Other Eating Disorders (OSFED)

When people think of eating disorders, conditions such as anorexia, bulimia, and binge eating disorder usually come to mind. But in reality, there are many types of eating disorders that do not fit neatly into these mental health diagnostic categories. In fact, statistics indicate that between 32% and 53% of people with eating disorders fall into a category known as Other Specified Feeding or Eating Disorder (OSFED).¹

The concept of OSFED extends to any eating disorder that causes significant impairment and distress in a person’s life but does not meet the diagnostic criteria for any specific eating disorder diagnosis.² Prior to the DSM-5 update, OSFED was referred to as Eating Disorder Not Otherwise Specified (EDNOS). Previously, this diagnosis served as a catch-all category and encompassed almost all eating disorders that couldn’t otherwise be accounted for with the more common diagnoses.

What Types of Eating Disorders Fall into This Category?

The OSFED diagnostic criteria set forth in the DSM-5 was established to help clinicians diagnose eating disorders that don’t necessarily fit into the more well-known categories of anorexia, bulimia, and binge eating disorder. These are the 5 major clinical examples provided for OSFED, but there are also many other manifestations of eating disorders that may not fit neatly into one of them:^1,3

• Atypical anorexia nervosa: People suffering from atypical anorexia nervosa may display some of the characteristics of typical anorexia, such as caloric restriction and fear of becoming fat, yet fall within a normal weight range for their height and age.
• Binge eating disorder of limited duration and/or low frequency: People with an OSFED binge eating disorder may exhibit a few signs and symptoms of binge eating disorder, but their binge eating may occur at a lower frequency or limited duration than most typical cases.
• Bulimia nervosa of limited duration and/or low frequency: Those with bulimia signs and symptoms who are diagnosed with an OSFED may exhibit most of the typical diagnostic criteria for bulimia but with symptoms at lower frequency or limited duration in comparison to typical cases.
• Purging disorder: Purging disorder is different from bulimia in that people suffering from this disorder will purge their calories by vomiting, taking laxatives, or by other means, but they do not binge eat in the way those with bulimia do.
• Night eating syndrome: Night eating syndrome is an eating disorder in which a person consumes 25% of their daily calories at nighttime and has recurring episodes of night eating, such as eating excessively after a typical evening meal or eating after awakening from sleep.

How Do Other Types of Eating Disorders Develop?

The factors leading to the development of an OSFED condition vary from person to person, but they frequently include some combination of the following:^4,5

• Genetic predisposition: While there is no specific gene responsible for eating disorders, there is some evidence that suggests disordered eating may have a genetic component. Certain genetic predispositions combined with other non-inherited factors may make a person more susceptible to developing an eating disorder.

• Cultural and social influences: There are many cultural and social influences that can contribute to the development of an eating disorder. For example, prevalent cultural attitudes surrounding beauty and attractiveness may influence how a person feels about their body, which can lead to an eating disorder if a person doesn’t meet those cultural standards of beauty. It is hypothesized that the recent rise in social media interaction may contribute to an increased incidence of eating disorders as young people are exposed to digitally altered images portraying unrealistic body standards, and other appearance-focused media platforms.
• Certain psychological traits: There are many personality traits and psychological dispositions that may also increase a person’s risk of developing an eating disorder, including:
  • Perfectionism.
  • Obsessive-compulsive behavior.
  • Low self-esteem.
  • Neuroticism.
  • Avoidant behaviors.
  • Need for control.

While psychological traits can play a role in eating disorders, it is sometimes difficult to discern cause and effect. For example, prolonged starvation can cause changes in a person’s mood, thinking, and behavior. Likewise, mental health disorders, such as anxiety and depression, often exist alongside eating disorders, so it is often unclear which came first.

While there are many risk factors (e.g., genetics, culture, and personality traits) that you have little influence over, there are, in fact, perspectives and behaviors that you can change, including:

• Internalizing social and cultural ideals of beauty and thinness.
• Extreme weight loss behavior.
• Body dissatisfaction.
• Low self-esteem.

Are OSFEDs as Serious as Other Eating Disorders?

The reality is that OSFEDs are serious behavioral health disorders that pose significant risks to your physical and mental health.Sometimes there is a misconception that OSFEDs are not as serious as other eating disorders. And while some people with this diagnosis may have less-severe eating disorders, many of them have just as severe an eating disorder as those with the more typical eating disorders. In fact, some research has suggested that mortality rates for OSFEDs may be just as high as those for anorexia and other eating disorders.¹

The reality is that OSFEDs are serious behavioral health disorders that pose significant risks to your physical and mental health, including:⁴

• Irregular or complete loss of menstruation in young girls and women.
• Increased risk of infertility in women and men.
• Chronic constipation or diarrhea.
• Inflammation or rupture of the stomach or esophagus (due to frequent vomiting).
• Irregular or slowed heart rate.
• Increased risk of heart failure.
• Kidney failure.
• Osteoporosis.

Treatment Options for OSFEDs

Recovery from OSFEDs is possible, especially if you seek professional treatment. And the earlier you seek treatment, the more likely you are to maintain long-term recovery, especially since many people with OSFEDs go on to develop complete anorexia, bulimia, or binge eating disorder if their condition is left untreated.¹

Inpatient treatment is typically recommended for those with more severe cases of this behavioral disorder. Since many people do not seek treatment until their condition has become an emergency, hospitalization is often the first line of treatment. Once you are medically stabilized, you may then enter a traditional treatment program; some options include:

• Inpatient treatment: Inpatient treatment takes places in a facility where patients live for a designated time, typically ranging from 30–90 days. In severe cases, a person may stay for a longer duration. Residential care is the best line of treatment for those with severe eating disorders who may have difficulty focusing on their recovery outside of the treatment environment. Inpatient treatment for OSFEDs can vary depending on the treatment center a person attends, but standard treatment options typically used include:
  • Individual counseling.
  • Group therapy.
  • Support groups.
  • 12-step programs.
  • Nutritional counseling.
  • Meal planning and assistance.
  • Family therapy.
  • Medical supervision.
  • Complementary therapies such as art therapy, music therapy, recreation therapy, yoga, meditation, exercise, and spa treatments.
• Outpatient treatment: Outpatient treatment may be a viable recovery option for those with less-severe eating disorders who wish to remain involved in activities outside of treatment. People attending outpatient facilities may continue to work, go to school, and engage in other personal commitments while they are seeking treatment. Treatment approaches are typically the same as those received in inpatient facilities, except care is less intensive and only takes place for a few hours each week. Those with severe eating disorders may graduate from an inpatient treatment program and enroll in outpatient treatment as a form of follow-up care.
• Aftercare programs: Just as relapse is common among those suffering from addiction, people with eating disorders are also at risk for relapse. For this reason, it is important that people completing standard treatment enroll in an aftercare program to help them maintain sobriety and prevent relapse. Aftercare treatment options may include ongoing counseling and therapy, support groups, 12-step programs, mentoring, and nutritional counseling.

Sources

1. Muhlheim, L. (2015). VeryWell. OSFED: The ‘Other’ Eating Disorder.
2. National Eating Disorders Association (NEDA). Other Specified Feeding or Eating Disorder.
3. National Association of Anorexia Nervosa and Associated Disorders (ANAD). Eating Disorder Types and Symptoms.
4. National Eating Disorders Collaboration. NEDC Fact Sheet—OSFED.
5. National Eating Disorders Collaboration (2016). Eating disorders risk factors.