What Is OSFED: Other Specified Feeding or Eating Disorder

Other Specified Feeding or Eating Disorders (OSFED) is a diagnostic category of disordered eating. Previously known as “Eating Disorder Not Otherwise Specified” or EDNOS (the category was updated in 2013 with the release of the newest edition of the DSM, the DSM-5), it encompasses those people who do not meet strict diagnostic criteria for anorexia nervosa, bulimia nervosa, or binge eating disorder but still have a clinically significant eating disorder.

OSFED is the most widely diagnosed eating disorder in outpatient settings. Often, OSFED can be mistaken as non-serious or sub-clinical disordered eating; however, OSFED is a serious and life-threatening disorder that requires clinical treatment. Research has illustrated this with the following findings:

• Children hospitalized for EDNOS had just as many medical complications as children hospitalized for anorexia nervosa
• Adults with ‘atypical’ or ‘subclinical’ anorexia and/or bulimia scored just as high on measures of eating disorder thoughts and behaviors as those with DSM-diagnosed anorexia nervosa and bulimia nervosa
• People with EDNOS were just as likely to die as a result of their eating disorder as people with anorexia or bulimia

What Is Other Specified Feeding or Eating Disorder (OSFED)

In The DSM-6, the diagnosis of EDNOS was formally changed to Other Specified Feeding or Eating Disorder (OSFED). [4] While OSFED has received less attention than other eating disorders, it is believed to be the most common with an estimated 32% to 53% of all individuals with eating disorders who have received the diagnosis. [5]

According to The National Association of Anorexia Nervosa and Associated Disorders, the following are five subtypes of OSFED:

1. Atypical Anorexia Nervosa: An individual has restrictive behaviors and other symptoms of anorexia, however they do not meet the low weight criteria.
2. Bulimia Nervosa: An individual meets the criteria for bulimia but engages in binging or purging behaviors at a lower frequency and/or for a limited period of time.
3. Binge Eating Disorder: An individual meets the criteria for binge eating disorder but engages in binging behaviors at a lower frequency and/or for a limited period of time. A person experiences episodes of eating, in a short period of time an amount of food that is larger than what most individuals would consume and feels out of control.
4. Purging Disorder: Purging behaviors that may include vomiting, excessive exercise, laxatives, etc.
5. Night Eating Syndrome: Recurrent episodes of night eating. The person recalls what they have eaten.  [6]

OSFED vs EDNOS

Eating Disorder Not Otherwise Specified (EDNOS) was a diagnosis from the DSM IV-which was utilized for individuals who had eating disorder symptomology and significant distress, but did who not meet the full criteria for any of the other eating disorder diagnoses.

Additionally it is important to note that, EDNOS used to be the most commonly diagnosed eating disorder and encompassed a varied group of people. “Approximately 40-60% of cases in eating disorder treatment centers fell into the EDNOS category and about 75% of individuals with eating disorders seen at non-specialty community settings had EDNOS.” [1]

The Diagnostic & Statistical Manual (DSM-IV) currently lists six clinical examples of EDNOS.

1. All criteria for anorexia are met, however the individual’s weight falls within normal range (despite significant weight loss).
2. All criteria for anorexia are met, however the individual has regular menstrual cycles.
3. All criteria for bulimia are met, however purging or binge-eating episodes happen less than two times per week or for fewer than three months.
4. Someone purges after eating a small amount of food and has a normal body weight.
5. An individual repeatedly chews and spits large amounts of food.
6. All of the criteria are met for binge eating disorder.  [2]

Eating Disorders Are Serious Mental Illnesses

The diagnosis of EDNOS has not received as much media or public attention as other eating disorder diagnoses, such as anorexia and bulimia nervosa. Further, some individuals mistakenly believe that a diagnosis of EDNOS means that their eating disorder is not “as serious” as the more traditional diagnoses.

However, this is utterly false. All eating disorders are serious mental illnesses-which can deadly if an individual does not receive appropriate treatment and support.

