Glossary

This eating disorders glossary defines terms you may encounter when seeking information and talking with care providers about diagnosis and treatment of all types of eating disorders. It also contains some slang terms about eating disorders sometimes encountered in the eating disorders community. ECRI Institute compiled these definitions from multiple sources.

Alternative therapy: In the context of treatment for eating disorders, a treatment that does not use drugs or bring unconscious mental material into full consciousness. Examples of alternative therapies include yoga, guided imagery, expressive therapy, and massage therapy.

Amenorrhea: Abnormal cessation of menses (periods).

Ana: slang for anorexia or anorexic.

ANAD: (National Association of Anorexia Nervosa and Associated Disorders). A nonprofit corporation that seeks to alleviate the problems of eating disorders, especially anorexia nervosa and bulimia nervosa.

Anorexia nervosa: A disorder in which an individual refuses to maintain minimally normal body weight, intensely fears gaining weight, and exhibits a significant disturbance in his/her perception of the shape or size of his/her body.

Anorexia athletica: The use of excessive exercise to lose weight (not an official diagnostic category in the psychiatric diagnostic manual, DSM-5).

Anticonvulsants: Drugs used to prevent or treat convulsions.

Antiemetics: Drugs used to prevent or treat nausea or vomiting.

Anxiety disorders: A group of disorders that share features of excessive fear, anxiety, and avoidance behaviors. The several types of anxiety disorders include separation anxiety disorder, selective mutism, panic disorder, agoraphobia, social and specific phobias, generalized anxiety disorder, and substance/medication-induced anxiety disorder.

Arrhythmia: An alteration in the normal rhythm of the heartbeat.

Art therapy: A form of expressive therapy that uses visual art to encourage the patient’s growth of self-awareness and self-esteem to make attitudinal and behavioral changes.

Atypical antipsychotics: A newer group of medications used to treat psychiatric conditions. These drugs may have fewer side effects than older classes of drugs used to treat the same psychiatric conditions.

B&P: An abbreviation used for binge eating (bingeing) and purging in the context of bulimic behavior.
Behavior therapy (BT): A type of psychotherapy that uses principles of learning to increase the frequency of desired behaviors and/or decrease the frequency of problem behaviors. When used to treat an eating disorder, the focus is on modifying the disorder’s behavioral abnormalities by teaching relaxation techniques and coping strategies that affected individuals can use instead of not eating or binge eating and purging. Hypnobehavioral therapy is a subtype of BT.

Beneficiary: The recipient of benefits from an insurance policy.

Binge eating: (also bingeing) — Consuming an amount of food that is considered much larger than the amount that most individuals would eat under similar circumstances within a discrete period of time (usually fewer than two hours) and feeling a lack of control over how much or what is being eaten. Binge eating disorder is now a recognized mental disorder in the psychiatric diagnostic manual, DSM-5.

Biofeedback: A technique that measures bodily functions such as breathing, heart rate, blood pressure, skin temperature, and muscle tension. Biofeedback is used to teach people how to alter bodily functions through relaxation or imagery. Typically, a practitioner describes stressful situations and guides a person through using relaxation techniques. The person can see how his/her heart rate and blood pressure change in response to being stressed or relaxed. This is a type of nondrug, nonpsychotherapy treatment.

Body dysmorphic disorder: A mental condition defined in the psychiatric diagnostic manual, DSM-5, in which the patient is preoccupied with a real or perceived defect in his/her appearance, and his/her behavior reflects significant distress (such as mirror checking, excessive grooming, skin picking, or constantly comparing themselves to others).

Body image: The subjective opinion about one’s physical appearance based on self-perception of body size and shape and the reactions of others.

Body mass index (BMI): A formula used to calculate the ratio of a person’s weight to height. BMI is expressed as a number that is used to determine whether an individual’s weight is within normal ranges for age and sex on a standardized chart. The U.S. Centers for Disease Control and Prevention website offers BMI calculators and standardized BMI charts.

Bulimarexia: A slang term used to describe individuals who engage alternately in bulimic behavior and anorexic behavior.

