KM, Smith BN, Mitchell KS. Associations between eating disorder symptoms, employment status, and occupational functioning among female veterans. Eat Behav 2021; 42:101536. [PMID: 34182295 DOI: 10.1016/j.eatbeh.2021.101536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 06/07/2021] [Accepted: 06/18/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Eating disorders (EDs) have been shown to negatively impact occupational functioning and may be associated with employment status. Findings have been inconsistent, and depression may mediate this relation. Further, prior research focuses mainly on binge eating disorder's (BED) impact on occupational functioning. We assessed the association between transdiagnostic ED symptoms and occupational functioning and employment status among female veterans, who tend to have high rates of EDs and unemployment but who remain understudied. METHOD Participants were 198 female veterans (Mage = 54.09) in the New England region who participated in a larger study. They completed a mailed survey including the Eating Disorder Diagnostic Scale, Center for Epidemiologic Studies-Depression Scale, employment status (employed vs. unemployed and out of the workforce), and the Inventory of Psychosocial Functioning to assess occupational functioning. RESULTS ED symptoms were not significantly related to employment status but were negatively associated with occupational functioning when controlling for body mass index. Depressive symptoms mediated the associations between ED symptoms and both being out of the workforce and occupational functioning, respectively. DISCUSSION Higher levels of ED symptoms were associated with worse occupational functioning in a female veteran sample. Further, comorbid depressive symptoms may be an important treatment target when addressing occupational health in women experiencing ED symptoms.
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Affiliation(s)
- Megan E Sienkiewicz
- National Center for PTSD, VA Boston Healthcare System, 150 South Huntington Avenue, Boston, MA 02130, USA
| | - Katherine M Iverson
- National Center for PTSD, VA Boston Healthcare System, 150 South Huntington Avenue, Boston, MA 02130, USA; Department of Psychiatry, Boston University School of Medicine, 715 Albany St, Boston, MA 02118, USA
| | - Brian N Smith
- National Center for PTSD, VA Boston Healthcare System, 150 South Huntington Avenue, Boston, MA 02130, USA; Department of Psychiatry, Boston University School of Medicine, 715 Albany St, Boston, MA 02118, USA
| | - Karen S Mitchell
- National Center for PTSD, VA Boston Healthcare System, 150 South Huntington Avenue, Boston, MA 02130, USA; Department of Psychiatry, Boston University School of Medicine, 715 Albany St, Boston, MA 02118, USA.
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18
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Post-traumatic stress disorder may set the neurobiological stage for eating disorders: A focus on glutamatergic dysfunction. Appetite 2021; 167:105599. [PMID: 34271078 DOI: 10.1016/j.appet.2021.105599] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 06/23/2021] [Accepted: 07/12/2021] [Indexed: 12/30/2022]
Abstract
Post-traumatic stress disorder (PTSD) is a trauma and stress-related disorder which has been shown to be highly comorbid with, and commonly a precedent of, the eating disorders anorexia nervosa, bulimia nervosa, and binge eating disorder. The objective of this review is to discuss a potential overlapping neurobiological mechanism for this comorbidity. Alterations in glutamatergic neurotransmission have been observed in all four of the aforementioned disorders. Excessive excitation via glutamate contributes to excitotoxicity, and over-activation of the hypothalamic-pituitary-adrenal axis, both of which have implications for the deterioration of various brain structures. Prominent structures impacted include the hippocampus, hypothalamus, and prefrontal cortex, all of which are integral to the regulation of stress and eating. The current review suggests that altered glutamate function by trauma or extreme stress may facilitate PTSD and subsequent eating disorder onset, and that glutamatergic modulation may be a key treatment for individuals suffering from these conditions. This overlapping mechanism may help inform future research on individuals with comorbid PTSD and eating disorders, and it could also help inform ways to potentially prevent the onset of these conditions.
