To the uninitiated, many of the things said about eating disorder treatment can be confusing. “Insiders” (staff and established patients) use words and phrases that may be unfamiliar. Whether you are a first-time patient, a family member, friend, or outside provider, “learning the lingo” can go a long way in demystifying the treatment process. Here is an introduction to some of the most common terms you may encounter.
Terms that Describe the Problem
Treatment relies on having a shared language so that everyone can communicate and understand each other. Although everyone in treatment has an eating disorder (which we refer to simply as an E.D.), each person’s E.D. is a unique blend of various symptoms and behaviors. We lump all of these together under the umbrella term “behaviors,” or sometimes “E.D. behaviors.” This umbrella includes anything someone may do to influence weight/shape, including restriction of food intake, binge eating, and any compensatory behavior – behavior that “makes up” for having eaten, such as purging or excessive exercise. It also includes other eating behavior, such as rituals involving how food is eaten. Treatment focuses on understanding E.D. behaviors, identifying triggers (what sets them off), interrupting the behaviors, and replacing them with healthy coping skills to manage emotions and stressors.
E.D.s aren’t just about behavior, of course. There is a whole pattern of thinking that fuels the behavior. Many of these thoughts do not accurately reflect reality; such thoughts may be referred to as “irrational” or “distorted.” Thoughts specifically related to the E.D. are often described as the “E.D. voice.” This expression does NOT mean the person is “hearing voices.” Instead, it’s a way to separate E.D. thoughts from the person’s own thoughts, beliefs, wishes, and values. Most patients notice that their minds hold both “voices” – their own and the E.D.’s. Treatment helps them resist the E.D. voice and listen to their own voice. Sometimes people will name the E.D. voice: some people call it “Ed,” but many other names – both male and female – have been used.
Terms that Describe Treatment
Treatment is itself an umbrella term that refers to services one receives in any of several treatment settings. Treatment settings vary in degree of structure and intensity, and exist on a continuum (called the “continuum of care”) from the most structured (inpatient hospitalization) to the least structured (outpatient counseling). In between these extremes are three other, lesser-known “levels of care.” When someone needs support 24 hours a day in order to interrupt their E.D. behavior, but is medically stable enough not to require hospital care, they may be admitted to residential treatment (or “resi”). People who are able to manage their behaviors for periods of time without support but still need intensive treatment may attend a Partial Hospital Program, or PHP, which meets 5 days a week for 6 hours. Those who do not need the daily structure of PHP, but need more support than standard outpatient counseling may attend an Intensive Outpatient Program, or IOP, where they attend three times a week for about 3 hours. Treatment at any level of care is provided by a “treatment team” – an interdisciplinary group of providers that may include psychiatrists or psychiatric nurse practitioners, nurses, dieticians, and therapists.
A core feature of E.D. treatment is nutritional rehabilitation to “normalize” patients’ eating. This is accomplished by helping each patient follow a meal plan – a list of what food groups should be included in each meal and snack. Meal plans typically utilize “exchanges,” which categorize foods by food group (e.g., grains, proteins, etc.) based on an “exchange list” of nutritionally-equivalent amounts of various foods in each category. If a patient does not complete all of the exchanges for a meal or snack, they may be given a “supplement” – a nutritional drink such as Boost or Ensure. If a patient is underweight, a goal of treatment is “weight restoration” – achievement of a healthy weight for the patient’s height and age, referred to as “ideal body weight” or IBW. Programs often use “blind weights,” where patients do not see their weight, to reduce fixation on the number.
Much of the therapy that takes place in treatment programs is group therapy. Groups often include psychoeducation (where patients learn more about eating disorders, their impact on the body, nutrition, and coping skills – ways to manage symptoms and emotions without using E.D. behaviors); Cognitive Behavioral Therapy, or CBT (which helps patients recognize and replace distorted thoughts, and change their behavior); and Dialectical Behavioral Therapy, or DBT (which focuses on developing skills in mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness).
The ultimate goal of treatment is “recovery” – that hard-to-define state of health where the E.D. recedes, and a richer, fuller life emerges. I hope that the key terms I’ve outlined here will help make the first steps on the journey from E.D. to recovery more understandable. As with any journey, the first steps are the most important part!
About the author:
Natalie Hill, LICSW, is Lead Clinician of the Adult PHP and IOP at the Braintree Clinic, where she provides group, individual and family therapy, facilitates a training program for masters-level interns, and plays a supportive role in clinic operations. Ms. Hill’s professional interests include Narrative Therapy, and innovations in Eating Disorder treatment. She is the author of the blog Practice Wisdom (http://practicewisdom.blogspot.com).