Unique Considerations of Seeking Treatment for Bulimia in the Military

Man lifting weights while suffering from Compulsive Exercise

The first article in this series made it clear that the subculture of the military comes with its own unique challenges that impact eating disorders such as anorexia nervosa, bulimia nervosa, and binge eating disorder.

The emphasis on power, control, and perfection, as well as physical fitness and the thin ideal, can absolutely lead to anorexia nervosa, but these are also key aspects of bulimia nervosa development.

Both disorders are characterized by distortion of body image and an obsession with weight loss. However, bulimia nervosa differs from anorexia nervosa as a disorder in that it involves episodes of bingeing and purging as opposed to restriction.

Bingeing involves episodes of secretive and obsessive eating, which, in bulimia, is followed by dangerous and inappropriate methods of expelling food, purging.

Bulimic Behaviors in the Military

Many military members report engaging in bulimic behaviors, with 3 to 9% of active-duty women, and 3 to 4% of active-duty men, reporting purging behaviors such as vomiting or laxative use (1).

These numbers are higher in prevalence than what is reported by civilian, non-military, US citizens (1). In fact, the incidence of active-duty women engaging in bulimic symptoms is higher even than that of anorexic symptoms, with 1.6% active duty females self-reporting anorexia nervosa symptoms and 9.7% of active duty females self-reporting symptoms of bulimia nervosa (1).

Eating disorder researchers and treatment specialists theorize that bulimic symptoms are higher in military members due to the physical fitness requirements.

Each military member is required to meet certain physical fitness requirements related to weight and exercise. In fact, they are provided with time in their weekly work schedule to engage in “physical training.”

Studies have indicated that binge-purge behaviors in service members increase prior to physical fitness tests when compared to non-fitness-testing periods (1). Military members surveyed have acknowledged engaging in these behaviors to lose weight prior to their physical fitness examinations (1).

Barriers to Bulimia Treatment in the Military

Woman in the military trying to lose weight before an examWith bulimia nervosa symptoms being so prevalent among military members, seeking treatment is challenging, partially because these behaviors are accepted, even if not overtly so.

An additional challenge to seeking and receiving treatment is the nature of treating an individual that must engage in certain behaviors and meet certain physical requirements to maintain their job and livelihood.

For example, many treatment centers would not allow a patient to engage in exercise, particularly intense forms of exercise, during an individual’s time in treatment.

However, time does not stop because someone is in treatment, and a military member may need to complete a PT test soon after they leave treatment.

Treatment centers must consider this as they treat that specific individual, supporting them in finding ways to fulfill the requirements of their job without engaging in harmful and life-threatening behaviors.

This also presents challenges for individuals leaving treatment, as they are thrust back into an environment that may not support their recovery-focused exercise and eating behaviors.

It is clear to see how military requirements and views on physical fitness could lead to the development of bulimia nervosa.

There is hope that leadership increasing knowledge of eating disorder symptoms may help to change this, as they can model positive relationships with exercise and food, effective yet safe ways to fulfill physical fitness requirements, and recognize any signs should a service member be engaging in disordered behaviors and need help.


[1] Bodell, L.,et al. (2015). Consequences of making weight: a review of eating disorder symptoms and diagnoses in the United States military. Clinical Psychology, 21:4.

About the Author:

Image of Margot Rittenhouse.Margot Rittenhouse, MS, PLPC, NCC is a therapist who is passionate about providing mental health support to all in need and has worked with clients with substance abuse issues, eating disorders, domestic violence victims, and offenders, and severely mentally ill youth.

As a freelance writer for Eating Disorder Hope and Addiction Hope and a mentor with MentorConnect, Margot is a passionate eating disorder advocate, committed to de-stigmatizing these illnesses while showing support for those struggling through mentoring, writing, and volunteering. Margot has a Master’s of Science in Clinical Mental Health Counseling from Johns Hopkins University.

The opinions and views of our guest contributors are shared to provide a broad perspective on eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Published September 18, 2020, on EatingDisorderHope.com
Reviewed & Approved on September 18, 2020, by Jacquelyn Ekern MS, LPC

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