Eating disorder symptoms in female veterans: The role of childhood, adult, and military trauma exposure
Objective: Eating disorders are understudied among female U.S. military veterans, who may be at increased risk due to their high rates of trauma exposure and trauma-related sequelae. The current study sought to examine whether different types of trauma in childhood and adulthood confer differential risk for eating disorder symptoms (EDSs) in this population. Method: We analyzed survey data from a sample of female Veterans Health Administration patients (N = 186) to examine the association between 5 trauma types (i.e., childhood physical abuse, adult physical assault, childhood sexual abuse, adult sexual assault, and military-related trauma) and EDS severity. Results: Approximately 14% of the sample reported clinical levels (i.e., standardized Eating Disorder Diagnostic Scale score ≥16.5) of EDSs. Multiple traumatization was associated with increased EDSs. Adult physical assault, adult sexual assault, and military-related trauma were individually associated with more severe eating disorder symptomatology, though only military-related trauma was uniquely associated with disordered eating in the full model. Discussion: EDSs are common among female veterans, and trauma exposures are differentially associated with symptom severity. It is critical to assess for EDSs in female veterans, particularly those with a history of military-related trauma, to facilitate detection and appropriate treatment.
Abstract: Disordered eating is a prevalent and relevant health concern that remains understudied among U.S. military veterans. Avoidant/restrictive food intake disorder (ARFID) is a newly recognized feeding and eating disorder characterized by overly restrictive eating due to (a) picky eating, (b) lack of appetite, and (c) fear of aversive consequences related to eating. The Nine-Item ARFID Screen (NIAS) is a recently developed ARFID screening tool with initial validation studies demonstrating psychometric support. However, the psychometric properties of the NIAS have not been investigated in a veteran sample. To advance our understanding of ARFID screening tools that may be appropriate for use in veterans, the present study examined the factor structure of the NIAS using survey data from a large national sample of recently separated veterans (N = 1,486). Measurement invariance across key subgroups was tested in addition to exploring differential associations between the NIAS and related constructs. Results suggested that a three-factor model provided an excellent fit of the data and demonstrated scalar invariance across self-identified men and women, race and ethnicity, and sexual and gender minority (SGM) identity. Some subgroups had higher latent means on the picky eating (women, SGM, non-Hispanic Black), appetite (women, SGM), and fear (women) factors. The NIAS had some overlap with another measure of disordered eating and was moderately correlated with psychosocial impairment and mental health. Overall, the NIAS may be a useful screening tool for ARFID in veterans, given support for the three proposed subscales and equivalence across diverse identities.