Bulimia nervosa: A disorder defined in the psychiatric diagnostic manual, DSM-5, in which a person binges on food an average of once weekly in a three-month time period, followed by compensatory behavior aimed at preventing weight gain. This behavior may include excessive exercise, vomiting, fasting, or misusing laxatives/enemas, diuretics, or other medications. In addition, the person’s self-evaluation is typically unduly influenced by his/her body shape or weight.

Case management: An approach to patient care in which a case manager, usually a social worker, mobilizes people to organize appropriate services and supports for a patient’s treatment. A case manager coordinates mental health, social work, educational, health, vocational, transportation, advocacy, respite care, and recreational services, as needed. The case manager ensures that the changing needs of the patient and family members supporting that patient are met.

COBRA: A federal law initiated in 1985 that included provisions to protect health insurance benefits coverage for workers and their families who lose their jobs. The landmark Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) health benefit provisions became law in 1986. The law amends the Employee Retirement Income Security Act (ERISA), the Internal Revenue Code, and the Public Health Service Act to provide continuation of employer-sponsored group health coverage that otherwise might be terminated. The U.S. Centers for Medicare & Medicaid Services has advisory jurisdiction for the COBRA law as it applies to state and local government (public sector) employers and their group health plans.

Cognitive analytic therapy (CAT): A type of cognitive therapy that focuses on discovering how a patient’s problems have evolved and how the procedures the patient has devised to cope with them may be ineffective or even harmful. CAT is designed to enable people to gain an understanding of how the difficulties they experience may be made worse by their habitual coping mechanisms. Problems are understood in light of a person’s personal history and life experiences. The focus is on recognizing how these coping procedures originated and how they can be adapted.

Cognitive behavioral therapy (CBT): The most widely used evidence-based treatment for eating disorders and other mental health disorders, CBT is a multicomponent treatment that focuses on problem solving, education, and changing unhealthy thought and behavior patterns by teaching new, positive coping skills, including those designed to prevent relapse. A course of individual CBT for bulimia nervosa usually involves 16- to 20-hour long sessions over 4 to 5 months. CBT is now also delivered in groups, via self-help manuals, and more recently, via telemedicine systems, e-mail, and online. The goals of CBT are designed to interrupt the proposed bulimic cycle that is perpetuated by low self-esteem, extreme concerns about shape and weight, and extreme means of weight control. Subtypes of CBT include dialectical behavioral therapy and exposure and response prevention.

Cognitive orientation therapy (COT): A type of cognitive therapy that uses a systematic procedure to understand the meaning of a patient’s behavior by exploring certain themes such as aggression and avoidance. The procedure for modifying behavior then focuses on systematically changing the patient’s beliefs related to the themes and not directly to eating behavior.

Cognitive therapy: A type of psychotherapeutic treatment that attempts to change a patient’s feelings and behaviors by changing the way the patient thinks about or perceives his/her significant life experiences. Subtypes include cognitive analytic therapy and cognitive orientation therapy.

Comorbid conditions: Multiple physical and/or mental conditions existing in a person at the same time. (See Dual Diagnosis)

Crisis residential treatment services: Short-term, round-the-clock help provided in a nonhospital setting during a crisis. The purposes of this care are to avoid inpatient hospitalization, help stabilize the individual in crisis, and determine the next appropriate step.

Cure: The treated condition or disorder is permanently gone, never to return in the individual who received treatment. Not to be confused with “remission.” (See Remission.)

Dental caries: Tooth cavities. The teeth of people with bulimia who use vomiting as a purging method may be especially vulnerable to developing cavities because of the exposure of teeth to vomit’s high acid content.

Depression: See: Major Depressive Disorder

Diabetic omission of insulin: A nonpurging method of compensating for excess calorie intake that may be used by a person with diabetes and bulimia. Sometimes referred to as diabulimia (not a diagnosis in the official psychiatric diagnostic manual, DSM-5).

Dialectical behavior therapy (DBT): A type of cognitive behavioral therapy that views emotional deregulation as the core problem in bulimia nervosa. It involves teaching people with bulimia nervosa about the triggers that lead to emotionally reactive states and problem-solving skills to regulate and reframe negative thoughts and emotions and replace dysfunctional behavior. A typical course of treatment is 20 group sessions lasting 2 hours once a week.

