Diagnoses of eating disorders, active component service members, U.S. Armed Forces, 2013-2017
Abstract: During 2013-2017, a total of 1,788 active component service members received incident diagnoses of one of the eating disorders: anorexia nervosa (AN), bulimia nervosa (BN) or "other/unspecified eating disorder" (OUED). The crude overall incidence rate of any eating disorder was 2.7 cases per 10,000 person-years. Of the case-defining diagnoses, OUED and BN accounted for 46.4% and 41.8% of the total incident cases, respectively. The overall incidence rate of any eating disorder among women was more than 11 times that among men. Overall rates were highest among service members in the youngest age groups (29 years or younger). Crude annual incidence rates of total eating disorders increased steadily between 2013 and 2016, after which rates decreased slightly. Results of the current study suggest that service members likely experience eating disorders at rates that are comparable to rates in the general population, and that rates of these disorders are potentially rising among service members. These findings underscore the need for appropriate prevention and treatment efforts in this population.
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.