Indicators of mental health among U.S. military service members with eating disorders with and without co-occurring trauma-related diagnoses.
Abstract
Objective
Active-duty service members (ADSMs) may be at particular risk for eating disorders (EDs), posttraumatic stress disorder (PTSD), and sexual assault (SA). This study aimed to determine the prevalence and mental health care complexity of ADSMs with EDs, with and without co-occurring trauma-related diagnoses.
Method
This retrospective ADSM cohort study utilized military electronic medical records and TRICARE insurance claims between 2016 and 2023. Those with ED-related International Classification of Diseases, 10th Revision, Clinical Modification codes were stratified by the presence of trauma-related care and evaluated for psychiatric comorbidity and psychotropic prescriptions.
Results
Of the 7,758 ADSMs with an ED, 28% had PTSD, 3% SA, and 8% both. Among those with ED only, 58% had an anxiety disorder, 54% had a mood disorder, and 61% were prescribed a selective serotonin reuptake inhibitor (SSRI). In multivariable logistic regression analysis adjusting for sex, service, rank, age, ED diagnosis, race/ethnicity, enrollment length, and body mass index, compared with those with ED alone, those with PTSD or PTSD and SA were significantly more likely to have anxiety disorder (aOR = 3.02 and 3.04, respectively), mood disorder (aOR = 3.54 and 4.58, respectively), or SSRI prescription (aOR = 2.70 and 4.68, respectively); those with SA without PTSD were more likely to have an anxiety disorder or SSRI prescription (ps < .01).
Conclusions
Approximately 40% of ADSMs with an ED had a trauma-related diagnosis. Trauma-related diagnoses were associated with odds of mood/anxiety disorders or SSRI prescriptions up to fivefold higher than those with EDs alone. Clinicians treating individuals with EDs should be well-versed in trauma-informed care and ensure access to specialty services for ADSMs with EDs to mitigate psychological stress and promote recovery. (PsycInfo Database Record (c) 2026 APA, all rights reserved).