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: Background: Exposure to potentially morally injurious events (PMIEs) during military service can lead to moral injury (MI) outcomes and posttraumatic stress symptoms (PTSS). This longitudinal study examined the relationships between PMIE exposure, MI outcomes, and PTSS among Israeli combat veterans, and the potential protective role of dispositional forgiveness in these associations. Method: Participants were 169 Israeli combat veterans who participated in a six-year longitudinal study with four measurement points (T1: 12 months before enlistment, T2: Six months following enlistment- pre-deployment, T3: 18 months following enlistment- post-deployment, and T4: 28 months following discharge). Participants’ characteristics were assessed via semi-structured interviews (T1) and validated self-report measures (T2-T4) between 2019-2024. Results: Approximately 36% of participants reported exposure to PMIEs during service, with 13% exceeding the clinical threshold for probable PTSD at T4. PMIE-Betrayal at T3 was positively associated with MI outcomes of shame and trust violation at T4. The indirect effect of PMIEs on PTSS through MI outcome-Shame depended on forgiveness levels. Among veterans with low forgiveness, higher exposure to PMIE-Betrayal was associated with increased MI shame, which was linked to more severe PTSS. Conversely, for those with high forgiveness, exposure to PMIE-Self and Other was associated with decreased MI shame and subsequently reduced PTSS. Conclusion: Dispositional forgiveness moderates the relationship between PMIE exposure and MI outcomes, particularly shame, which mediates the development of PTSS. These findings highlight forgiveness as a potential target for intervention in treating moral injury and preventing PTSS among combat veterans.