Discharge planning: If an individual is an inpatient or residential care facility, as the time approaches for discharge from that level of care, the care team meets (ideally) to devise a comprehensive ongoing care plan for the patient. The care plan is intended to include all necessary components of medical and psychological care needed in the immediate and longer term. This plan may be communicated to the patient by a social worker, nurse, or other type of healthcare professional. Instructions are typically provided to the patient in writing and includes recommendations for referrals to the necessary outpatient healthcare providers as appropriate, scheduling follow up appointments for the near-term follow-up, and ensuring that any recommended prescriptions are submitted to the patient’s pharmacy provider.

Disordered eating: A term used to describe any atypical eating behavior.

DSM-5: The fifth (and most current as of 2017) edition of the Diagnostic and Statistical Manual for Mental Disorders published by the American Psychiatric Association (APA). This manual lists mental diseases, conditions, disorders, and the criteria established by APA to diagnose them. The manual lists criteria for diagnosis of several different eating, including bulimia nervosa.

Dual diagnosis: The presence of two mental health disorders in a patient at the same time, as diagnosed by a clinician. For example, a patient may be given a diagnosis of both bulimia nervosa and obsessive-compulsive disorder or anorexia and major depressive disorder.

Drunkorexia: A slang term for behaviors that include replacing food consumption with excessive alcohol consumption and/or consuming food along with sufficient amounts of alcohol to induce vomiting as a method of purging and numbing feelings.

Eating Disorders Anonymous (EDA): A fellowship of individuals who share their experiences with each other to try to solve common problems and help each other recover from their eating disorders. The group typically follows a 12-step program of recovery.

Eating Disorder Inventory (EDI): A self-report test that clinicians use with patients to diagnose specific eating disorders and determine the severity of a patient’s condition.

Eating Disorder Inventory-2 (EDI-2): Second edition of the Eating Disorder Inventory.

ED: Acronym for eating disorder

Electrolyte imbalance: A physical condition that occurs when ionized salt concentrations (commonly sodium and potassium) are at abnormal levels in the body. This condition can occur as a side effect of some bulimic compensatory behaviors, such as vomiting.

Emetic: A class of drugs that induces vomiting. Emetics may be used as part of a bulimic compensatory behavior to induce vomiting after a binge-eating episode.

Enema: The injection of fluid into the rectum to cleanse the bowel. Enemas may be used as a bulimic compensatory behavior to purge after a binge-eating episode.

Equine therapy: (animal-assisted therapy). A treatment program in which people interact with horses and become aware of their own emotional states through the reactions of the horse to their behavior.
Exercise therapy: An individualized exercise plan that is written by a doctor or rehabilitation specialist, such as a clinical exercise physiologist, physical therapist, or nurse. The plan takes into account an individual’s current medical condition and provides advice for what type of exercise to perform, how hard to exercise, how long, and how many times per week.

Exposure and response prevention (ERP): A type of cognitive behavior therapy based on the theory that purging decreases the anxiety associated with eating. Purging is therefore negatively reinforced via anxiety reduction. The goal of ERP is to modify the association between anxiety and purging by preventing purging following eating until the anxiety associated with eating subsides.

Expressive therapy: A nondrug, nonpsychotherapy form of treatment that uses the performing and/or visual arts to help people express their thoughts and emotions. Whether through dance, movement, art, drama, drawing, painting, etc., expressive therapy provides an opportunity for communication that might otherwise remain repressed.

Eye Movement Desensitization and Reprocessing (EMDR): A nondrug and nonpsychotherapy form of treatment in which a therapist waves his/her fingers back and forth in front of the patient’s eyes, and the patient tracks the movements while also focusing on a traumatic event. It is thought that the act of tracking while concentrating allows a different level of processing to occur in the brain so that the patient can review the event more calmly or more completely than before.

Family therapy: A form of psychotherapy that involves members of a nuclear or extended family. Some forms of family therapy are based on behavioral or psychodynamic principles; the most common form is based on family systems theory. This approach regards the family as the unit of treatment and emphasizes factors such as relationships and communication patterns. With eating disorders, the focus is on the eating disorder and how the disorder affects family relationships. Family therapy tends to be short-term, usually lasting only a few months, although it can last longer depending on the family circumstances.

