What is OSFED? Definition, Symptoms, & Treatments

What is OSFED?

Other specified feeding and eating disorder (OSFED) captures a broad range of eating disorders, allowing healthcare professionals to acknowledge and address individuals who don’t fit neatly into other eating disorder diagnoses such as anorexia or bulimia. Previously, this diagnosis was known as an eating disorder not otherwise specified (EDNOS), however that criteria provided less clarity and distinction when diagnosing someone.

Some of the specific reasons why an individual is diagnosed with OSFED versus another eating disorder is that symptoms may be less frequent, or they are missing certain symptoms.¹ OSFED has been reported as the most commonly diagnosed eating disorder.^2,3 Additionally, it should be noted that research indicates OSFED is just as severe, enduring, and clinically significant as more strictly defined eating disorders despite the differences in criteria.^4,5

Symptoms of OSFED

In OSFED, as with other eating disorders, individuals will likely experience both physical and psychological symptoms, as well as engage in problematic behaviors around food and/or exercising. Common negative behaviors might include problematic thoughts and behaviors related to food, hyper aware of eating, and body image issues. Symptoms of OSFED can cause distress or impairment across various areas of an individual’s life, including in one’s social life or work environment.

Physical symptoms of OSFED include:

• Fluctuating body weights
• Irregularity or the loss of menstrual cycle in women
• Decreased libido
• Dry skin
• Brittle nails and hair
• Gastrointestinal issues: Examples may include nausea, bloating, feeling excessively full after eating, and heartburn
• Anemia: In anemia, the individual’s blood produces not enough healthy red blood cells. Anemia can result in other symptoms such as fatigue.
• Difficulty sleeping
• Compromised immune system and slow wound healing
• Fainting, dizziness, or lightheadedness
• Dental enamel erosion
• Scars or calluses on knuckles as a result of self-induced vomiting
• Feeling cold frequently
• Abnormal lab results

Psychological symptoms of OSFED include:

• Preoccupation with eating, dieting, exercise, or body image
• Feelings of shame during or after eating
• Anxiety
• Low self-esteem
• Depression
• Body-dysmorphia 
• Negative self-talk
• Intense fear of gaining weight or becoming fat
• Impulsivity
• Inflexible or rigid thinking
• A strong desire to control one’s environment sometimes resulting in limited social spontaneity
• Restrained emotional expression
• Suicidal ideation and attempts

Behavioral symptoms of OSFED include:

• Dieting
• Laxative abuse, diuretics, or enemas
• Isolating when having meals
• Drinking excessive amounts of water
• Food rituals: examples may include taking unusually small bites of food or cutting food into small pieces, chewing a specific number of times, or eating foods in a certain order
• Excessive exercise
• Binge eating
• Self-induced vomiting
• Hiding or hoarding food
• Non-suicidal self-injury (NSSI)
• Eating a large amount of food after last meal of the day or after waking up during the night

What Causes OSFED?

While the exact causes of OSFED are unknown, it is generally believed that the disorder stems from a variety of factors. These factors can include genetics such as family history, chemical imbalances, and temperament, as well as environmental triggers including both social and psychological factors.

One hypothesis is that genetics may make the development of an eating disorder more likely. Eating disorders appear to run in families.¹ There is research that indicates several biological factors can be linked to eating disorders, particularly in various genetic mutations. Some inherited temperament and personality traits have also been associated with the development of eating disorders, including perfectionism.

It is also believed that environmental triggers can lead to unhealthy eating behaviors. There is thought to be an interplay between genetics and environment, with some genetic risk factors being triggered by environmental stressors. For example,  parents may pass down genes related to eating disorders and also model eating disorder behavior in the home. This contributes to the development of an eating disorder in their child.⁶ Research on genetic factors and the interplay between genetics and environment is growing.

Environmental triggers that may lead a person to develop OSFED include:

• Body representation in social media
• Dieting and diet culture
• Trauma
• Abuse
• Bullying
• Stress or adverse life events
• Life transitions
• Pressures to be thin/lose weight, appearance focused environments, or parental modeling of eating disorder behavior
• Medical illnesses that cause malnourishment

How is OSFED Diagnosed?

