At Wellness Coaching & Nutrition Therapy, and Conquer & Bloom Katy Counseling, we work with many families who are new to eating disorders. Whether they are coming in with their teenager who struggled with the COVID-19 quarantine isolation and their eating disorder came in fast and hard since the spring, or a teen who has been hiding their behaviors for several months or years (yes, years, we hear that a lot as well), or even adults who have been fighting this battle for over a decade and have decided to bring in help to their fight-- we are ready for you, and welcome (encourage!!) loved ones to the team as well.
Part of beginning treatment for an eating disorder is learning the lingo. We’re happy to break it down and explain each part to you; and many still reach out to recovery networks or on social media to hear about the journeys of others, and the language can get confusing if you’re not used to it. There may also be words you think you know what they mean, but have a different definition in the eating disorder field. By no means is this an exhaustive list, but the goal is to help you understand more of what you see and hear, as well as ask questions you may not have thought about before!
*Note: these are grouped by concept, rather than alphabetically.
Disordered Eating vs. Eating Disorder -- By clinical criteria, an eating disorder is identified by specific symptoms, behaviors, and duration. Disordered eating, on the other hand, is more encompassing to include any behaviors related to eating and food which interrupt and interfere with energy needs, relationship with food, and can compromise medical health. If you feel you have been on “every diet” or “yo-yo dieted” throughout your life, you have engaged in disordered eating-- and it’s more common than you’d think. Diagnosis and severity cannot be determined by weight and body shape alone; rather, an assessment of current symptoms by a trained professional are necessary.
Seeking help and treatment is appropriate and important no matter how long, severely or mildly, consistently or intermittently you believe you have been engaging in these patterns.
Anorexia nervosa -- This is the eating disorder most people are familiar with. It is categorized two ways: restricting type, and binge eating/ purging type (see Part 2 for more explanation of binging and purging). Restricting type is “strictly” refusing to eat enough to meet the needs of your body; while binge eating/purging type is characterized by primarily restricting intake while also having binge eating and/or purging behaviors.
Bulimia nervosa -- This eating disorder is marked by primarily engaging in binging then engaging in compensatory behaviors (whether forcing themselves to throw up, overexercising, or use of laxatives, etc) to “get rid” of the calories consumed.
Binge Eating Disorder -- Characterized by frequent binging without trying to “get rid” of what was just eaten or only following periods of skipping meals and snacks.
ARFID / Avoidant Restrictive Food Intake Disorder -- This is a disorder denoted by the restriction of food due to sensory hypersensitivity (including taste, color, texture), fear of illness or gastrointestinal reaction, or any combination of these. Body image and weight concerns do not affect these clients.
Other Specified Feeding / Eating Disorder (OSFED) -- This is a catch-all diagnosis for when someone’s symptoms don’t fit precisely within another eating disorder diagnosis. This does not mean it isn’t potentially severe or dangerous, just not currently within another diagnosis. While eating disorders can happen at the same time as mood and anxiety disorders, someone cannot be diagnosed with multiple eating disorders at one time, so a mixed presentation would be diagnosed as OSFED.
Orthorexia -- Though not a formally recognized diagnostic category at this time, it is used to classify people who not not have concerns with weight, but have obsessions around health and restrict to only foods they deem ‘good’ enough. At this time, someone with orthorexic patterns would be diagnosed with OSFED. Preoccupation with “clean eating” fits into this category.
Treatment Team -- this is the group of specialists who will work with you to break through the eating disorder, heal your body, relationship with food, and psychological distress.
Therapist -- I am a therapist. Specifically, my license is Licensed Professional Counselor (LPC) meaning that I have completed a Master’s degree in Professional Counseling, then completed a supervised internship as an LPC-Intern and passed the National Counselor Exam. Other types of therapists include: Licensed Marriage and Family Therapists (LMFT), Licensed Clinical Social Worker (LCSW), and Psychologist (someone with a doctorate in clinical psychology and a license to provide clinical services). We work with you on the emotional, cognitive, and behavioral components of your recovery.
Registered Dietitian -- Unlike the term “nutritionist”, which has no professional requirements or oversight to use, “Registered Dietitian” is a protected term that denotes that the identified clinician has completed required coursework in nutrition, as well as a supervised internship in various professional settings, then passed a national professional exam to earn this credential. This is the treatment team member who will work with you to identify your specific nutritional deficits, appropriate weight goals based on your growth and development history, and create structure for your eating patterns so you can meet your energy needs appropriately.