Guided imagery: A mind-body technique that uses directed suggestions, either in person by an instructor or via audio recording, to promote relaxation, support changes in attitude or behavior, and encourage physical healing. The patient is asked to imagine certain calming images and scenes, or specific outcomes of an intimidating situation, to experience alternative perceptions, thoughts, feelings, and sensations. Guided imagery is sometimes called visualization. Sometimes soothing music is used as background noise during the imagery session. (See Alternative Therapy.)

Health Insurance Portability and Accountability Act (HIPPA): A federal law enacted in 1996 with a number of provisions intended to ensure certain consumer health insurance protections for working Americans and their families and standards for electronic health information and to protect the privacy of individuals’ health information. HIPAA applies to three types of health insurance coverage: group health plans, individual health insurance, and comparable coverage through a high-risk pool. HIPAA may lower a person’s chance of losing existing coverage, ease the ability to switch health plans, and/or help a person buy coverage on his/her own if a person loses employer coverage and has no other coverage available.

Health Maintenance Organization (HMO): A health plan that employs or contracts with primary care physicians to write referrals for all care that covered patients obtained from specialists in a network of healthcare providers with whom the HMO contracts. The patient’s choice of treatment providers is usually limited.

Hematemesis: The vomiting of blood.

Hypno-behavioral therapy: A type of behavioral therapy that uses a combination of behavioral techniques such as self-monitoring to change maladaptive eating disorders and hypnotic techniques intended to reinforce and encourage behavior change.

Hypoglycemia: An abnormally low concentration of glucose in the blood.

In-network benefits: Health insurance benefits that a beneficiary is entitled to receive from a designated group (network) of healthcare providers. The “network” is established by the health insurer that contracts with certain providers to provide care for beneficiaries within that network.

Indemnity insurance: A health insurance plan that reimburses the member or healthcare provider on a fee-for-service basis, usually at a rate lower than the actual charges for services rendered and often after a deductible has been satisfied by the insured.

Independent living services: Services for a person with a medical or mental-health-related problem who is living on his/her own. Services include therapeutic group homes, supervised apartment living, monitoring the person’s adherence with prescribed mental and medical treatment plans, and job placement.

Intake screening: An interview conducted by health service providers when a patient is admitted to a hospital or treatment program.

Integrated cognitive affective therapy (ICAT): A type of individual psychotherapy that focuses on the link between a person’s emotional state and their bulimic behaviors while helping them diffuse triggers for those behaviors and develop the skills to regulate negative emotions.

 

International Classification of Diseases (ICD-10): The World Health Organization lists international standards used to diagnose and classify diseases. The listing is used by the healthcare system so clinicians can assign an ICD code to submit claims to insurers for reimbursement for services for treating various medical and mental health conditions in patients. The code is periodically updated to reflect changes in classifications of disease or to add new disorders.

Interpersonal therapy: IPT (also called interpersonal psychotherapy) is designed to help people identify and address their interpersonal problems, specifically those involving grief, interpersonal role conflicts, role transitions, and interpersonal deficits. In this therapy, no emphasis is placed directly on modifying eating habits. Instead, the expectation is that the therapy will enable people to change as their interpersonal functioning improves. IPT usually involves 16- to 20-hour-long, one-on-one treatment sessions over a period of 4 to 5 months.

Ketosis: A condition characterized by an abnormally elevated concentration of ketones in the body tissues and fluids, which can be caused by starvation. It is a complication of diabetes, starvation, and alcoholism.

Level of care: The care setting and intensity of care a patient is receiving (e.g., inpatient hospitalization, partial hospitalization [day program, outpatient basis], intensive outpatient, residential, outpatient). Health plans and insurance companies correlate their payment structures to the level of care being provided and map a patient’s eligibility for a particular level of care to the patient’s medical/psychological status.

Major depressive disorder: A severe mental health disorder in the psychiatric diagnostic manual, DSM-5. It is characterized by a period of two or more weeks during which a patient experiences either a depressed mood of loss of interest or pleasure in nearly all activities, along with at least four additional symptoms that include changes in appetite or weight, sleep or motor activity, decrease in energy, feelings of guilt or worthlessness, suicidal thoughts, plans or attempts, or difficulty thinking, concentrating or making decisions.