In fact, “Many studies have shown that individuals with the EDNOS diagnosis experience eating pathology and medical consequences that are just as, if not more, severe than individuals who receive a formal anorexia or bulimia diagnosis. Furthermore, one recent study found that 75% of individuals with EDNOS had co-occurring psychiatric disorders and 25% endorsed suicidality.” [3]

Identifying OSFED

Like other eating disorders, OSFED has psychological, behavioral, and physical signs and symptoms. While these signs and symptoms can vary based on which disordered eating behaviors are being used, it is important to recognize that OSFED is as serious as other eating disorders and should not be minimized or underestimated. These signs and symptoms include:

Psychological and behavioral signs and symptoms

• In general, behaviors and attitudes indicate that weight loss, dieting, and control of food are becoming primary concerns
• Attitudes about food and weight conflict with a productive, satisfying life
• Dramatic weight loss
• Dresses in layers to hide weight loss or stay warm
• Is preoccupied with weight, food, calories, fat grams, and dieting
• Refuses to eat certain foods, progressing to restrictions against whole categories of food (e.g., no carbohydrates, etc.)
• Makes frequent comments about feeling “fat” or overweight despite weight loss
• Complains of constipation, abdominal pain, cold intolerance, lethargy, and/or excess energy
• Denies feeling hungry
• Evidence of binge eating, including the disappearance of large amounts of food in short periods of time or lots of empty wrappers and containers indicating consumption of large amounts of food
• Evidence of purging behaviors, including frequent trips to the bathroom after meals, signs and/or smells of vomiting, presence of wrappers or packages of laxatives or diuretics
• Appears uncomfortable eating around others
• Develops food rituals (e.g., eats only a particular food or food group [e.g., condiments], excessive chewing, doesn’t allow foods to touch)
• Skips meals or takes small portions of food at regular meals
• Disappears after eating, often to the bathroom
• Any new practice with food or fad diets, including cutting out entire food groups (no sugar, no carbs, no dairy, vegetarianism/veganism)
• Fear of eating in public or with others
• Steals or hoards food in strange places
• Drinks excessive amounts of water or non-caloric beverages
• Uses excessive amounts of mouthwash, mints, and gum
• Hides body with baggy clothes
• Maintains excessive, rigid exercise regimen – despite the weather, fatigue, illness, or injury—due to the need to “burn off ” calories
• Shows unusual swelling of the cheeks or jaw area
• Has calluses on the back of the hands and knuckles from self- induced vomiting
• Teeth are discolored, stained
• Creates lifestyle schedules or rituals to make time for binge-and-purge sessions
• Withdraws from usual friends and activities
• Looks bloated from fluid retention
• Frequently diets
• Shows extreme concern with body weight and shape
• Frequent checking in the mirror for perceived flaws in appearance
• Has secret recurring episodes of binge eating (eating in a discrete period of time an amount of food that is much larger than most individuals would eat under similar circumstances); feels lack of control over ability to stop eating
• Purges after a binge (e.g., self-induced vomiting, abuse of laxatives, diet pills and/or diuretics, excessive exercise, fasting)
• Extreme mood swings

Physical signs and symptoms

• Noticeable fluctuations in weight, both up and down
• Bodyweight is typically within the normal weight range; may be overweight
• Stomach cramps, other non-specific gastrointestinal complaints (constipation, acid reflux, etc.)
• Menstrual irregularities — missing periods or only having a period while on hormonal contraceptives (this is not considered a “true” period)
• Difficulties concentrating
• Abnormal laboratory findings (anemia, low thyroid and hormone levels, low potassium, low blood cell counts, slow heart rate)
• Dizziness
• Fainting/syncope
• Feeling cold all the time
• Sleep problems
• Cuts and calluses across the top of finger joints (a result of inducing vomiting)
• Dental problems, such as enamel erosion, cavities, and tooth sensitivity
• Dry skin
• Dry and brittle nails
• Swelling around area of salivary glands
• Fine hair on body
• Thinning of hair on head, dry and brittle hair (lanugo)
• Cavities, or discoloration of teeth, from vomiting
• Muscle weakness
• Yellow skin (in context of eating large amounts of carrots)
• Cold, mottled hands and feet or swelling of feet
• Poor wound healing
• Impaired immune functioning

Treatment for OSFED

OSFED and Cognitive Behavioral Therapy

Professionals normally treat eating disorders, regardless of type, with cognitive-behavioral therapy (CBT) in various settings, and sometimes, medication is included in the treatment program.

