Jenifer Beaudean's bulimia began when she was a third-year cadet at the United States Military Academy at West Point, N.Y.
The pressure from her family, school and peers to "make the uniform look good," she said, took a toll on her self-image.
At a routine weigh-in held to ensure cadets are maintaining the standard height-weight balance, Beaudean came in at a heavier weight and had to be "taped" -- meaning a measuring tape was used to ensure her waist size matched regulations proportional to her height.
"I had a very poor body image," said Beaudean, who talked of her first time purging in her dorm. "It really culminated into this moment of desperation."
For 13 years and throughout her seven-year Army career, Beaudean, now 43, of Southbury, Conn., battled the cycle of binging and purging.
"Although I was a good and healthy weight, it felt like I couldn't be thin enough," said Beaudean, who has documented her disorder in her memoir, "Whatever the Cost." "Every success was diminished by a number on the scale."
As many as 10 million women and 1 million men in the U.S. battle anorexia or bulimia, and at least 15 million more struggle with binge eating disorder, according to the National Eating Disorder Association. Millions more practice disordered eating because of an obsession with dieting.
Mounting evidence suggests that eating disorders are higher among service members than among civilians.
While there's not enough substantial data collected to quantify the prevalence of eating disorders among service members, previous research suggests female service members are 4 percent more likely to develop an eating disorder than females not in the service.
A study published 2009 in Military Medicine found no difference in the prevalence of eating disorders between West Point cadets and students at civilian colleges.
A review published in 2008 looking at nearly a decade of medical data from service members diagnosed with an eating disorder, suggested that the diagnosis of eating disorders among service members doubled from 1998 to 2006, although the number remained relatively small. A majority of those diagnosed were Marines.
Experts said a combination of environmental and traditional factors place soldiers, especially women, at higher risk for developing an eating disorder than any other group of people.
Women who report feeling deployment stress may be at higher risk for developing eating problems and weight loss, according to a 2009 study published in the American Journal of Epidemiology.
An estimated 14 percent of active duty military personnel are women, according to the U.S. Department of Defense.
According to Dr. Kim Dennis, medical director of Timberline Knolls, a residential eating disorder treatment center in Lemont, Ill., eating disorders among women in the military are underreported and often difficult to detect.
"I think that goes hand in hand with denial and minimization of eating disorders," said Dennis, whose facility sees a substantial amount of women in the military. "They're more recognized as having a substance disorder."
Eating disorders can range in forms including excessive physical activity, extreme dieting, anorexia, binging and bulimia.
At the height of her illness, Beaudean purged up to five times a day.
"The pressure from the chain of command is to be fit, but in my mind that translated to skinny," said Beaudean.
After commissioning, Beaudean was stationed at Fort Hood, Texas.
"By that time, bulimia no longer because a decision," she said. "There was an addictive behavior in place."
When Beaudean felt she had "one bite too many," she said, she felt an overwhelming anxiety come over her and a natural reaction to run to the bathroom.
But all the while, she kept her illness a secret, and called herself a "functioning bulimic." No one suspected there was anything wrong.
The military, much like professional sports, appears to be an environment where eating disorders are more likely to develop, according to experts. The environment cultivates severe pressures to attain and maintain peak physical condition marked with regular weigh-ins.
Although female height-weight standards differ by numbers from men, women are expected to maintain standards equivalent to male soldiers.
But male soldiers may be just as much at risk for eating disorders as their female counterparts, said Dennis.
"Historically, people think of eating disorders as a woman's disease," she said. "And there's some of that mentality of segmenting it just to women."
Although soldiers look physically fit, many crash diet, and some resort to starving before physical tests so they can meet the weight standards. Appetite suppressants, laxatives and other supplements run rampant within the military.
"There are both men and women with active eating disorders," said Dennis. "It's a lot easier to hide an eating disorder than an alcohol and drug problem."
A 2009 study by officers at the Naval Post Graduate School found that nearly one in three Marines turned to excessive and, at times, unhealthy methods to meet the weight standards.
These methods can open doors to a diagnosis Dennis described as "eating disorder not otherwise specified" -- a term used to define binge eating, or extreme dieting and physical activity, that may not meet the clear-cut definition of more commonly known terms like anorexia or bulimia.
Many military bases have most recently pulled commonly used dietary supplements containing an ingredient known as dimethylamylamine (DMAA) from store shelves after toxicology reports for two male soldiers who died of heart attacks during fitness exercises identified the ingredient in their systems. DMAA has been advertised in dietary supplements as a way to burn fat and increase energy, but some experts liken the ingredient to ephedra, a stimulant that's been linked to deaths of many professional athletes.
According to Dr. Angela Guarda, director of the eating disorder program at Johns Hopkins Medicine, long-term health risks of eating disorders include depleting potassium levels that can lead to heart problems, lower heart rate, lower blood pressure, infertility, and depression.
"Just educating people about their risk is not effective to prevent an eating disorder," said Guarda. "Teaching healthy nutritional principles for a balanced diet or changes in lifestyle behavior may be more useful."
While the pressures she felt during her time in the military contributed to her eating disorder, Beaudean said her circumstances may not be as uncommon as some of the pressures felt more widely to stay thin.
"If an eating disorder can happen among the best of us, then truly, eating disorders are everywhere," said Beaudean. "It is everywhere in every walk of life, often in secret."
For more information on Eating Disorders, visit the National Eating Disorders Association