Mallory-Weiss Tear: One or more slit-like tears in the mucosa at the lower end of the esophagus as a result of severe vomiting.

Mandometer therapy: Treatment program for eating disorders based on the idea that psychiatric symptoms of people with eating disorders emerge as a result of poor nutrition and are not a cause of the eating disorder. A Mandometer is a computer that measures food intake and is used to determine a course of therapy.

Massage therapy: A generic term for any of a number of various types of therapeutic touch in which the practitioner massages, applies pressure to, or manipulates muscles or certain points on the body or other soft tissues to improve health and well-being. Massage therapy is thought to relieve anxiety and depression in patients with an eating disorder.

Maudsley Method: (family-based therapy) A family-centered treatment program with three distinct phases. The first phase for a patient who is severely underweight is to regain control of eating habits and break the cycle of starvation or binge eating and purging. The second phase begins once the patient’s eating is under control with a goal of returning independent eating to the patient. The goal of the third and final phase is to address the broader concerns of the patient’s development.

Mealtime support therapy: Treatment program developed to help patients with eating disorders eat healthfully and with less emotional upset.

Mental health parity laws: Federal and state laws that require health insurers to provide the same level of healthcare benefits for mental disorders and conditions as they do for medical disorders and conditions. For example, the federal Mental Health Parity Act of 1996 (MHPA) may prevent a group health plan from placing annual or lifetime dollar limits on mental health benefits that are lower, or less favorable, than annual or lifetime dollar limits for medical and surgical benefits offered under the plan.

Mia: Slang for bulimia or bulimic.

Modified cyclic antidepressants: A class of medications used to treat depression.

Monoamine oxidase inhibitors (MAOIs): A class of medications used to treat depression.

Motivational enhancement therapy (MET): A treatment based on a model of change, with focus on the stages of change. Stages of change represent constellations of intentions and behaviors through which individuals pass as they move from having a problem to doing something to resolve it. The stages of change move from “pre-contemplation,” in which individuals show no intention of changing, to the “action” stage, in which they actively engage in overcoming their problem. Transition from one stage to the next is sequential, but not linear. MET’s aim is to help individuals move from earlier stages into the action stage using cognitive and emotional strategies.

Movement (or dance) therapy: The psychotherapeutic use of movement as a process that furthers the emotional, cognitive, social, and physical integration of the individual, according to the American Dance Therapy Association.

Nonpurging: Any of a number of behaviors engaged in by a person with bulimia nervosa to offset potential weight gain from excessive calorie intake from binge eating. Nonpurging can take the form of excessive exercise, underdosing of insulin by people with type 1 diabetes, or long periods of fasting.

Nutritional therapy: Therapy that provides patients with information on the effects of their eating disorder. For example, therapy often includes, as appropriate, techniques to avoid binge eating, refeeding as necessary, and advice about making meals and healthy eating. The goals of nutrition therapy for individuals with anorexia and bulimia nervosa differ according to the disorder. With bulimia, for example, goals are to stabilize blood sugar levels, help individuals maintain a diet that provides them with enough nutrients, and help restore gastrointestinal health.

Obsessive-compulsive disorder: A mental health disorder in which recurrent and persistent thoughts, impulses, or images cause inappropriate anxiety and distress, and are often accompanied by repetitive acts that an individual feels compelled to perform to alleviate this anxiety. Full criteria for this diagnosis can be found in the psychiatric diagnostic manual, DSM-5.

Opioid antagonists: A type of drug therapy that interferes with the brain’s opioid receptors and is sometimes used to treat eating disorders.

Orthorexia nervosa: An eating disorder in which a person obsesses about eating only “pure” and healthy food to such an extent that it interferes with the person’s life. This disorder is not a diagnosis listed in the psychiatric diagnostic manual, DSM-5.

Osteoporosis: A condition characterized by a decrease in bone mass with decreased density and enlargement of bone spaces, thus producing porosity and brittleness. This can sometimes be a complication of an eating disorder, including bulimia nervosa and anorexia nervosa.

