One of President Donald Trump’s first acts in office was an executive order that labeled a range of mental health conditions as “incompatible” with military service. Experts, including a military psychiatrist, say Trump put a dark cloud over troops with mental health conditions, many of whom may now try to “go underground.”
The order, ‘Prioritizing Military Excellence,’ specifically targeted transgender troops but laid out a dire opinion of several mental health conditions: “Many mental and physical health conditions are incompatible with active duty, from conditions that require substantial medication or medical treatment to bipolar and related disorders, eating disorders, suicidality, and prior psychiatric hospitalization.”
That language, said Dr. Stephen Xenakis, a retired Army brigadier general and practicing psychiatrist, could force service members who sought or planned to reach out for help for their mental health to “go underground.”
“Labeling them like that, it does add to stigma and it makes it much more difficult when they really are common, which means that other folks are going to go underground,” Xenakis said. “We want them when they feel they’ve got a problem to really feel like they can go get help.”
Pentagon officials did not respond to inquiries about what the executive order means for troops dealing with similar mental health conditions or if it would lay the groundwork for new policies — as the same executive order did for shaping the future of transgender service members. Last week, Defense Secretary Pete Hegseth ordered a stop to all medical gender affirming-care for transgender troops and banned bringing in recruits who previously sought similar treatments. That memo said the moves were being made to comply with Trump’s ‘Prioritizing Military Excellence’ order.
A DoD official told Task & Purpose that “there has been no change to policy at this time.”
Mental health in the ranks
Between 2019 and 2023, more than 540,000 active-duty service members were diagnosed with at least one mental health disorder — the majority classified as adjustment disorder, anxiety, depression, and alcohol abuse disorder. In 2023, behavioral health disorders accounted for the highest number of hospital bed days and the second-highest number of medical encounters across the active duty force, according to the Defense Health Agency.
The military has expanded mental health services in recent years, giving service members more options for treatment. However, how a diagnosis impacts a service member’s career can still vary widely.
Whether troops are deemed “fit for duty,” according to a Military Psychologist Journal analysis, can come down to a case-by-case assessment of conditions like bipolar-related disorders, anxiety, depressive disorders, eating disorders, and other behavioral health issues. The difference between continuing in the military or being forced out might depend on whether the condition causes “persistent duty modifications” or impairs everyday functions. According to Department of Defense Instruction 6130.03, which the Trump order cites, new recruits should not have medical conditions that take away “excessive” duty time for treatment or hospitalization.
Over the last two decades, behavioral health experts have preached that “if you don’t catch problems early on, they tend to get worse,” said Dr. Harold Kudler, a 40-year psychiatrist for the Department of Veterans Affairs and former senior policy lead for VA mental health. “You’re left to imagine what that might mean.”
“Our entire suicide prevention campaign, both in the military and the VA, is predicated on the idea that when you have a problem early on, it’s essential to talk about it and to get help for it,” he said. “The one thing that everyone agrees on is that if you can’t talk about a problem, you can’t deal with the problem.”
Despite the millions of dollars spent on suicide prevention and treatment for troops, there have been “gradual” increases in suicide rates among the active duty population since 2011, according to the Pentagon’s latest annual suicide report.
“Irrespective of language in the executive order, there’s always been a stigma, especially on the active duty communities about reaching out for care,” said Brian Kinsella, founder and chairman of Stop Soldier Suicide.
According to the Pentagon’s latest suicide report, in fiscal year 2023, less than half of the 363 troops who committed suicide that year met with a provider and were given a mental health diagnosis, indicating that many did not seek care. In a January study that looked at the Army’s annual health assessment, researchers found that 95% of suicide attempts “occurred among soldiers who denied suicidality” in their questionnaires.
Suffering in silence
Leah Stiles, founder of SEA WAVES, an organization that focuses on eating disorders among active duty and veterans, worries that the order’s language will cause “hopelessness” among service members who often suffer in secret.
“The fact that eating disorders are considered not compatible with military service, that’s not new. However, shining a light on it and making the announcement, that’s the part that’s concerning me,” Stiles said. “We have several people in our SEA WAVES community that are still active-duty that are absolutely petrified and are hiding their struggle right now. That’s why I feel so compelled to speak, because I do have a DD 214.”
SEA WAVES is the only Veteran Service Organization focused on eating disorders despite serving a population where strict physical fitness and appearance standards are expected and act as a “breeding ground” for disordered behaviors, according to Stiles.
Research of eating disorder prevalence in the military indicates that troops suffer from it at similar levels to civilian populations but also notes that it is disqualifying from enlistment, meaning troops are less inclined to report it, and that the topic is understudied. Other studies have shown that eating disorders are common comorbidities for patients with post-traumatic stress disorder and sexual trauma, which are prevalent in military and veteran groups.
SEA WAVES is still trying to push past the taboos and resistance of leaders to recognize the role that the military’s diet culture plays in troops developing full-blown eating disorders. Stiles, a former Navy senior chief who served 20 years, gave the example of methods that troops use to lose weight before personal weigh-ins like intentional dehydration, laxative use, sitting in the sauna, wrapping their bodies in saran wrap with hemorrhoid cream, and going for a run.
“There’s a lot of disordered behavior that has just been normalized over the years,” she said. “You can go to any base, any station, and see these behaviors happening.”
There’s also limited knowledge of the military’s experts who could treat these disorders. Stiles said she has “yet to come across” experts who are certified in diagnosing and treating eating disorders, adding that behavioral health and nutrition professionals receive around 15 minutes of specific training on the subject.
With a lack of awareness, institutional expertise, and now the order’s pointed language, Stiles says she is worried it’ll drive troops even further away from asking for what is sometimes life-saving help. During her service, Stiles was running full marathons and excelling in her career, making it to the rank of chief petty officer in under a decade.
“The whole time I was struggling,” she said. “The things that made me a wonderful sailor and a wonderful leader also fueled my eating disorder.”
While on deployment with the USS George H.W. Bush aircraft carrier, Stiles was medevacked back to the U.S. for treatment.
“My body was shutting down in multiple different ways and my chain of command held an intervention,” she said. “When I arrived back at the States, there was not one single eating disorder informed professional that was there to treat me.”
Mental health and recruiting
Xenakis, the retired general and psychiatrist, voiced concern that new policies would likely impact recruiting, noting that mental health diagnoses are “common problems that young people have.”
Nearly 49.5% of adolescents have had a mental health disorder at some point in their lives. When compared to adults over 26 years old, those 18 to 25, had a higher rate of mental health issues, according to the 2022 National Survey on Drug Use and Health.
Because of the prevalence of certain mental health disorders among those of enlistment age, the Pentagon expanded eligibility in October to include those with attention-deficit/hyperactivity disorder, or ADHD, to serve without a waiver.
Xenakis pointed to the military’s establishment of substance abuse programs in the 1980s to treat common problems among troops at a poignant time for the Army’s recruiting efforts.
“We knew that coming out of Vietnam that we had a lot of service members with those kinds of problems and rather than ask them to leave — particularly when we were trying to build up the Army — we said why don’t we just help them and treat them,” he said. “I think we’re in a similar situation now where there are challenges to recruiting.”
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