eating disorder terminology

So, I've had a few people ask me questions about eating disorders, and I figured I'd answer them for all to see. But I realized that before I start, there's terminology that will make no sense to some people. I've lived with it for so long it's second nature, but outside my little mental health community it's gibberish. I also think it's important to get some of these terms and their acronyms out there, because people with eating disorders frequently use the confusing terminology so that "normal" people have no idea what they're talking about. *guilty as charged*



Eating disorder (ED): There are many different types; those listed in the DSM-5 are anorexia nervosa (AN) ("ana" is a term usually used by those who love their ED and see it as a lifestyle), bulimia nervosa (BN) ("mia", similar to ana), binge eating disorder (BED), and eating disorder not otherwise specified (EDNOS). EDNOS includes orthorexia, pica, night-eating, and others. There's a comprehensive description of each here, including symptoms, warning signs, and health consequences.

The following terms are known as "behaviors". Not every person with an ED will use all behaviors.

• Binging: My definition of this is probably a little different than the normal one, which is something along the lines of "a large quantity of food consumed in a small amount of time." This is certainly a large part of it, but for me the element of control was always important. Binging for me was eating food in an unstoppable manner, whether it was an entire jar of nutella or a few pieces of lettuce. Typically, however, binges involve many thousands of calories worth of food eaten in one sitting.
• Purging: Getting rid of food/calories you've consumed. Most commonly, this is done by making yourself throw up, but can also include excessive exercise, use of laxatives, etc.
• b/p: Short for binge/purge. A cycle of eating excessively, throwing up the food, eating more, and continuing this process over a finite amount of time.
• Restricting: Not eating the necessary amount of calories to sustain a healthy body. It's important to distinguish this from unintentionally undereating, as restriction (at least to me) implies a conscious decision to eat less than you should.
• Fasting: Not eating for extended periods of time, usually at least a day.
• SI: Self-injury. While not specifically related to eating disorders, many people with EDs do some (other) form of self-harm such as cutting, burning, etc. There's a host of other mental illnesses linked with eating disorders, that you can read about here. (This entire site is awesome. Just FYI.) 
• Body checking: Checking to see if you've lost weight by a variety of (non-scale/measurement) methods. Everyone has their own little rituals; mine included touching my thumb and index finger around the top of my elbow, counting the number of fingers I could stick between my thighs, laying on my side to see if my thighs touched. Also done with clothing: checking if new (smaller) clothes fit, if old clothes are baggy, etc.
• Bone checking is a form of this, where a person literally just feels their bones and how much they're sticking out. For me, back hip bones (if you don't know what those are, good for you), the tail, collar bones, hip bones, etc. I could go on, and these are just my own personal checks.

Weight:

• CW: current weight
• HW: high weight
• GW: goal weight. For those with eating disorders, a number they're trying to lose to. For treatment personnel, the appropriate weight for your body given your height.
• LGW: low goal weight. The number an eating disordered person sets as their ultimate desired goal. For anoretics, this number tends to continue dropping. For those who realize their eating disorder will kill them (or who want it to) this number is 0. Because we even lose our bones, guys. (I'm getting snarky. I should sleep.)
• BMI: body mass index. Something I definitely WON'T link you to if you don't already know what it is. It uses your weight and height to give you a number evaluating how over or underweight you are, on a very generalized scale. The "criteria" for AN is a BMI <17.5. Starvation is generally assigned to a BMI of <15. While these numbers are generally used to "assign" someone an ED (anorexia, specifically), it's VERY important to note that you BMI ABSOLUTELY DOESN'T determine whether or not you have an ED. People of normal or high weights can have one just as easily as those with low weights.

Treatment:

This section actually has to start out with motherfucking INSURANCE COMPANIES. Because eating disorders are a mental illness, insurance doesn't like to cover them. When they do, they rarely cover treatment in full. Different companies all have different policies, of course; some will cover residential (the best form of care for EDs, as I see it), while others will not. When in treatment, there is an entire team devoted to dealing with insurance companies. They have to reassess your "progress" every 3 days, and the insurance will let them know if they'll cover you for the next 3 days. Sometimes, they'll be lenient and give you an entire week. For someone who has been stuck in a psych ward and is already in a really bad place mentally, LET ME TELL YOU HOW STRESSFUL THIS IS.

I should also say that the average cost of treatment is: $1000-1500/day for IP/resi, and $500-700/day for PHP/IOP. This doesn't include any outside doctors or therapists. This shit's EXPENSIVE.

