OSFED stands for Other Specified Feeding and Eating Disorder. Prior to the publication of the 5th edition of the Diagnostic and Statistical Manual (DSM-5), OSFED was instead called ‘EDNOS’, which stands for Eating Disorder Not Otherwise Specified. We may see both terms floating around, but they mean the same thing.
OSFED is an umbrella term used to describe any diagnosable feeding or eating disorder that does not meet the criteria for ‘other eating disorders outlined in the DSM-5. These ‘other’ eating disorders include anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), and avoidant/restrictive food intake disorder (AFRID). Folks living with OSFED usually have symptoms very similar to one or more of these eating disorders, but may not meet every DSM-5 criterion, so they fall under the ‘OSFED’ category instead.
Given the strict and specific diagnostic criteria of AN, BN and BED in the DSM5, it is not surprising that OSFED is considered the most common eating disorder. It is important to remember that the severity and damage of an eating disorder is not determined by how many boxes it checks on a DSM-5 checklist. An OSFED diagnosis is just as serious as any other eating disorder. Many individuals with OSFED experience distress and disturbances in their eating habits, body image, and overall well being.
What are the Subtypes of OSFED?
These are the subtypes of OSFED:
- Atypical Anorexia Nervosa
- Bulimia Nervosa of Low Frequency and/or Limited Duration
- Binge Eating Disorder of Low Frequency and/or Limited Duration
- Purging Disorder
- Night Eating Syndrome
Atypical Anorexia Nervosa
Folks with atypical anorexia nervosa meet all criteria for anorexia nervosa, but they still have a ‘normal’ BMI. This means that their BMI does not fall within the ‘underweight’ category.
Bulimia Nervosa of Low Frequency and/or Limited Duration
Folks with Bulimia Nervosa of Low Frequency and/or Limited Duration partake in binging or overcompensation after binging less than one time per week or for less than three months.
Binge Eating Disorder of Low Frequency and/or Limited Duration
Folks with Binge Eating Disorder of Low Frequency and/or Limited Duration will partake in binges less than once a week or for less than three months.
Purging Disorder
Folks with a Purging Disorder will use purging behaviours to lose weight, but they do not use binging behaviours.
Night Eating Syndrome
Folks with Night Eating Syndrome will repeatedly consume excessive amounts of food after waking or after dinner.
What Does OSFED look like?
The red flags we watch for when we’re worried someone may be living with a DSM-5-classified eating disorder are also seen in OSFED. Folks living with OSFED may show physical signs, psychological signs, and/or behavioural signs. We have provided some of these red flags below; however, this is not an exhaustive list!
Physical signs of OSFED may include:
- Fainting or dizziness
- Getting sick more often than usual (possible due to a compromised immune system)
- Absence of periods of menstrual changes in individuals who menstruate
- Fluctuations in body weight
- Dry skin, hair or fingernails
- Feeling cold
- Damage to teeth or gums
- Trouble sleeping
Psychological signs of OSFED may include:
- A preoccupation with eating, physical activity or physical appearance
- Sensitivity to conversations around eating, physical activity, or physical appearance
- Feelings of guilt, shame and disgust eating
- Increased irritability and anxiety
- Distorted body image or dissatisfaction
- Low self-esteem, depression, anxiety, suicidality
Behavioural signs of OSFED may include:
- ‘Dieting’ behaviours:
- Counting macros
- Counting calories
- Pre-occupation with ‘perfect’ or ‘clean’ eating or numbers
- Sudden aversion to specific types of foods or food groups
- Saying they have eaten when they have not actually eaten
- Social withdrawl
- Hiding or hoarding food
- Eating alone and avoiding others around mealtimes
- Purging behaviours
- Increased interest in food preparation (planning, buying, cooking for others, but not eating it themselves)
- Obsessive rituals around food
- Compulsive physical activity even if unwell or injured
- Body-checking behaviours
- Wearing loose or baggy clothing
Who is at risk for OSFED?
There is no guarantee that we will or will not develop OSFED based on our environment, lifestyle, or biology; however, research has shown a few relationships that can help us gain a better understanding of who is at risk for OSFED. For example, research shows that folks with one or more close family members who have an eating disorder diagnosis are more likely to develop OSFED. In addition, we know that folks who frequently experience situations where thinness is idolized and/or food is moralized (i.e., food is ‘good’ or ‘bad ‘) are more likely to develop OSFED. Below are some other risk factors that may increase the chance of developing OSFED:
- A lack of close relationships
- Experiencing bullying and/or teasing
- High levels of anxiety
- Perfectionistic practices and/or attitudes
- Low self-esteem
- Mental rigidity and inflexibility
- A Type 1 Diabetes diagnosis
- Identifying as a visible minority
What are the possible consequences of OSFED?
If folks with OSFED do not receive proper treatment and support, serious issues can arise. Below we have detailed some possible consequences of OSFED; however, this is not an exhaustive list!
Untreated OSFED can contribute to:
- Gastrointestinal issues, including stomach and esophagus damage
- Constipation and diarrhea
- Kidney damage
- Osteoporosis or osteopenia (i.e. weak bones)
- Slowed growth in youth
- Infertility
- Cardiovascular conditions (i.e. issues with our heart)
OSFED may co-occur with:
- Anxiety disorders
- Obsessive compulsive disorders
- Self-injurious behaviours
- Mood disorders
- Substance use and addiction
- Body dysmorphic disorder
OSFED recovery
Research shows that folks with OSFED who recognize red flags and seek treatment early have the best chance at a quicker and full recovery. This does not mean that folks who have been living with OSFED for many years cannot recover – recovery from an eating disorder is possible at any stage.
Everyone’s eating disorder and recovery journey can look different, so each treatment plan may also look a little different. Some approaches that have been used to treat OSFED include Cognitive Behavioural Therapy for Eating Disorders (CBT-E) and Family-Based Treatment (FBT). Research shows that a treatment plan involving a multidisciplinary approach is effective for treating OSFED. This means that a team of professionals with expertise in different areas work together to develop and follow through with a treatment plan.
Where can I get help for OSFED?
If you feel that you or someone you know may be living with OSFED, we can help you now. Book a free consultation call with us today to get started.