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19
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Masheb RM, Ramsey CM, Marsh AG, Decker SE, Maguen S, Brandt CA, Haskell SG. DSM-5 eating disorder prevalence, gender differences, and mental health associations in United States military veterans. Int J Eat Disord 2021; 54:1171-1180. [PMID: 33665848 DOI: 10.1002/eat.23501] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 02/23/2021] [Accepted: 02/24/2021] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Little is known about prevalence estimates of new and revised DSM-5 eating disorders diagnoses in general, and especially among high-risk, underserved and diverse eating disorder populations. The aim of the current study was to determine prevalence, gender differences and correlates of DSM-5 eating disorders in veterans. METHOD Iraq and Afghanistan war era veterans (N = 1,121, 51.2% women) completed the Eating Disorder Diagnostic Scale-5 and validated measures of eating pathology and mental health between July 2014 and September 2019. RESULTS Overall more women than men (32.8% vs. 18.8%, p < .001) reported symptoms consistent with a DSM-5 eating disorder. Prevalence estimates (women vs. men) for the specific diagnoses were: Anorexia Nervosa (AN; 0.0% vs. 0.0%), Bulimia Nervosa (BN; 6.1% vs. 3.5%), Binge-Eating Disorder (BED; 4.4% vs. 2.9%), Atypical AN (AAN; 13.6% vs. 4.9%), Subclinical BN (0.0% vs. 0.2%), Subclinical BED (1.4% vs. 0.6%), Purging Disorder (2.1% vs. 0.7%), and Night Eating Syndrome (NES; 5.2% vs. 6.0%). Women were more likely to have BN or AAN, and there was no difference for BED or NES among genders. The eating disorder group had a higher mean BMI, and significantly greater eating pathology and mental health symptoms than the non-eating disorder group. DISCUSSION Approximately one-third of women, and one-fifth of men, reported symptoms consistent with a DSM-5 eating disorder diagnosis. These high prevalence estimates across genders, and associated mental health concerns, suggest an urgent need to better understand and address eating disorders in military and veteran populations.
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Affiliation(s)
- Robin M Masheb
- VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Yale School of Medicine, New Haven, Connecticut, USA
| | - Christine M Ramsey
- Yale School of Medicine, New Haven, Connecticut, USA.,Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
| | - Alison G Marsh
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Suzanne E Decker
- VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Yale School of Medicine, New Haven, Connecticut, USA
| | - Shira Maguen
- University of California San Francisco Medical School, San Francisco, CA, USA.,San Francisco VA Health Care System, San Francisco, CA, USA
| | - Cynthia A Brandt
- VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Yale School of Medicine, New Haven, Connecticut, USA
| | - Sally G Haskell
- VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Yale School of Medicine, New Haven, Connecticut, USA
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20
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Becker CB, Middlemas K, Gomez F, Kilpela LS. An exploratory examination of internalized weight stigma in a sample living with food insecurity. Body Image 2021; 37:238-245. [PMID: 33770554 PMCID: PMC8991369 DOI: 10.1016/j.bodyim.2021.03.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 02/25/2021] [Accepted: 03/06/2021] [Indexed: 11/19/2022]
Abstract
Internalized weight stigma (IWS) is associated with various health concerns, regardless of body size. One weakness of existing IWS research is that it largely lacks diverse study populations. One recent exception, however, found increasing IWS was associated with higher levels of food insecurity (FI) in a low-income, majority Latinx sample. Using the same sample (N = 530), the present study further explored levels of IWS as compared to documented (mostly White/European) samples; we also investigated IWS in relation to three dichotomous eating disorder (ED) outcomes (e.g., any/no vomiting). Finally, based on previous qualitative findings regarding dietary restraint in the most severe level of FI, we explored the independent contribution of dietary restraint and IWS to cross-sectional risk of ED pathology. Results indicated that individuals living with FI experience IWS at concerning levels. Additionally, IWS played a small yet significant role in cross-sectional risk for ED pathology regardless of FI severity, while dietary restraint contributed to independent risk only in those with the most severe FI. Findings suggest that IWS is prevalent in this marginalized population, associated with ED pathology, and that the effect of dietary restraint on risk for ED pathology appears to uniquely impact those living with severe FI.
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Affiliation(s)
| | - Keesha Middlemas
- Department of Political Science, Howard University, United States
| | | | - Lisa Smith Kilpela
- Barshop Institute for Longevity and Aging Studies, Research to Advance Community Health Center, Department of Psychiatry and Behavioral Sciences, UT Health San Antonio, United States
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21
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Wiblin J, Holder N, Holliday R, Jeon-Slaughter H, LePage J, Surís A. A Factor Analysis of the Suicide Cognitions Scale in Veterans with Military Sexual Trauma-Related Posttraumatic Stress Disorder. J Trauma Dissociation 2021; 22:319-331. [PMID: 33460353 DOI: 10.1080/15299732.2020.1869643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The Suicide Cognitions Scale (SCS) assesses suicide-specific cognitions which may drive suicide risk. Nonetheless, prior work has been mixed regarding optimal factor structure. Additionally, this measure has not been validated for use with veterans with military sexual trauma-related posttraumatic stress disorder (MST-related PTSD), a population that is at elevated risk for suicidal self-directed violence (SDV). This study sought to determine the optimal factor structure of the SCS for use with veterans with MST-related PTSD as well as its psychometric properties. An exploratory factor analysis revealed a four-factor structure, including unlovability, unbearability, unsolvability, and negative urgency. The SCS also demonstrated excellent internal consistency and good convergent validity. This study identified a novel factor, negative urgency, which may explain some of the predictive power of the SCS found in previous research. This paper provides initial support for a four-factor structure of the SCS among those with MST-related PTSD. Additional work remains necessary in evaluating the SCS as a tool for detecting risk for future suicidal SDV among veterans with MST-related PTSD.
