Otherwise Specified Feeding and Eating Disorder (OSFED)
Today we want to talk about an eating disorder diagnosis that is often not discussed, Other Specified Feeding or Eating Disorder (OSFED). Just because these diagnoses are not as well known as anorexia or binge eating disorder does not mean they are any less severe or any less worthy of treatment.
Otherwise Specified Feeding and Eating Disorder (OSFED)
Diagnostic Criteria
The DSM-5 states that the OSFED category is for the presentation of symptoms characteristic of eating disorders that “cause significant distress or impairment in social, occupational, or other important areas of functioning” but do not meet the criteria for any other eating disorder diagnosis [1].
The frustration with this diagnosis can be that an individual might believe they do not really have a problem or aren’t ‘sick enough’ to warrant seeking help because they do not ‘present’ as someone with a ‘typical’ eating disorder.
The DSM-5 lists a few example presentations that fall under the OSFED category:
Atypical Anorexia Nervosa (AAN). We have a post dedicated to anorexia (AN) and atypical anorexia (AAN) that you can read here. The only difference between AN and AAN is that those with AAN have a weight that is within or above the normal range. Remember that only 6% of people with AN are medically underweight.
Bulimia Nervosa (low frequency or limited duration). An individual would meet all criteria for bulimia nervosa, except binge eating/compensatory behaviors occur, on average, less than once a week or for less than 3 months.
Binge-Eating Disorder (low frequency or limited duration). An individual would meet all criteria for binge eating disorder, except binge eating occurs, on average, less than once a week or for less than 3 months.
Purging Disorder. An individual engages in recurring purging behavior through self-induced vomiting, laxatives, diuretics, etc., to influence body size/shape without binge eating.
Night Eating Syndrome. An individual engages in recurring night-eating episodes after waking up from sleeping or by excessive food intake after an evening meal. The night eating causes significant impairment or distress and is not better explained by another mental health disorder, substance use, or medication.
It’s important to note that these are just 5 examples. Eating disorders rarely fit perfectly in a nice box (i.e. DSM diagnoses are helpful, but do not encompass all feeding and eating difficulties). Rember that there is a fine line between disordered eating and a DSM-diagnosable eating disorder. If you are struggling with your relationship with food, exercise, and/or your body, you deserve help.
Symptoms of OSFED
Symptoms of OSFED are similar to that of other eating disorders we’ve written about on the blog before. A simplified list includes:
binge eating behavior
restriction
compulsive exercise
distorted body image
intense guilt and shame around food, exercise, and body
* this is not an exhaustive list
Medical Complications of OSFED
fatigue
IBS
high blood pressure and cholesterol
osteoporosis
organ failure
* this is not an exhaustive list
OSFED has a mortality rate of 5.2% and affects up to 6% of the population [2]. Of people with OSFED, nearly half also have a co-occurring mood disorder [3].
What Causes OSFED?
Like other mental health and eating disorders, there is a variety of biological, psychological, and social (bio-psycho-social) components that influence the development of OSFED. Factors include trauma, genetics, diet culture and the normalization of eating disorder behaviors, low self-esteem, depression, anxiety, stress, and more.
Treatment
Treatment for OSFED is dependent on the level of care needed. Due to the nature of medical complications, medical treatment, and nutritional rehabilitation/therapy are important. Depending on the severity, this can be done in an inpatient or outpatient setting. Like other eating disorder treatments, psychotherapy in the form of Family-Based Treatment (FBT), Cognitive Behavioral Therapy (CBT), Dialectical Behavioral Therapy (DBT), and Acceptance and Commitment Therapy (ACT) can be beneficial for recovery.
Seeking Help
Our team of therapists and dietitians specializes in helping individuals with diagnoses on the eating disorder spectrum. If you’ve been struggling with your relationship with food, exercise, or your body, you deserve help! Reach out to our team today!
This post is for education purposes only and should not be used as a substitute for treatment for an eating disorder. If you believe you have an eating disorder or would like to talk to a team member about dietetic or therapeutic services, please fill out the contact form and someone will get back to you within 72 hours.
Resources Used:
[1] American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th Edition: DSM-5 (5th ed.). American Psychiatric Publishing.
[2] Eating Recovery Center. (n.d.). Other Specified Feeding and Eating Disorders. https://www.eatingrecoverycenter.com/conditions/osfed
[3] Ulfvebrand, S., Birgegard, A., Norring, C., Hogdahl, L., & von Hausswolff-Juhlin, Y. (2015). Psychiatric comorbidity in women and men with eating disorders results from a large clinical database. Psychiatry Research, 230(2), 294-299