Other Specified Feeding or Eating Disorder: (formerly Eating Disorder Not Otherwise Specified): Any eating disorder that does not meet the criteria for anorexia nervosa or bulimic nervosa.

Out-of-network benefits: Healthcare obtained by a beneficiary from providers (e.g., hospitals, clinicians) that are outside the network that the insurance company has assigned to that beneficiary. Benefits obtained outside the designated network are usually reimbursed at a lower rate. In other words, beneficiaries share more of the cost of care when obtaining that care “out of network” unless the insurance company has given the beneficiary special written authorization to go out of network.

Parity: Equality (see Mental Health Parity Laws).

Partial hospitalization: For a patient with an eating disorder, partial hospitalization is a time-limited, structured program of psychotherapy and other therapeutic services provided through an outpatient hospital or community mental health center. The goal is to resolve or stabilize an acute episode of mental/behavioral illness.

Peptic esophagitis: Inflammation of the esophagus caused by reflux of stomach contents and acid.

Pharmacotherapy: Use of drugs for treatment of a mental or emotional disorder.

Phenethylamine monoamine reuptake inhibitors: A class of drugs used to treat depression.

Preexisting condition: A health problem that existed or was treated before the effective date of one’s health insurance policy.

Provider: A healthcare facility (e.g., hospital, residential treatment center), doctor, nurse, therapist, social worker, or other professional who provides care to a patient.

Psychoanalysis: An intensive, nondirective form of psychodynamic therapy in which the focus of treatment is exploration of a person’s mind and habitual thought patterns. It is insight-oriented, meaning that the goal of treatment is for the patient to increase understanding of the sources of his/her inner conflicts and emotional problems.

Psychodrama: A method of psychotherapy in which patients enact the relevant events in their lives instead of simply talking about them.

Psychodynamic therapy: Psychodynamic theory views the human personality as developing from interactions between conscious and unconscious mental processes. The purpose of all forms of psychodynamic treatment is to bring unconscious mental material and processes into full consciousness so that the patient can gain more control over his/her life.

Psychodynamic group therapy: Psychodynamic groups are based on the same principles as individual psychodynamic therapy and aim to help people with past difficulties, relationships, and trauma, as well as current problems. The groups are typically composed of eight members plus one or two therapists.

Psychotherapy: The treatment of mental and emotional disorders through the use of psychologic techniques designed to encourage communication of conflicts and insight into problems, with the goal of relieving symptoms, changing behavior leading to improved social and vocational functioning, and personality growth.

Psychoeducational therapy: A treatment intended to teach people about their problem, how to treat it, and how to recognize signs of relapse so that they can get necessary treatment before their difficulty worsens or recurs. Family psychoeducation includes teaching coping strategies and problem-solving skills to families, friends, and/or caregivers to help them deal more effectively with the individual.

Psychopathological Rating Scale Self-Rating Scale for Affective Syndromes (CPRS-SA): A test used to estimate the severity of an individual’s depression, anxiety, and obsession.

Recovery retreat: See Residential Treatment Center.

Relaxation training: A technique involving tightly contracting and releasing muscles to release or reduce stress.

Remission: A period in which the symptoms of a disease are absent. Remission differs from the concept of “cure” in that the disease can return. The term “cure” signifies that the treated condition or disorder is permanently gone, never to return in the individual who received treatment.

Residential services: Healthcare services delivered in a structured residence under supervision other than the hospital or a client’s home.

Residential treatment center: A live-in healthcare environment outside the home where an individual receives 24-hour care or access to support personnel capable of meeting the client’s needs. These are often utilized as a stepdown treatment from inpatient hospitalization before a patient returns home or as a last attempt to provide intensive treatment before hospitalization, depending on the severity of a person’s condition and diagnosis.

Selective serotonin reuptake inhibitors (SSRIs): A class of drugs used to treat depression, anxiety disorders, and some personality disorders. These drugs are designed to elevate the level of the neurotransmitter serotonin. A low level of serotonin is currently seen as one of several neurochemical symptoms of depression. Low levels of serotonin, in turn, can be caused by an anxiety disorder because serotonin is needed to metabolize stress hormones.