• Inpatient (IP): full hospitalization, usually in either a medical hospital or a psychiatric ward. Some IP facilities have specific eating disorder programs, while others do not. IP is used for patients who are medically unstable (eating disorders do bad shit to your body, who'da thunk?) or if residential is not an option (insurance) but the person needs to be in 24hr care. Fun activities include: counting in the bathroom (or singing, if you're creative) so the nurse knows you're not purging, 15min checks even while you're sleeping (flashlights in the face, yay!), vitals every morning at 6am wearing hospital gowns, blood drawings, EKGs, and all sorts of other goodies. Length of stay usually 2-10weeks.
• Residential (resi): similar to IP, but in a facility designed only for eating disordered patients and intended to have a more "homey" feel, rather than a hospital feel. Length of stay is generally longer than for IP (2-6months). Focuses more on the mental aspects of the disorder than IP, rather than just returning the body to medical stability. (I've never been in resi, so I can't give you any awesome details)
• Partial hospitalization program (PHP): step-down from IP/resi. Usually a 8hrs a day, 7 days a week program to start with, that includes at least 2 meals. Intended to help patients reintegrate back into real life, where not every aspect is controlled as it was in the hospital.
• Intensive Outpatient (IOP): similar to PHP, but with shorter hours and less days a week. Intended to continue the reintegration at a slow pace, so it's not overwhelming. Ideally, if insurance holds out, the patient can drop down one day at a time until they no longer need the program. Length of stay for PHP/IOP varies greatly, from 1-6 months.
• Outpatient (OP): use of outside treaters, rather than a facility. Usually, the patient sets up a treatment team while still in facility care, so there is overlap between the two.
• Treatment team: people designed to help us keep our shit together. But seriously. Consists of (not necessarily all of these): psychologist (a.k.a. therapist, shrink), psychiatrist (can prescribe medication, while therapists cannot), and nutritionist (to help with ongoing meal planning). Patients usually start off seeing a therapist at least 3 times a week, then slowly taper off as need/expenses allow. Psychiatrists are necessary as long as the patient is still on psychoactive drugs that cannot be prescribed by a normal doctor. Nutritionists are the most "optional", and are usually dropped a few months out of treatment if they are used at all.
• Alumni: most treatment facilities offer support groups for anyone who went there, after they've discharged.
• Discharge: leaving the facility.
• AMA: against medical advice. Label given if you check yourself out of a facility before the doctors believe you're ready.
• Psychiatric hold: being put in a psych ward, involuntarily (called a 5150 in California). Done when a person is believed a danger to themself or others.

Methods of torture (only sorta joking):

• Ensure: a nutritional drink that can be used as a meal substitute or supplement, particularly for patients refusing food.
• Feeding tube: a tube that goes through either a person's nose or directly through the abdomen, into the stomach. Used if a patient refuses food, or if they have other medical complications. There are many types.
• Blind weigh: weighing the patient so they cannot see the number, either by making them stand on the scale backwards, covering the dial or using a scale with a detached reader.
• Meal plan: exactly what it sounds like. There are two types used, either exchanges based on fats, starches and proteins, or menu-style where you're given one or two choices for each meal.
• Add-ons: for those on weight gain, additional calories are added to the basic meal plan. 

Finally, I've been asked what a trigger is and what it means for something to be triggering. It's impossible to give one single definition for this, as 1. it applies to much more than just eating disorders and 2. it's different for every person. In treatment, one exercise we did was to write down a list of our own personal triggers to give to friends/family, so they'd understand things to avoid saying and why we might sometimes randomly flip out at them. Common triggers for eating disorders include: scales, discussion of numbers (calories, weight, etc), food, exercise, "healthy living", and others. Again, every person has their own unique set of triggers.

So, my best vague answer is: a trigger is something that causes a person to retreat to a mentally Bad Place. It could be something very concrete - a smell or a certain food. It could be very nebulous or build up over time - a certain time of year, or looking through old pictures for an evening. It's somewhat like nostalgia, except taken to a mentally damaging level. So when I put a trigger warning on things, I do so to warn people (probably with eating disorders in my case) that reading/viewing the content of this blog could remind them of their own struggles, and send them into a downward mental spiral. Which is the last thing I want to do.

Like I said, this applies to much more than eating disorders. There's a fairly comprehensive list of trigger warnings here. It's considered common courtesy to tag things if you're discussing material that might be sensitive for someone. I see a lot of complaints about this, with the whole JUST DON'T READ IT logic. That works for things like fandom wars, but in the case of mental triggers once the topic has been raised, the mind takes on a will of its own and drags a person down with it. "Just don't read it" doesn't work, because even reading one small intro sentence could be enough to send someone over the edge. (example: I have self-injury/self-harm/SI/SH blacklisted everywhere I can, because seeing that shit sends me bad, bad places. I can't just scroll past it.)

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I'm sure there are a lot of terms I'm missing, so I'll be updating this periodically. Hope it helps! If you have questions or suggestions about these terms or ones I've forgotten, please let me know! My goal is to help people understand this disease, and prevent cryptic jargon from allowing sufferers to hide themselves further.