Anorexia history = Never serve in military?

I believe in full recovery. (Also known as full remission**) I believe fully recovered eating disorder patients are often mentally HEALTHIER and have better life skills and resilience than those around them!

So, here's a question. What if a young person recovers and then wants to join the military? In Australia, apparently, it's a deal killer. I think that's wrong, and I want some help to gather some information and support for this amazing young woman:

Dear Laura,
 
My name is S.-, I am a 21 year old university student in Australia who suffered from anorexia nervosa for five of my teenage years but have subsequently recovered, and moved on to pursue a healthy and happy life. Anorexia took away a substantial portion of my adolescent years and now its repercussions are threatening to affect my future employment hopes; it is for this reason I am contacting you to ask for your opinion, as I know you are a strong advocate of full recovery being possible...

I suffered from severe anorexia between the ages of 14 -18 and spent a large portion of that time in hospital, sectioned under the mental health act and being fed via an NG tube. Unfortunately, as you are well aware, eating disorder treatment is often poor and the hospital I attended was no exception (more due to funding than anything). The treatment kept me alive when I was at the verge of death (for which I am eternally grateful) but did little else. When I was 18, and facing the reality of being locked up in an adult psych unit, my parents sent me to Stockholm, Sweden for treatment at the Mandometer clinic. By the time I commenced treatment I hadn’t eaten anything other than liquids in months and hadn’t picked up a knife and fork in several years. I was so emaciated and malnourished that I was hallucinating and unable to even get onto a train without having a massive panic attack and bashing my head on the wall screaming that I was ‘being contaminated’. My situation was dire and my mother didn’t know if I would ever make it home to see her again.

After eight months of treatment at Mandometer I returned to Australia in 2008. After years of living in a ‘malnourishment cloud’ I had been fed back to sanity. With huge amounts of hard work, help from the staff and proper food (as opposed to NG feeds) I came home eating a full diet without any fears or restrictions. Within a few months of being back at home I was up to my full healthy weight and had dealt with the emotions that came with being healthy and alive. Since then I haven’t looked back. Life is so much more amazing than I ever imagined and I love it.
 
The fact that I have recovered, and recovered so well, is truly fantastic. I am hoping soon to start along the path that I have always yearned to travel; I am waiting for medical school offers to be released. My goal is to be sponsored by the Australian Defence Force (ADF) for the latter half of my degree and then work for them as a Medical Officer. It’s not a goal that I’ve decided on lightly, it’s taken serious deliberation but, regardless of the downsides, it’s the path I am drawn to and I feel it suits me to a tee.

I decided to apply as a soldier in the part time Army in order to get an insight into life in the forces. Unfortunately, as soon as they found out I had a history of anorexia nervosa, it was an instant ‘no’. I sent a letter of appeal, along with a letter from my previous case manager (stating I was fit, healthy and happy) but received another adamant ‘no’. This time it also came with a letter explaining the fact that, having previously had AN, the stresses of military life could cause a relapse or another mental health issue.

In response to their letter I sent a second appeal. I argued that, due to what I had been through, I was a mentally stronger person and less likely than others to succumb to mental health issues due to ‘the stress of military life’. Obviously nothing in life is certain; there is always the small possibility that I may relapse, but there is also the possibility that your average, healthy Joe Bloggs is going to develop paranoid schizophrenia. At least I can prevent relapse by acting sensibly (ie staying in a healthy weight range and not skipping meals).

As well as my own letter I spent an inordinate sum of money to be assessed by, and receive a thorough and persuasive letter from, a psychiatrist who confirmed that I had fully recovered and that a relapse was highly unlikely.

Unfortunately, none of this has worked thus far. I just recently received a two page letter rejecting my appeal yet again. It saddens and angers me that people are so misinformed about eating disorders; yes, if treatment is poor then outcomes can be expected to be unfavourable but, with appropriate treatment, a full recovery is achievable; I am proof of that. Unfortunately the ADF seems to be functioning under the assumption that employing a person who has previously suffered anorexia nervosa is too much of a high risk endeavour; I think of this as discrimination. I know that some previous sufferers are still plagued by issues and are not suitable candidates for enlistment but we shouldn’t all be thrown into that same category, each case should be looked at on an individual basis to prevent such generalised discrimination.