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Affiliation(s)
- Jessica Wiblin
- Department of Psychiatry, Veterans Affairs North Texas Health Care System, Dallas, Texas, USA.,Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Nicholas Holder
- San Francisco Veterans Affairs Health Care System, San Francisco, California, USA.,Sierra Pacific Mental Illness Research, Education, and Clinical Center, San Francisco, CA, USA.,University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Ryan Holliday
- Rocky Mountain Mental Illness, Education, and Clinical Center for Suicide Prevention, Denver, Colorado, USA.,Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Haekyung Jeon-Slaughter
- Department of Psychiatry, Veterans Affairs North Texas Health Care System, Dallas, Texas, USA.,Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - James LePage
- Department of Psychiatry, Veterans Affairs North Texas Health Care System, Dallas, Texas, USA.,Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Alina Surís
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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22
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Military Sexual Trauma: An Update for Nurse Practitioners. J Nurse Pract 2021. [DOI: 10.1016/j.nurpra.2020.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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23
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Jessup SC, Blakey SM, Abramowitz JS. Anxiety sensitivity and posttraumatic stress symptoms in sexual assault survivors. Bull Menninger Clin 2020; 84:197-213. [PMID: 33000967 DOI: 10.1521/bumc.2020.84.3.197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Anxiety sensitivity (AS), the fear of anxiety-related physiological sensations, is a predictor of posttraumatic stress symptoms (PTSS) following a traumatic event, yet there is limited research on the relationship between AS and PTSS among sexual assault survivors. The present study was designed to test the hypothesis that AS would emerge as a statistical predictor of PTSS dimensions among community members and undergraduate students endorsing lifetime exposure to sexual trauma. Adults endorsing a history of sexual assault (N = 52) completed an online battery, including self-report measures of AS, general distress, dysfunctional trauma-related beliefs (i.e., posttraumatic cognitions), and PTSS. Although AS was associated with PTSS dimensions at the bivariate level (rs ranged .68-82), AS did not emerge as a significant unique predictor of PTSS dimensions in linear regression analyses after controlling for general distress and posttraumatic cognitions. In fact, general distress was the only significant statistical predictor of PTSS total and dimension scores (ps < 01). Study implications, limitations, and future directions are discussed.
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Affiliation(s)
- Sarah C Jessup
- Graduate Student, Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill.,Vanderbilt University, Nashville, Tennessee
| | - Shannon M Blakey
- Postdoctoral fellow, Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill
| | - Jonathan S Abramowitz
- Professor of psychology, Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill
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24
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Cuthbert K, Hardin S, Zelkowitz R, Mitchell K. Eating Disorders and Overweight/Obesity in Veterans: Prevalence, Risk Factors, and Treatment Considerations. Curr Obes Rep 2020; 9:98-108. [PMID: 32361915 DOI: 10.1007/s13679-020-00374-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW Eating disorders (EDs) and overweight/obesity (OW/OB) have a significant impact on veterans. This review highlights current research on EDs and OW/OB in this population. RECENT FINDINGS Prevalence estimates for both EDs and OW/OB among veterans remain consistent with and possibly higher than those in the general population. Both diagnoses share multiple risk factors, including trauma history, and mental health comorbidities. Although weight loss treatments have been fairly well studied among veteran samples, there are no published investigations on psychotherapies for EDs in this population. The Veterans Healthcare Administration is working to train providers in ED treatments. VHA treatments for OW/OB show some benefits and areas for improvement. Areas for future research include structured assessments for EDs and disordered eating behaviors in veterans to clarify prevalence estimates. There is a need for interventions that consider common mechanisms for ED and OW/OB, and there is a need for more research on the associations between different types of trauma and ED/OW/OB in veterans.
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Affiliation(s)
- Kristy Cuthbert
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
- National Center for PTSD at the VA Boston Healthcare System, Boston, MA, 02130, USA
| | - Sabrina Hardin
- National Center for PTSD at the VA Boston Healthcare System, Boston, MA, 02130, USA
| | - Rachel Zelkowitz
- National Center for PTSD at the VA Boston Healthcare System, Boston, MA, 02130, USA
| | - Karen Mitchell
- National Center for PTSD at the VA Boston Healthcare System, Boston, MA, 02130, USA.
