Words can be tricky things and need to be used carefully. A brief article by former editors of the International Journal of Eating Disorders (Weissman et al., 2016) look at words we should avoid or reconsider in the field of eating disorders. The article seems largely written for researchers submitting articles to the journal, but has application to clinicians as well.

Terms that we should no longer use include “anorexic” “bulimic” and “binge eater”. These terms confuse the person with the disorder and refer to them as one and the same thing. We don’t refer to someone with a diagnosis of cancer as “canceric”. There is a clear illness that is effecting the individual. The same needs to be held for people who make criteria for an eating disorder.  Of course, we work really hard to do this in the clinic room by externalising the eating disorder and separating this from the individual.

The authors suggest using a number of terms to replace “anorexic,” one of which is “patient”. I wonder if patient is a term we should also rethink?  It is suggested that the field reconsiders referring to people with an eating disorder as “sufferers” or as “struggling with an eating disorder”. They question if these terms are pejorative.  I wonder if they are not a pretty accurate description. The article does not mean to imply that people who are “seeking treatment” for an eating disorder (which is a term they suggest) are not suffering with the consequences of a life threatening illness. (I don’t know what it implies for those who don’t seek treatment for an eating disorder – see, words are tricky).

Now, I’m pretty sure someone might go through things I have written and find that I have frequently used a term that the article suggests no longer using.  The term is “gold standard”. This is frequently used to suggest that a treatment (such as FBT or CBT) is the best treatment available and should be the treatment you are offered or offering. However, it may imply that the treatment is perfect and has a guaranteed outcome.  The rationale for not using this term is that even well validated treatments are imperfect.  Better terms (but less catchy) are “extensively validated” (although can we define ‘extensively’?) or “demonstrably superior to other treatments”. I can live with that term. Given a plenary I organized at a conference in Boston was titled “Dissemination and Development of Psychological Treatments in Eating Disorders: Evidence-Based or How to Sell Snake Oil?”, removing sales pitch terms when describing treatments is something worth putting into practice – as long as we don’t ignore the data that does suggest some treatments seem superior to others with certain populations.

It is also suggested that we reconsider the use of the word “refeeding”.  This is a term I have always been uncomfortable with as it has been described to me by my patients as conjuring up images of battery hens and animals being “fattened up”.  Better terms are “renourishing” or “nutritional rehabilitation”.  The problem is that whatever we call this one, for a person undergoing the process it is so difficult and anxiety provoking that calling it by a different name may not be that important in the whole scheme of things.

Download article:
weissman_et_al-2016-international_journal_of_eating_disorders.pdf