Introduction. Survivors of military sexual trauma (MST) and combat trauma (CT) are at disproportionate risk for disordered eating, including restricting, bingeing, and purging. Four unique correlates of disordered eating in trauma survivors have been identified: trauma-related self-blame, emotion regulation challenges, body dissatisfaction, and dissociation. However, little research has sought to better understand the underlying factors that may influence disordered eating in survivors of MST and CT. Further research examining mechanisms of disordered eating among MST and CT survivors is needed to understand the unique factors maintaining disordered eating in this unique population.
Methods. Using a concurrent mixed-methods design, the present study examined four potential catalysts (trauma-related self-blame, emotion regulation challenges, body dissatisfaction, and dissociation) for disordered eating among MST and/or CT survivors by means of quantitative and qualitative analysis. Quantitative data were collected from 246 participants (72.8% men) on Amazon Mechanical Turk and Reddit who completed measures examining MST exposure (47.2%), CT exposure (87.4%), trauma-related self-blame, emotion regulation challenges, body dissatisfaction, dissociation, and disordered eating subtypes (bingeing, purging, and restricting). Six parallel mediation analyses were conducted. These analyses examined trauma-related self-blame, emotion regulation challenges, body dissatisfaction, and dissociation as mediators of the relationships between MST and CT, separately, with subtypes of disordered eating (purging, restricting, and bingeing). Analyses of Covariance were also completed to examine rates of disordered eating by trauma exposure type (MST exposure, CT exposure, MST and CT Exposure, and No MST or CT Exposure). In tandem, qualitative interviews with six MST and/or CT survivors who reported at least one symptom of disordered eating were performed. Interviews focused on understanding participant’s perceptions regarding how the four proposed mediators may influence their disordered eating. To follow, interviews were transcribed and analyzed by means of thematic analysis.
Results. Results indicated that individuals exposed to MST and CT reported greater bingeing, restricting, and purging than individuals exposed to either CT, MST, or neither. MST and CT were indirectly related to restriction via emotion regulation difficulties and trauma-related self-blame, such that MST and CT were associated with greater emotion regulation difficulties and trauma-related self-blame, which in turn related to greater restrictive eating. Results suggested that MST was also indirectly related to purging via emotion regulation difficulties, dissociation, and trauma-related self-blame. Further, CT was indirectly related to purging via emotion regulation difficulties and trauma-related self-blame. CT and MST were indirectly associated with binge eating via emotion regulation difficulties. Body dissatisfaction was not a significant mediator in any model. Thematic analysis provided contextual illustrations of how the proposed mediators (trauma-related self-blame, emotion regulation challenges, body dissatisfaction, and dissociation) were perceived by MST and/or CT survivors to influence disordered eating. Participants endorsed each of the four mediators as actively influencing their disordered eating. Participants also expressed that military culture and systemic influences were additional factors impacting their development of disordered eating. MST and CT survivors shared their perceptions regarding the differential effects of MST and CT on disordered eating.
Discussion. Quantitative and qualitative findings provide insight into the nuanced symptoms that may increase risk for bingeing, restricting, and purging among MST and/or CT survivors. Findings should be used to inform future development of psychological treatment and assessment methods that serve MST and CT survivors with disordered eating.