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA.
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25
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Masheb RM, Kutz AM, Marsh AG, Min KM, Ruser CB, Dorflinger LM. "Making weight" during military service is related to binge eating and eating pathology for veterans later in life. Eat Weight Disord 2019; 24:1063-1070. [PMID: 31471885 DOI: 10.1007/s40519-019-00766-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 08/07/2019] [Indexed: 11/25/2022] Open
Abstract
PURPOSE "Making weight" behaviors are unhealthy weight control strategies intended to reduce weight in an effort to meet weight requirements. This study aimed to examine a brief measure of making weight and to investigate the relationship between making weight and weight, binge eating, and eating pathology later in life. METHODS Participants were veterans [N = 120, mean age 61.7, mean body mass index (BMI) 38.0, 89.2% male, 74.2% Caucasian] who were overweight/obese and seeking weight management treatment. Participants completed the making weight inventory (MWI), a measure of making weight behaviors engaged in during military service, and validated measures of eating behavior. Analyses compared participants who engaged in at least one making weight behavior (MWI+) versus those who did not (MWI-). RESULTS The MWI had good internal consistency. One-third of participants were MWI+ and two-thirds were MWI-. The most frequently reported behavior was excessive exercise, reported in one-quarter of the sample, followed by fasting/skipping meals, sauna/rubber suit, laxatives, diuretics, and vomiting. MWI+ participants were significantly more likely to be in a younger cohort of veterans, to be an ethnic/racial minority, and to engage in current maladaptive eating behaviors, including binge eating, vomiting, emotional eating, food addiction, and night eating, compared to the MWI- group. Groups did not differ on BMI. CONCLUSIONS One-third of veterans who were overweight/obese screened positive for engaging in making weight behaviors during military service. Findings provide evidence that efforts to "make weight" are related to binge eating and eating pathology later in life. Future research and clinical efforts should address how to best eliminate unhealthy weight control strategies in military service while also supporting healthy weight management efforts.
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Affiliation(s)
- Robin M Masheb
- The Veterans Initiative for Eating and Weight/11ACSLG, VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT, 06516, USA.
- Yale School of Medicine, 333 Cedar St, New Haven, CT, 06510, USA.
| | - Amanda M Kutz
- VA Salt Lake City Health Care System, 500 Foothill Drive, Salt Lake City, UT, 84148, USA
| | - Alison G Marsh
- The Veterans Initiative for Eating and Weight/11ACSLG, VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT, 06516, USA
| | - Kathryn M Min
- Graduate Institute of Professional Psychology, University of Hartford, 200 Bloomfield Avenue, West Hartford, CT, 06117, USA
| | - Christopher B Ruser
- The Veterans Initiative for Eating and Weight/11ACSLG, VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT, 06516, USA
- Yale School of Medicine, 333 Cedar St, New Haven, CT, 06510, USA
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26
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Monteith LL, Holliday R, Schneider AL, Forster JE, Bahraini NH. Identifying factors associated with suicidal ideation and suicide attempts following military sexual trauma. J Affect Disord 2019; 252:300-309. [PMID: 30991258 DOI: 10.1016/j.jad.2019.04.038] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 03/12/2019] [Accepted: 04/07/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND As increasing research demonstrates that military sexual trauma (MST) is associated with suicidal ideation and attempts, discerning factors that place MST survivors at risk for these outcomes is critical. The present study aimed to: (1) characterize suicidal ideation and attempts among MST survivors; (2) identify factors associated with post-MST suicide attempts, post-MST suicidal ideation, and past-week suicidal ideation. METHODS A convenience sample of 108 veterans (66 women, 42 men) who reported a history of MST participated in this cross-sectional study. Pre-MST suicidal ideation and attempt, childhood physical and sexual abuse, military sexual assault, institutional betrayal, and posttraumatic cognitions about self, world, and self-blame were examined, with age and gender as covariates. RESULTS Seventy-five percent of participants reported experiencing post-MST suicidal ideation, and 40.7% reported attempting suicide following MST. Pre-MST suicide attempt and posttraumatic cognitions about self were associated with post-MST suicide attempt. Pre-MST suicidal ideation, military sexual assault, childhood physical abuse, and posttraumatic cognitions about self were associated with post-MST suicidal ideation. Lastly, pre-MST suicidal ideation and posttraumatic cognitions about self were associated with past-week suicidal ideation; results were unchanged when accounting for recent PTSD or depressive symptoms. LIMITATIONS The cross-sectional design, retrospective self-report, and small sample are limitations. CONCLUSIONS Addressing negative posttraumatic beliefs about self may be important for managing suicide risk among MST survivors. Assessing for pre-MST suicidal ideation and attempt is likely also warranted. Further understanding of the longitudinal impact of posttraumatic beliefs about self on subsequent risk for suicidal ideation and attempt is warranted.