I have decided to pursue this via a legal avenue; I am healthy in mind and body and detest the thought that an illness I fought so hard to recover from could prevent me from pursuing my goal of serving my country. I am aware that even if I they say ‘yes’ and let me proceed with the enlistment process, I may well be knocked back at some other stage but that is irrelevant; it’s the simple injustice that, as a healthy individual, I can be denied the honour of serving just because I was unwell in the past.

In this latest letter they referred to high relapse rates; do you know of any research papers that show relapse rates are low, specifically for those that suffered as adolescents? I’m also looking for evidence to back up my claims that people can fully recover and go on to lead normal lives. I’ve tried to search online but all I can find is articles that portray outcomes very negatively and I thought you may know of articles that portray recovery in a positive light...? It’s rather disheartening to read ‘20% make a full recovery; 40% of these relapse’!!

I know that we are both aware that those who have suffered from anorexia can go on to recover and lead healthy, happy lives; I would be interested to hear your opinion of an ex-sufferer serving in the army.

S-
(edited for privacy and brevity)

(**Remission is the more accurate term, because the biological predisposition remains even when a person is living mentally well the rest of their life, but people seem to hate the term because they think it means not being completely well or that it means having to spend every day fighting to stay well - and that isn't what I mean.)

Comments

  1. In this old blog post (http://nourishingmyson.blogspot.com/2008/12/fears-of-future.html), I described some of my concerns for my son's (who is recovering from anorexia) future. I've done a little research since then. Apparently, the United States military would reject N because of his eating disorder. Eating disorders are included in the "unwaiverable medical conditions," but they are only documented if they occur after the applicant is 12 years old. I wondered about civilian positions, but wasn't able to find any additional information.

    Though I want my son to be able to be all that he wants to be, this makes some sense to me. In tough military-type conditions, especially those with high calorie expense and low calorie intake, someone potentially relapsing into anorexia symptoms could compromise a mission as well as his companions.

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  2. Wendy, I just talked this over with an Australian mother and we had similar concerns regarding nutrition.
    I'm just not sure this is possible in all situations you may encounter in the services:
    "At least I can prevent relapse by acting sensibly (ie staying in a healthy weight range and not skipping meals)."
    From that perspective, it is a kind and wise action not to allow you to be put in that position.

    "Sectioning" is permanently on your recorded in Australia and will alter some choices in your future rightly or wrongly.

    M

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  3. A recent study highlights extreme methods to method US soldiers use to meet weight regulations.

    http://www.armytimes.com/news/2010/12/army-extreme-weight-loss-120510w/

    It seems that caution is warranted.

    Your personal commitment to staying healthy is admirable and I have every confidence that you'll follow through. Unfortunately, relapse rates for anorexia nervosa are not low.

    Child Adolesc Psychiatr Clin N Am. 2009 Jan;18(1):225-42.
    Outcome of eating disorders.
    Steinhausen HC.

    Department of Child and Adolescent Psychiatry, University of Zurich, Neum√ľnsterallee 9, Postfach, CH-8032 Zurich, Switzerland.

    Abstract
    Both Anorexia Nervosa (AN) and Bulimia Nervosa (BN) are marked by a serious course and outcome in many of the afflicted individuals. In AN, there are an almost 18-fold increase in mortality including a high suicide rate, chronic courses in approximately 20 per cent of the cases, and more than half of the patients showing either a complete or a partial eating disorder in combination with another psychiatric disorder or another psychiatric disorder without an eating disorder. Mitigating factors of the outcome include onset of the disorder during adolescence and longer duration of follow-up. Vomiting, bulimia and purgative abuse, chronicity, and obsessive-compulsive features represent unfavourable prognostic factors in various studies. The longer-term outcome of BN is only slightly better result as compared to AN; however, the rate of mortality is low. Diagnostic crossover from bulimia nervosa to other eating disorders is a rather rare phenomenon, whereas the high rates of partial eating disorders may explain a large proportion of chronic courses. Social adjustment and the quality of personal relationship normalize in the majority of the affected patients. At present, the study of prognostic factors in bulimia nervosa does not allow any definite conclusions.

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  4. I did some more research into the policy of ADF on Eating Disorders and recruitment.

    Their website doesn't say much apart from medical assessments will be done and a certain level of fitness is required to be met and maintained.