Recovery Coach -- this is a treatment team member who has been trained in offering meal support, planning for and going grocery shopping while you are relearning what such activities need to look like while transitioning from eating disorder to recovery, and other day-to-day support between sessions with your dietitian and therapist. Our office has the amazing Emily Lefler available for clients interested in adding a recovery coach to their treatment team!
Specialist & Certified specialist -- A specialist is a clinician who has sought out specific and extensive training, as well as supervision in a defined area of practice. A Certified Specialist in eating disorders is known as a Certified Eating Disorder Specialist (CEDS) or Certified Eating Disorder Registered Dietitian (CEDRD), and is a clinician who has at least 2500 hours of eating disorder practice which has been supervised by a designated supervisor, completed educational requirements, then been approved by the certification committee of the International Association of Eating Disorder Professionals (iaedp). In our practice, we are all either Certified specialists, or under supervision to earn the CEDRD/CEDS designation (I’m submitting my application to the committee this month!).
Levels of care (LOC) -- Levels of care is exactly what it sounds like: What level of professional care someone needs at any given point in treatment. Below are the different levels and what they involve. If you see a note about “HLOC”, it stands for Higher Level of Care
**Important to note: not every person in eating disorder recovery needs every level of care, and what someone’s treatment journey looks like in this regard is unique to them. Level of care determinations are serious discussions between the treatment team, family, and client, and involve ongoing assessment and contemplation.**
In patient -- Again, straight forward. This level of care involves being admitted to a hospital, particularly an eating disorder specific unit (Denver ACUTE is only for eating disorder care for those 17 years and older). The goals at this level are to medically stabilize and address acute physical symptoms (including beginning the refeeding process (see Part 2 for more on refeeding). Because of the focus on medical stabilization, very little therapeutic work is done at this level, and is typically the shortest of the levels of care.
Residential (RTC) -- The 2nd shortest of the treatment levels, someone admitted to residential care is living at the treatment facility for specialized care. This does not mean that it’s forever! Lengths of stay at RTC typically range from 3-8 weeks and depend on a number of factors. The treatment at this level involves 24/7 monitoring by treatment staff, regular medical assessment, medication prescribing or adjusting, supported meals and snacks with a higher degree of oversight, therapeutic groups, 1:1 counseling (both psychotherapy and nutrition), and family support programming.
Partial Hospitalization Program (PHP)-- This is the first “outpatient” level of care because it means the client has time away from the treatment center and is sleeping at home (some treatment facilities do have PHP apartments as a step down from RTC and provide transportation to and from programming each day). PHP programs vary in how many hours a day they run, generally between 7 and 10 hours of programming between 5 and 7 days per week. Either 2 meals and a snack, or 3 meals and 2 snacks are done at the center with professional meal support (program dependant), as well as therapy and nutrition groups, family education and support groups, and 1:1 sessions with a therapist, dietitian, and psychiatrist. Medical support is most often done outside of the program.
Intensive Outpatient (IOP) -- This is the “lowest” of the higher levels of care. This treatment level is typically around 3 hours per day, between 3 and 5 days per week. While still working with your program treatment team 1:1, you’ll also be connecting with your outpatient treatment team to create a smoother transition once finished with IOP, as well as address concerns outside of the eating disorder.
Outpatient -- This is the general term for seeing your treatment team about once a week each and otherwise engaging in school, work, family life, etc. This is the most common and longest part of treatment and recovery maintenance. This is the level where recovery is solidified. Higher levels of care are important, but they do not complete the treatment process. Having a solid outpatient team is important, and continuing to work with that team after stepping down is where lasting recovery happens.
Step up /down -- moving between levels of care
Eating Disorder vs Mental Health centers -- While an eating disorder is a mental illness and requires mental health treatment, the general terms for the two types of treatment facilities are different. Eating disorder treatment centers are very specifically focused on recovery from eating disorders with knowledge and support for co-occuring disorders (such as depression, anxiety, PTSD). Mental health treatment centers, however, are specifically focused on treating mood disorders, anxiety, trauma disorders, etc. but without specific nutritional support.
Milieu -- the group of clients in a treatment center at the same time.
Lapse vs Relapse-- A lapse is an isolated or short term (day or two) return to use of eating disorder behaviors, then returning to recovery based choices. Seeking more support when someone notices a lapse may be helpful to “nip it in the bud”. A pattern of lapses, or lack of regular recovery based choices denotes a relapse and requires additional support than when in a stronger state of recovery, depending on how severe the relapse, the treatment team may recommend a step up to a higher level of care.