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Affiliation(s)
- Lindsey L Monteith
- Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC) for Suicide Prevention, 1700 North Wheeling, Aurora, CO 80045, United States; Department of Psychiatry, University of Colorado Anschutz Medical Campus, United States.
| | - Ryan Holliday
- Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC) for Suicide Prevention, 1700 North Wheeling, Aurora, CO 80045, United States; Department of Psychiatry, University of Colorado Anschutz Medical Campus, United States
| | - Alexandra L Schneider
- Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC) for Suicide Prevention, 1700 North Wheeling, Aurora, CO 80045, United States
| | - Jeri E Forster
- Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC) for Suicide Prevention, 1700 North Wheeling, Aurora, CO 80045, United States; Department of Biostatistics and Informatics, University of Colorado Anschutz Medical Campus, United States; Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, United States
| | - Nazanin H Bahraini
- Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC) for Suicide Prevention, 1700 North Wheeling, Aurora, CO 80045, United States; Department of Psychiatry, University of Colorado Anschutz Medical Campus, United States; Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, United States
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27
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Gross GM, Cunningham KC, Moore DA, Naylor JC, Brancu M, Wagner HR, Elbogen EB, Calhoun PS, Kimbrel NA. Does Deployment-Related Military Sexual Assault Interact with Combat Exposure to Predict Posttraumatic Stress Disorder in Female Veterans? TRAUMATOLOGY 2018; May 2018:325827753. [PMID: 30202245 PMCID: PMC6128291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The objective of the present research was to expand upon previous findings indicating that military sexual trauma interacts with combat exposure to predict PTSD among female Iraq/Afghanistan-era veterans. Three hundred and thirty female veterans completed self-report measures of combat experiences, military sexual assault (MSA) experiences, and PTSD symptoms as well as structured diagnostic interviews for PTSD. A significant strength of the present research was the use of PTSD diagnosis as an outcome measure. Consistent with prior research, both combat exposure and MSA were significant predictors of PTSD symptoms (linear regression) and PTSD diagnoses (logistic regression). Specifically, participants who experienced deployment-related MSA had approximately six times the odds of developing PTSD compared to those who had not experienced deployment-related MSA, over and above the effects of combat exposure. Contrary to expectations, the hypothesized interaction between MSA and combat exposure was not significant in any of the models. The low base rate of MSA may have limited power to find a significant interaction; however, these findings are also consistent with other recent studies that have failed to find support for the hypothesized interaction. Thus, whereas the majority of available evidence indicates that MSA increases risk for PTSD among veterans over and above the effects of combat, there is presently only limited support for the hypothesized MSA x combat interaction. These findings highlight the continued need for prevention and treatment of MSA in order to improve veterans' long-term mental health and well-being.
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Affiliation(s)
- Georgina M. Gross
- Durham Veterans Affairs Medical Center, Durham, NC, USA
- VA Connecticut Healthcare System, West Haven, CT, USA
| | - Katherine C. Cunningham
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC), Durham, NC, USA
| | | | - Jennifer C. Naylor
- Durham Veterans Affairs Medical Center, Durham, NC, USA
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC), Durham, NC, USA
- Duke University School of Medicine, Durham, NC, USA
| | - Mira Brancu
- Durham Veterans Affairs Medical Center, Durham, NC, USA
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC), Durham, NC, USA
- Duke University School of Medicine, Durham, NC, USA
| | - H. Ryan Wagner
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC), Durham, NC, USA
- Duke University School of Medicine, Durham, NC, USA
| | - Eric B. Elbogen
- Durham Veterans Affairs Medical Center, Durham, NC, USA
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC), Durham, NC, USA
- Duke University School of Medicine, Durham, NC, USA
| | - Patrick S. Calhoun
- Durham Veterans Affairs Medical Center, Durham, NC, USA
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC), Durham, NC, USA
- Duke University School of Medicine, Durham, NC, USA
- VA Center for Health Services Research in Primary Care, Durham, NC, USA
| | | | - Nathan A. Kimbrel
- Durham Veterans Affairs Medical Center, Durham, NC, USA
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC), Durham, NC, USA
- Duke University School of Medicine, Durham, NC, USA
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