    When I inquire directly about the policy, I received a response from them stating that they did not release the guidelines to the public.

    M

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  5. I support the decision to refuse enlistment to this person.

    I know of someone else who was in similar shoes who was admitted to the military in the United States.
    Her weight during Basic Training dropped significantly from median healthy BMI to complete life endangerment in that if she had dropped from a helicopter (which was part of her future training) with the required 85-pound backpack, it would have killed her as it weighed far more than she did (I promise that's the only weight reference I'll post here).

    Training requires meals, of course. Training requires that a recruit learn to shove food into his/her mouth as fast as possible. Literally shovel it down to learn how to do this under battle conditions.

    Training requires at times a minimal amount of water.

    Training requires battle condition simulations that are huge stressful and to anyone vulnerable can easily trigger post-traumatic stress disorder.

    Training requires extreme lack of sleep. Many times this person was required to be up in the middle of the night do keep fire watch as it was called to make sure fellow recruits were not trying to kill themselves which happens not infrequently.

    Training requires enduring (although I have learned that this has been reduced somewhat) disparaging belittling remarks that totally undercut one's self-esteem.

    Training for a woman particularly and military life in general does absolutely not protect her from rape and similar abuse from male recruits and military people. Things have gotten better in this department, too, but it is still far too common.

    I could go on and on. It may be that this person could make it through all of this but I would really caution her to reconsider and enter some other kind of service that might give her similar rewards.

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  6. Okay, my two cents.

    My sister recovered from anorexia nervosa and she was at one time very ill for an extended period of time.

    No, she has not joined the military.

    She is a doctor now (not a stress free job).

    She survived the unexpected and sudden death of her husband at a young age.

    And she raised 4 kids solo including college.

    Did I worry about her?
    Yes.

    Did she slip back into anorexia?
    No.

    There are success stories.
    She is one of the strongest people I know. I love her dearly as well as deeply admire her.

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  7. My thoughts, based on my own personal military experience:

    First off, I did have an eating disorder prior to enlisting. I was in severe denial about it and the fact that I had never been officially diagnosed is the only reason I was allowed to enlist in the Air Force.

    During basic training, I was underweight and placed on an eating waiver - to get me to gain weight. I had MTIs come up to my table with food telling me they wanted to make me a little piggy. This did nothing to help my mindset.

    Constantly having people tear you down - which they do in basic training - did not help. Having such an emphasis placed upon your physical shape was added stress.

    Being physically fit in the military is highly praised. In the Air Force it's part of your rating - which affects your promotion.

    Having your waist measured, your sit-ups counted, your mile and a half timed, etc feeds into over exercise which I had previously had problems with.

    Tech School - which goes after basic training, is high pressure for some career fields. They cram programs such as pharmacy tech into 9 weeks... they cram dental lab training (which on the outside is about 2 years) into 7 months. It's high pressure.

    My eating disorder went rampant in tech school - feeding off of the pressure to be perfect. The "you can't mess up or people get hurt" mentality.

    I went into therapy and was recommended to go into IOP, but PCS'ed to a new base. I got to that new base, was the only female in my career field (there technically was another one, but she was gone a lot as she was trying to change career fields) and I had the misfortune of dealing with the "good old boys club." Inappropriate comments were made about me and my body.

    I took up running as an outlet. I became addicted and wound up having to have surgery because damage caused by the excessiveness.

    When I injured my shoulder again and couldn't run I lost the only outlet I had. I couldn't handle the comments and the pressure being placed on me to have the same productivity level as those 2 or 3 ranks my senior. I would make mistakes and be told I was impacting their promotion.

    I finally told my supervisor I was throwing up when things got stressful and he told me not to mention it to anyone about it because it could negatively impact his career. I bit my tongue.

    Things continued to escalate and I was punished for speaking out. Nothing I ever did was good enough. I got coined by the base commander for community service, yet was told in a performance feedback that I "lacked community involvement"

    I wound up going to see a counselor that did not understand and said that I wasn't thin enough to have an actual problem. I did manage to get moved out of the lab though.