CBT, which aims to change behavior by altering thoughts, is recognized as the “most effective treatment” for bulimia, surpassing in successful outcomes the use of other psychotherapies and antidepressant medication, according to a large study of outcomes. [2]

Unfortunately, even with CBT, only about half of those with bulimia actually recover, researchers found.

People with anorexia also positively respond to CBT. One study compared two groups of adults with anorexia, one had CBT and the other had only nutritional counseling. [3] Those with nutritional counseling dropped out at a far greater rate (73%) than those with CBT (22%). Still, the researchers make a good point: “We know of no empirical support for any intervention for adult anorexia nervosa.”

OSFED and Medication Management

Medication is often used in the treatment of eating disorders, however, the Federal Drug Administration has only approved Prozac (fluoxetine) for bulimia nervosa and, just last year, Vyvanse for binge-eating disorder (BED). Prozac and other antidepressants, along with anti-anxiety medications, are also commonly used in treatment.

Still research shows people with anorexia experience little to no benefit from Prozac and other antidepressants. This puzzles researchers because anorexia often presents symptoms similar to depression and obsessive-compulsive disorder, both of which respond to antidepressants. [4]

Even though eating disorders are serious mental illnesses, they also involve food, and recovery must include some type of nutritional therapy. It’s important, too, that a nutritional professional understand the complexities of eating disorders.

Other treatment types include family-based therapies, as well as body movement, and various creative therapies. Paramount when addressing an eating disorder is to realize everyone will have different needs but recovery is real and possible.

Support Groups

Support groups can be helpful for people with any type of eating disorder, including those with OSFED, other specified feeding or eating disorder, and they’re available in most areas— even online — for low or no cost. Research underscores the important role support groups play in recovery from eating disorders, for which relapse is frighteningly high at roughly 30-50%. [1]

Even if people with OSFED don’t have all the diagnostic criteria of specific eating disorders – anorexia, bulimia, or binge-eating disorder – they normally have some or most of the symptoms of one or more eating disorders.

According to the Diagnostic Statistical Manual or DSM, now in its fifth version, OSFED includes those with:

• Atypical Anorexia Nervosa, or food restriction without low weight or loss of menstruation
• Bulimia Nervosa (of low frequency and/or limited duration)
• Binge Eating Disorder (of low frequency and/or limited duration)
• Purging Disorder
• Night Eating Syndrome

Finding One that Fits

There are many types of eating-disorder support groups out there, and you just have to find one that fits and is convenient for you. The more trouble it takes to get to a group, the more excuses you’ll find not to attend.
Many support groups are moderated by a professional, for example some treatment centers offer therapist-led support groups for former clients and others who are practicing recovery in real life.

Other groups like Eating Disorder Anonymous, based on the widely known 12-step process, can be started by any EDA member but must follow an accepted format.

Many online support groups offer constant access and benefits similar to face-to-face groups; but be cautious for using the Internet for support with an eating disorder.

First, voice and facial cues we have in normal conversations aren’t present in online interactions and meanings can be misinterpreted. Secondly, there are many pro-eating-disorder sites, upon which it’s easy to stumble in a search for healthy support groups; and if someone is walking the line between recovery and the eating disorder, such sites may be difficult to avoid.

Lastly, there’s little control over who can participate in these forums, and some signing on may provide hurtful or dangerous information.

If You Have Been Denied Coverage by Your Insurance Provider

If you or someone you love is seeking treatment for OSFED and has been denied insurance coverage, it’s important to appeal the denial. People who struggle with OSFED need and deserve treatment.

Although insurance companies can be intimidating, it’s important to be confident and comprehensive when appealing denial of a claim. The National Eating Disorder Association (NEDA) gives this important advice for the process:

Continue treatment during the appeals process.

Appeals can take a while, so stick with your treatment and continue to work toward recovery. Also, staying in treatment can be important to reinforce the need for treatment.

Clarify with the insurer the reasons for the denial of coverage.

Request in print or email a reason the insurance company has denied coverage.

Send copies of the letter of denial to all concerned parties with documentation of the patient’s need.

Documentation is key in the appeals process. It may be the denial can easily be solved, and if not, when it’s in black and white, all parties know exactly what denial is being appealed.

Ask the insurer what evidence-based outcome measures it uses to assess patient health and eligibility for benefits.

