Cooper Zafra, Smith Brian N, Kehle-Forbes Shannon, Dorset Julianne, Mitchell Karen S
Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA.
National Center for PTSD at VA Boston Healthcare System, Boston, Massachusetts, USA.
J Clin Psychol. 2025 Mar;81(3):133-144. doi: 10.1002/jclp.23756. Epub 2024 Dec 8.
To assess, by interview, the rates of eating disorders in a nationally representative sample of recent veterans, describe their DSM-5 eating disorder diagnoses and the occurrence of comorbid psychiatric disorders. To conduct an exploratory case-control analysis of previously documented and additional specific military risk factors before eating disorder onset to inform studies of prospective risk.
Using a two-stage design, probable cases and controls were identified by screening questionnaires from a sample of 1494 veterans who completed a survey study and interviewed to establish case status and confirm probable co-morbid psychiatric diagnoses. Previously documented risk factors and military risk factors occurring before disorder onset were investigated.
Ninety-one cases and 51 controls were confirmed. Weighted prevalence for any eating disorder was 5.2%, with estimates for anorexia nervosa, bulimia nervosa, binge eating disorder and other specified eating disorder being 0.01%, 0.6%, 1.4%, and 1.6%, respectively. Seventy-nine (86.8%) confirmed cases had a diagnosis of one or more co-morbid psychiatric disorders. Previously documented risk factors were associated with subsequent case status, while in this sample, military risk factors were not.
Rates of eating disorder and co-occurring psychiatric disorders in recent veterans were comparable to those reported for non-veterans, with levels of posttraumatic stress disorder likely higher. As co-occurring psychiatric disorders, particularly posttraumatic stress disorder, may complicate achieving good outcomes with existing evidence-based treatments, there is an urgent need to adapt them where necessary to improve outcomes. Military risk factors may maintain or exacerbate pre-existing problems and need to be investigated alongside other maintaining factors in longitudinal studies.
Rates of eating disorder and co-occurring psychiatric disorders in recent veterans were comparable to those reported for non-veterans, highlighting a need to detect eating problems and address unmet treatment need. Co-occurring psychiatric disorders may complicate achieving good outcomes with existing treatments, emphasising a need to adapt them to improve outcomes. Investigating maintaining factors, including military factors in longitudinal studies will likely aid treatment development.
通过访谈评估近期退伍军人全国代表性样本中的饮食失调发生率，描述他们的《精神疾病诊断与统计手册》第五版（DSM-5）饮食失调诊断情况以及共病精神障碍的发生情况。对饮食失调发作前记录在案的以及其他特定的军事风险因素进行探索性病例对照分析，以为前瞻性风险研究提供信息。
采用两阶段设计，通过对1494名完成调查研究的退伍军人样本进行筛查问卷来确定可能的病例和对照，并进行访谈以确定病例状态并确认可能的共病精神诊断。对记录在案的风险因素以及疾病发作前出现的军事风险因素进行调查。
确认了91例病例和51例对照。任何饮食失调的加权患病率为5.2%，神经性厌食症、神经性贪食症、暴饮暴食症和其他特定饮食失调的估计患病率分别为0.01%、0.6%、1.4%和1.6%。79例（86.8%）确诊病例被诊断出患有一种或多种共病精神障碍。记录在案的风险因素与随后的病例状态相关，而在本样本中，军事风险因素则不然。
近期退伍军人的饮食失调率和共病精神障碍率与非退伍军人报告的情况相当，创伤后应激障碍的水平可能更高。由于共病精神障碍，尤其是创伤后应激障碍，可能会使现有循证治疗难以取得良好效果，因此迫切需要在必要时对其进行调整以改善治疗效果。军事风险因素可能会维持或加剧先前存在的问题，需要在纵向研究中与其他维持因素一起进行调查。
近期退伍军人的饮食失调率和共病精神障碍率与非退伍军人报告的情况相当，这突出表明需要检测饮食问题并满足未得到满足的治疗需求。共病精神障碍可能会使现有治疗难以取得良好效果，强调需要对其进行调整以改善治疗效果。在纵向研究中调查维持因素，包括军事因素，可能有助于治疗的发展。