    Eventually I wound up in treatment - IOP - and when I came back I got my EPR and they had docked me down as a direct result of having to seek treatment. They said it didn't matter that it was medically related, that it was different than pregnancy or another illness because I CHOSE that path for myself -

    Later my med board results came back and it was deemed that my eating disorder made me unfit for duty and that the military had severely aggravated the disorder. They were going to be medically discharging me and giving me money to smooth it over - to make it okay that they had, admittedly, played a huge role in its escalation.

    Eating disorders and the military do not mix.

    Stats show that eating disorders affect a larger % of the military population than the general population.

    The question is whether or not it's because people with eating disorders are drawn to enlist (due to the high standards) or if they're developed within due to the pressure and the higher instances of sexual harassment.

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  8. I am so divided on how to respond to this post. I want to cheer you on. I really do.

    Did you read the research link on Laura's blog:

    "Keep Loving. Keep Going."

    "Is this a background trait in certain people that is ramped up by low nutrition? Is it permanent?"


    Also, there are no studies on how a person who is recovered from anorexia will do under semi-starvation conditions.

    After, I was no longer at an anorexic BMI, I purposely put my mind in a stressful situation because I was suppose to avoid getting that high of being able to push my body to survive on less.

    I could see how people with Eds are drawn to enlist in the military.

    I also see how a previous poster said her sister did well in college while studying to be a doctor. Because I went back to college.

    I didn't need another degree and both my doctors told me to avoid stress. (Because I had just been weight restored in May 2009 and I have an ulcer.)

    **

    I had to appeal the decision to be admitted at my University and then appeal to be let in the Masters program. It was stressful but I got in!

    What helped me was that I had a written plan for a relapse (in a university setting). My doctors wrote letters and my hospital sent records of admission dates.

    I also chose a Masters program with a highest number of students and professors with disabilities.

    Basically, my relapse plans where that my parents still keep tabs and understand that the thoughts aren't gone. Everyone at college knows about my disorder (Dean, Counselors, Student Health Services, Admissions. etc) I also attend all of my doctor and specialist appointments.


    **

    I think it's great that you are further along in you recovery!

    But please ask yourself why you are doing it. Is this the only option if you want to get into the medical field?

    If you are planning to appeal then write a personal statement outlining your plans for a relapse in military conditions.

    It's will not be enough to say that you will not skip meals etc. or self monitor.


    Find out if there is a clinic or a counselor/clinic (in the military) that you could list as a place to report too in case you feel like relapsing. What are the drawbacks of seeking help?


    **
    I will post a recent study that reports high rates of recovery from anorexia in another post because this is long.

    B.R

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  9. I have access to the whole research study. Here is one part:

    Update on Course and Outcome in Eating Disorders

    Pamela K. Keel, PhD*
    Tiffany A. Brown, BA

    International Journal of Eating Disorders Volume 43, Issue 3,

    Article first published online: 22FEB 2010

    Results

    Anorexia Nervosa

    Remission. Durations of follow-up in studies of AN have ranged from 2.5 years to 18 years with
    remission rates varying considerably across studies.
    The lowest remission rate (29%) was associated with the shortest duration of follow-up. Supporting
    an association between duration of follow-up and remission, Nilsson and Hagglof reported that
    remission from AN increased from 68 to 84% between 8 and 16 year follow-up. Although remission
    rates appear to be associated with duration of follow-up, other factors likely contribute to improved outcome. Notably, a relatively high proportion
    of patients enrolled in a Randomized Controlled
    Trial achieved remission by 5-year follow-up (76%) and a relatively high proportion of patients followed from a community health clinic achieved remission by 8-year follow-up (82%)compared to remission rates reported an average of 12- and 18-
    years following intake in studies of an inpatient sample from Germany or a community-based
    sample.


    The Objective, Method, Results and Discussion can be found at the link:
    http://www.ncbi.nlm.nih.gov/pubmed/20186717

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  10. Eating disorders in the military:

    http://jama.ama-assn.org/content/282/24/2291.3.extract

    http://www.stormingmedia.us/71/7117/A711784.html

    also: google "recruit medicine chapter 18 eating disorders" it'll link you to a pdf

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  11. Could you keep us updated on this issue? I have also been interested in joining the army (Aus) and have been under an ITO for EDNOS. If you hear anymore from S. please let us know or if S. is reading this please keep us updated. Thank-you.