Self-directedness: A personality trait that comprises self-confidence, reliability, responsibility, resourcefulness, and goal-orientation.

Self-guided cognitive behavior therapy: A modified form of cognitive behavior therapy in which a treatment manual is provided for people to proceed with treatment on their own or with support from a nonprofessional. Guided self-help usually implies that the support person may or may not have some professional training, but is usually not a specialist in eating disorders. The important characteristics of the self-help approach are the use of a highly structured and detailed manual-based CBT, with guidance as to the appropriateness of self-help and advice on where to seek additional help.

Self-report measures: An itemized written test in which a person rates his/her feeling toward each question; the test is designed to categorize the person’s personality or behavior.

Self-psychology: A type of psychoanalysis that views anorexia and bulimia as specific cases of pathology of the self. According to this view, for example, people with bulimia nervosa cannot rely on human beings to fulfill their self-object needs (e.g., regulation of self-esteem, calming, soothing, vitalizing). Instead, they rely on food (its consumption or avoidance) to fulfill these needs. Self-psychological therapy involves helping people with bulimia give up their pathological preference for food as a self-object and begin to rely on human beings as self-objects, beginning with their therapist.

State mandate: A proclamation, order, or law from a state legislature that issues specific instructions or regulations. Many states have issued mandates pertaining to coverage of mental health benefits and specific disorders the state requires insurers to cover.

Substance abuse: Use of a mood- or behavior-altering substance in a maladaptive pattern resulting in significant impairment or distress of the user.

Substance use disorder: The psychiatric diagnostic manual, DSM-5, states that the essential feature of a substance use disorder is a cluster of cognitive, behavioral, and physiological symptoms indicating that an individual continues to use the substance despite significant substance-related problems. The overall diagnosis is based on a pattern of behaviors related to the use of the substance. Criteria are grouped into four main categories: impaired control, social impairment, risky use, and pharmacologic.

Subthreshold eating disorder: Condition in which a person exhibits disordered eating but not to the extent that it fulfills all the criteria for diagnosis of an eating disorder.

Supportive residential services: See Residential treatment center.

Supportive therapy: Psychotherapy that focuses on the management and resolution of current difficulties and life decisions using the patient’s strengths and available resources.

Telepsychiatry (telemental health, telebehavioral health, telehealth, telemedicine): The use of telecommunication and/or information technologies such as mobile apps, telephone, texting, and Skype, to deliver healthcare and health monitoring from a distance. This type of treatment benefits people who do not have ready access to medical or behavioral healthcare close to where they live. It can also benefit all patients who have access to technology by providing more frequent opportunities for check-ins, monitoring, and quick consultations. Various types of behavioral therapy, including CBT, are being delivered using telehealth.

Telephone therapy: A type of psychotherapy provided over the telephone by a trained professional.

Tetracyclics: A class of drugs used to treat depression.

Therapeutic foster care: A foster care program in which youths who cannot live at home are placed in homes with foster parents who have been trained to provide a structured environment that supports the child’s learning, social, and emotional skills.

Thinspiration: A slang term for photographs, poems, or any other stimulus that influences a person to strive to lose weight.

Third-party payer: An organization that provides health insurance benefits and reimburses for care for beneficiaries.

Treatment plan: A multidisciplinary care plan for each beneficiary in active case management. It includes specific services to be delivered, the frequency of services, expected duration, community resources, all funding options, treatment goals, and assessment of the beneficiary environment. The plan is updated monthly and modified when appropriate.

Tricyclic antidepressants: A class of drugs used to treat depression.

Trigger: A stimulus that causes an involuntary reflex behavior. A trigger may cause a recovering person with bulimia to engage in bulimic behavior again.

Thyroid medication abuse: Excessive use or misuse of drugs used to treat thyroid conditions; a side effect of these drugs is weight loss.

Usual and customary fee: An insurance term that indicates the amount the insurance company will reimburse for a particular service or procedure. This amount is often less than the amount the service provider charges.

Vocational services: Programs that teach skills for self-sufficiency.

Yoga: A system of physical postures, breathing techniques, and meditation practices to promote body or mental control and well-being.