Some insurance companies may use body mass index (BMI) as a criterion for inpatient admission or discharge from treatment, for example, which may not be a valid outcome measure.

Ask that medical benefits, rather than mental-health benefits, be used to cover hospitalization costs for health issues related to OSFED.

Sometimes claims for physical problems, like those related to food restriction or purging, are filed under mental-health, when in fact, they are physical issues.

Aftercare Recovery

It can be stressful to return to work after treatment for an eating disorder, like OSFED (other specified feeding and eating disorder). People will probably ask provoking questions.

• Where have you been?
• Do you want to go to lunch?
• OSFED, is that anorexia or bulimia or what?

And you don’t have to answer any of these questions. In fact, it’s probably best before going back to work to prepare for the probing, perhaps with your therapist. You may not want some or any coworkers to know where you’ve been. And that’s okay. As long as you’re facing your own truths, nobody else has to.

Support is Important

It is important to have a therapist or other members of your treatment team, like a nutritionist or psychiatrist, lined up before you leave treatment. Make appointments if you need to. You’ll need support during this transition.

You will also need cheerleaders to applaud you through this next step of recovery. You’re taking the skills you learned and applying them to your own life, making them your own. This is an achievement. Celebrate it.

Reaching Out for Support

Try to find someone at work with whom you’re comfortable sharing your story. You’ll need some help when you struggle. The struggle is inevitable, so prepare for it. There’s a reason why 30-50%, depending on your source, relapse within months after treatment for an eating disorder. Struggling alone or struggling on someone’s shoulder may be the difference between relapse and recovery.

If you’re comfortable, share with this “go-to person” your meal plan or ask him or her to be a bathroom buddy. If you can’t find a go-to person at work, have a support person to call or text when the vending machine in the break room is screaming your name; or you feel full after lunch; or you want to run “blank” miles during lunch.

Treatment intentionally creates structure and support around meals unfound in the real world. Afterwards, you may be eating alone, with others – at home, at work – and not always the same time each day. First, be patient with yourself. And get a meal plan before you leave treatment until you see your local nutritionist.

I repeat: Get a meal plan. A realistic meal plan reflecting your work hours, environment, and flexibility. Make this as easy on yourself as you can. If you have a 30-minute lunch break, lunch shouldn’t take 15 minutes to prepare.

Find food with which you are comfortable and you can eat at work. Protein or granola bars, nuts, dried fruit, crackers, juice, anything. The most important thing here is eating your meal plan and not compensating for the healthy calories you’ve consumed. This doesn’t have to be pretty. In fact, recovery isn’t pretty. Get through it. Tomorrow will be better. And eventually, it will be pretty, beautiful, in fact.

---

References:

[1]:A closer look at eating disorder not otherwise specified. The Center for Eating Disorders at Shepard Pratt. Retrieved from: http://eatingdisorder.org/eating-disorder-information/eating-disorder-not-otherwise-specified-ednos/
[2]: A closer look at eating disorder not otherwise specified. The Center for Eating Disorders at Shepard Pratt. Retrieved from: http://eatingdisorder.org/eating-disorder-information/eating-disorder-not-otherwise-specified-ednos/
[3]: A closer look at eating disorder not otherwise specified. The Center for Eating Disorders at Shepard Pratt. Retrieved from: http://eatingdisorder.org/eating-disorder-information/eating-disorder-not-otherwise-specified-ednos/
[4]: Muhlheim, L. (2015). OFSED, the “other” eating disorder. Retrieved from: http://eatingdisorders.about.com/od/diagnosis_and_symptoms/fl/OSFED-the-ldquoOtherrdquo-Eating-Disorder.htm
[5]: Muhlheim, L. (2015). OFSED, The “Other” Eating Disorder. Retrieved from: http://eatingdisorders.about.com/od/diagnosis_and_symptoms/fl/OSFED-the-ldquoOtherrdquo-Eating-Disorder.htm
[6]: Other specified feeding or eating disorder. (2016). Retrieved from: http://www.anad.org/get-information/about-eating-disorders/eatingdisorders-not-otherwise-specified/

---

The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Last Updated & Reviewed By: Jacquelyn Ekern, MS, LPC on March 8, 2016
Published on EatingDisorderHope.com