What Is OSFED?
Other Specified Feeding or Eating Disorders (OSFED) is a “catch-all” eating disorder for men and women who struggle with eating disorder behaviors, but do not meet all of the diagnostic requirements for a particular disorder.
By: Ekin Kiyici
Many individuals with OSFED are not provided with necessary treatment and insurance coverage because it is often seen as a “less-serious” eating disorder diagnosis. This presents a challenge for many because its impact on one’s physical and mental health is just as severe and disruptive as other recognized eating disorders.
As research on eating disorders and mental health grows, our understanding of specific diagnoses grows with it. Formerly categorized as EDNOS (eating disorder not otherwise specified), OSFED now includes disorders of clinical severity that do not fall under the criteria for anorexia nervosa, bulimia nervosa, binge eating disorder, avoidant/restrictive food intake, pica, or rumination disorder.
Before 2013, EDNOS was known as the eating disorder diagnosis for individuals whose symptoms did not match the criteria for one eating disorder in particular. Over time, EDNOS mistakenly became thought of as “less severe,” so, in an attempt to be more specific with diagnoses and to dissociate the lesser severity of EDNOS, the American Psychological Association did away with the EDNOS diagnosis and recognized several new eating disorder diagnoses in the DSM-5, one of which was OSFED.¹
OSFED is just as dangerous and potentially fatal as the other eating disorder diagnoses. OSFED affects 6% of the population or an estimated 32% to 53% of all people with eating disorders. The several presentations of OSFED include, but are not limited to:
Purging Disorder
Characterized by frequent and recurring purging episodes without binge eating episodes.²
Atypical Anorexia Nervosa
Characterized by all criteria for anorexia nervosa, including restriction of food and fear of weight gain. It does not, however, include weight criteria (less than 85% of expected body weight).³ This criteria is highly debated because weight does not always reflect the presence of disordered behaviors.
Atypical Bulimia Nervosa
Characterized by all criteria for bulimia nervosa, including binge eating, compensatory behavior, except for the frequency or duration criteria for bulimia nervosa (once a week for three months).⁴
Atypical Binge Eating Disorder
Characterized by all criteria for binge eating disorder, including lack of control, eating past fullness, eating while not hungry, except the frequency or duration criteria for binge eating disorder (once a week for three months).⁴
Night Eating Syndrome
Characterized by consuming a large percentage of one day’s caloric intake during the nighttime.⁵
Common Warning Signs
Significant weight loss
Preoccupation with weight and body image
Over-exercising
Rigid food rituals
Preoccupation with food and eating
Low self-esteem
Anxiety or depression
Depending on the severity of symptoms and frequency of behaviors, individuals with OSFED should engage with the appropriate level of care. Several treatment options range from individual therapy or nutritional counseling, various group therapies, outpatient and inpatient care, and residential treatment.
If you feel that you or a loved one may have an eating disorder, even without experiencing symptoms for one disorder, it is important to remember recovery is possible, and getting the support and treatment you need can help you begin living a healthy and satisfying life again. In addition to our full-time Day Treatment Program and Weeknight Intensive Outpatient Program, BALANCE eating disorder treatment center™ we offer high-quality programming, nutrition counseling with a licensed dietitian, meal support, and programs and services targeted at helping clients overcome fear foods and develop a healthy relationship with food. Click the button below to learn more about our programs and services.
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This post was written by BALANCE Intake Coordinator, Ekin Kiyici (she/her).
Ekin Kiyici is an Admissions Assistant at BALANCE eating disorder treatment center. She graduated in 2020 from the University of California, Los Angeles, with a Bachelor of Science in Psychobiology. During her undergraduate career, she coordinated four studies as a research assistant for both the Anxiety and Depression Research Center and the Mind-Body lab. She is also currently a writer for a mental health and wellness platform, The Human Condition. Ekin is very passionate and dedicated to aiding in the treatment of eating disorders and wants to better understand the variables that span across eating, anxiety, and mood disorders. She plans to pursue a doctoral program in Clinical Psychology with the hopes of providing accessible treatment to eating disorder and anxiety populations as a clinical psychologist.
References
Mancuso, S., Newton, J., Bosanac, P., Rossell, S., Nesci, J., & Castle, D. (2015). Classification of eating disorders: Comparison of relative prevalence rates using DSM-IV and DSM-5 criteria. British Journal of Psychiatry, 206(6), 519-520. doi:10.1192/bjp.bp.113.143461
Keel P. K. (2019). Purging disorder: recent advances and future challenges. Current opinion in psychiatry, 32(6), 518–524. https://doi.org/10.1097/YCO.0000000000000541
Moskowitz, L., & Weiselberg, E. (2017). Anorexia Nervosa/Atypical Anorexia Nervosa. Current Problems in Pediatric and Adolescent Health Care, 47(4), 70–84. https://doi.org/10.1016/j.cppeds.2017.02.003
Brownell, K. D., & Walsh, B. T. (2018). Atypical eating disorders (eating disorder not otherwise specified). In Eating disorders and obesity: a comprehensive handbook. essay, Guilford.
Allison, K.C., Lundgren, J.D., O'Reardon, J.P., Geliebter, A., Gluck, M.E., Vinai, P., Mitchell, J.E., Schenck, C.H., Howell, M.J., Crow, S.J., Engel, S., Latzer, Y., Tzischinsky, O., Mahowald, M.W. and Stunkard, A.J. (2010), Proposed diagnostic criteria for night eating syndrome. Int. J. Eat. Disord., 43: 241-247. https://doi.org/10.1002/eat.20693