Narratives of chronic pain from armed forces veterans
This PhD thesis explores the experiences of 14 veterans of the UK Armed Forces who live with chronic pain. While there is a wealth of data exploring chronic pain in Armed Forces veterans, the existing literature overwhelmingly views chronic pain through a quantitative lens which does not explore the depth of chronic pain lived experience as a result of this; therefore, it is unclear how veterans live with and manage their chronic pain. Participants' stories of living with chronic pain were collected and analysed using dialogical narrative analysis and the analytical lens of autobiographical time, to detail veterans’ autobiographical stories of living with chronic pain, and how they use these stories to make sense of their pain experience in the context of their identity as a veteran. The analysis identifies that the participants understood and made sense of their chronic pain experience through three distinct storytelling phases. The first of these were stories of the military body, and this situated a career that was marked by physicality and the churn of life within the military institution. The second phase of storytelling was about the stigmatised body. These stories situate the attitudes toward pain and weakness within the military and the consequences of showing that the military body is infallible, which in turn inform stoic attitudes toward pain and personal pain management. The final phases of storytelling were told about the moving body, stories about the moving body were about making sense of a new body with pain, how some movement is avoided, and the consequences of this on identity. And how movement is used to understand, learn, and respond to and from their bodies on any given day. This is the first in-depth qualitative study that explores the lived experiences of veterans with chronic pain. It found that stories about chronic pain were told in the context of military experience and how the culture of the military shapes attitudes toward chronic pain, while movement was a keyway in which participants live with and manage their chronic pain.
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.