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  12. It really has surprised me that so many parents have had such a negative reaction. In Kat's case, she had an active, but undiagnosed, ED. So I can easily see why this environment would have been extremely detrimental for her. I also understand that if you've the genetics for an ED, then you may always have the potential for an elevated risk. HOWEVER, I think full recoveries DO occur. I think doing what you are passionate about and following your heart is most likely to help keep you a physically and mentally well person. If this young woman has been free of an ED for some time, has been pronounced healthy in all respects by her doctors and knows what she needs to do to stay well, I personally see no reason for her not to pursue her life's passion. I applaud your courage. Go for it with all your heart.

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  13. The military isn't the only thing organization that does this though... The Peace Corps will not take you if you've had an eating disorder (recovered or not)... Because sometimes you wind up in situations that can trigger someone that's even recovered.

    A friend of mine is fully recovered - has been for years now... she's having medical issues where she has to be on this very strict diet and she's finding it incredibly triggersome...

    In my opinion it makes complete sense why the military (and the Peace Corps) do not allow those with eating disorder histories in.

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  14. Hi Kat,

    I admit I'm neither an expert on the military or the Peace Corps. I've no experience with either one. I also understand the nervousness of caretakers who've seen a loved one through an ED illness. I speak from experience, twice over. But, to truly heal, we have to all move on at some point and we have to have faith in our loved ones that they can do it and they can make it. It is the absolute most precious gift we can ultimately give them. This doesn't mean turning a blind eye to realities, only assessing risks realistically for each and every person. It isn't easy to do after you've been through hell and back.

    I did do a really quick google search on eating disorders and the peace corps. The very first link I found was this one. It seems this young woman had an ED, felt herself recovered (and got documentation to that effect) and WAS accepted by the Peace Corps. I'm going to try to leave the link on a separate comment page because every time I post it here MY comment seems to vanish. Not sure why.

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  15. Actually, it would be interesting to know exactly what the US Army's regulations are (I know this young woman is not American).

    One site I found says "...eating disorders that are habitual or persistent occurring beyond age 12..." and lists it as a behavioral disorder (I might like to disagree with them on it being behavior,but I'm not sure I'm up to taking on the whole US Army at this point). It also has some statement about never having been in residential. However, to me, this does not necessarily preclude everyone with an ED.

    Just as treatment needs to be customized to an individual's needs and stage of recovery, so should the aftermath. I think it is discriminatory to say to someone, "You were not well at one point in your life and we don't believe you will ever be truly well again."

    Maybe I'm naive.

    But, in my heart, I don't believe that.

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  16. Whoops. I am not sure why that didn't copy correctly. Here is the right link:
    http://esayward85.wordpress.com/2009/06/10/and-thus-it-
    begins-phone-interview-with-peace-
    corps-placement-officer/

    Laura, Can you delete the one right before this?

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  17. I just know from friends and from reading that the Peace Corps does not just accept people with an eating disorder history -- they had to appeal... which is the same as the military (case by case basis).

    I do agree that part of recovery is going out and living your own life... and having family support would make that a lot easier.

    However, I do still believe there is a period of sensitivity. Further proof of this could be found in why there's a certain number of years that you have to have went without seeking treatment for an eating disorder (including therapy) to do a practicum in an eating disorder treatment facility.

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  18. It would seem to me that if one can eventually be well enough to work with others that are actively ill with ED's (in effect surrounding themselves daily and hourly with all that they themselves once suffered from), then the same should hold true for working in any job situation. I can't imagine a more potentially 'triggering' (excusing me for using this word because I actually dislike it) situation than to be a former sufferer working with actively ill eating disordered patients. But, if that is possible (and allowable), then anything is (and should be).

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  19. I completely agree with that Anne... I guess the question, in my mind, is how long of a wait is a safe one?

    For the practicum it differs from facility to facility - most according to my therapist - are at least 6 years without seeking any form of treatment for it...

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  20. S - I believe you may have been discriminated against on the basis of a past disability. This is against the law in Australia under the Disability Discrimination Act, 1992 (Cth). I think it is worth you getting a legal opinion on whether you can challenge this decision. The army is making a huge assumption that because you had AN you are at risk of relapse. They should be looking more closely at the type of treatment you had - the research suggests that the rate of relapse with Mandometer treatment is relatively low.

    Good luck!

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