Prevalence of eating disorders and comorbid psychopathology in a US sample of treatment-seeking veterans.

OBJECTIVE: Eating disorders (EDs) are a well-studied public health issue in the general population. Less is known, however, about the prevalence of such conditions and levels of comorbid psychopathology among military and veteran populations. The current study sought to describe the probable prevalence of EDs and levels of comorbid psychopathology using a racially diverse treatment-seeking sample of US veteran men and women. METHOD: Veterans (N =254) presenting for routine clinical care completed self-report questionnaires assessing EDs, posttraumatic stress disorder, depression, and shame. RESULTS: Thirty-one percent of the sample met probable criteria for either bulimia nervosa (BN), binge-eating disorder, or purging disorder. Although overall ED prevalence estimates were similar across men and women, estimates of BN were higher among Black veterans compared to White veterans or veterans who identified as a race other than Black or White. Further, mean levels of psychopathology were significantly higher in veterans with a probable ED compared to those without. DISCUSSION: This study extends previous research and highlights the importance of establishing dedicated ED screening programs within the Veterans Health Administration.

Efficacy of structured approach therapy in reducing PTSD in returning veterans: A randomized clinical trial.

The U.S. military deployed in support to Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) show high rates of posttraumatic stress disorder (PTSD) and relationship, partner, and parenting distress. Given the pervasive effect of combat-related PTSD on returning veterans and its effect on their loved ones, the investigators have developed a couples-based treatment, structured approach therapy (SAT), to reduce PTSD while simultaneously decreasing relationship and partner distress. This study presents treatment outcome data measuring PTSD and relationship outcomes from a randomized clinical trial (RCT) comparing SAT, a manualized 12-session novel couples-based PTSD treatment, to a manualized 12-session couples-based educational intervention (PTSD Family Education [PFE]). Data were collected from 57 returning veterans meeting Diagnostic and Statistical Manual of Mental Disorders (fourth edition, text revision; DSM-IV-TR) criteria for PTSD and their cohabiting partners; data collection was scheduled for pretreatment, posttreatment, and 3-month follow-up. Findings from an intent-to-treat analysis revealed that veterans receiving SAT showed significantly greater reductions in self-rated (PTSD Checklist; p < .0006) and Clinician-Administered PTSD Scale (CAPS)-rated PTSD (p < .0001) through the 3-month follow-up compared with veterans receiving PFE; 15 of 29 (52%) veterans receiving SAT and 2 of 28 (7%) receiving PFE no longer met DSM-IV-TR criteria for PTSD. Furthermore, SAT was associated with significant improvements in veteran relationship adjustment, attachment avoidance, and state anxiety. Partners showed significant reductions in attachment anxiety. This couples-based treatment for combat-related PTSD appears to have a strong therapeutic effect on combat-related PTSD in recently returned veterans.

Changes in psychopathology and symptom severity in bulimia nervosa between 1993 and 2003.

OBJECTIVE: This study investigated changes in symptom severity and the psychopathology of patients with bulimia nervosa between 1993 and 2003. METHOD: Pretreatment data of patients diagnosed with bulimia nervosa, collected between 1993 and 1997 from two multisite studies (N = 263), and from 2001 to 2003 from a third multisite study (N = 233) were compared for differences in psychopathology, eating disorder symptoms, and demographic characteristics. RESULTS: There was a significant increase in baseline age between the cohorts (1993M = 28.7 +/- 7.9, 2001M = 30.3 +/- 8.7, p = 0.036) together with a decrease in personality disorders and in several aspects of eating disorder psychopathology. After controlling for age however, significant pretreatment differences were found only in the restraint subscale on the EDE. CONCLUSION: Results suggest that the presentation of individuals with bulimia nervosa has changed between 1993 and 2003, in that participants were older and demonstrated less dietary restraint. Hence, comparisons between samples and treatment trials over time must be made with caution.