As with most disorders, receiving a proper diagnosis is key to starting and maintaining an effective treatment plan. Behaviors related to food and exercise can be a part of other diagnoses related both to physical and mental health, which can complicate diagnosing OSFED. Various examinations or diagnostic tests can help rule out other disorders and help identify the most appropriate diagnosis for an individual.

A diagnosis of OSFED could be given by various healthcare professionals, including primary care or general physicians, psychiatrists, or licensed therapists. If an individual is concerned they may be experiencing OSFED, they may reach out to a professional. Typically, the diagnostic process will then start with the professional taking a medical and/or psychological history and assessing responses aligning with OSFED criteria.

Alternatively, the diagnosis process may start due to an individual demonstrating signs of OSFED during other physical or mental health appointments. Unexplained physical and psychological symptoms may trigger the exploration of OSFED as a possible cause. Being honest with healthcare providers is an important part of proper diagnosis.

Diagnosing OSFED may require:

• Physical examination: Physical examination involving the collection of vital signs, evaluation of the body, and the taking of medical history may reveal symptoms associated with OSFED, such as a low heart rate.
• Psychiatric examination: A psychiatric evaluation will likely involve answering questions as part of a clinical interview or in the form of written assessments that can capture family and personal history related to psychological symptoms that can indicate OSFED.
• Blood tests: The impacts of OSFED can result in abnormal lab results from blood tests, including low thyroid or hormone levels, as well as low red blood cell count potentially indicating anemia.

Complications of Living with OSFED

OSFED can result in health complications in addition to affecting an individual’s daily activities and life. OSFED is no less serious than other eating disorders. Not only is OSFED the most common eating disorder, but it can also be life-threatening.

Complications of living with OSFED may include:

• Weakened bones, also known as osteoporosis, which can increase the risk of bone fractures and breaks
• Risk for loss of fertility in both men and women due in part to hormonal imbalances as a result of the eating disorder
• Kidney failure resulting from self-induced vomiting or the abuse of diuretics and from the deprivation of needed food, fluids, vitamins, and minerals
• Chronic constipation as the intestines come to struggle to push food through the digestive tract appropriately
• Cardiovascular problems such as an irregular heartbeat, high or low blood pressure, or heart disease
• Increased risk for Type 2 diabetes due to the impact on insulin and blood sugar levels

Treatment for OSFED

The treatment of OSFED may benefit from intervention through various methods, including mental health therapists, dietitians, and psychiatrists. While there are no currently accepted medications for the specific treatment of eating disorders, there are still some medications that may help alleviate certain symptoms associated with OSFED and address underlying comorbid diagnoses.

Psychotherapy Options

Psychotherapy has shown promise in the treatment of OSFED. One type of therapy that can be particularly helpful is cognitive behavioral therapy for eating disorders (CBT-E) which can help individuals modify unhelpful thoughts and behaviors surrounding food and body image.^5,8 Dialectical behavioral therapy (DBT) may also be beneficial in addressing specific symptoms and underlying issues, including addressing emotion regulation and distress tolerance.

Because social support can be an important part of OSFED recovery, family therapy may be used. Family therapy can help address unhelpful patterns within a family system that may be contributing to OSFED in addition to equipping family members with their own skills for providing support.

Nutritional therapy through a dietitian may also be a part of treatment for OSFED. Some individuals with OSFED may benefit from having a treatment team consisting of both a therapist and a dietitian to address the disorder. Therapy can help interrupt unhealthy behaviors while also addressing what led to the development and maintenance of the eating disorder. Additionally, therapy can help in developing skills necessary for recovery.

Medications

Some prescription medications may be used to help treat comorbid diagnoses and symptoms such as depression, anxiety, and obsessive-compulsive disorder. Addressing these comorbid diagnoses and symptoms can help decrease the use of unhealthy eating behaviors as a way of coping with the associated symptoms.

Some medications that reduce anxiety can be helpful in addressing anxiety around eating.⁸ Additionally, some selective serotonin reuptake inhibitors (SSRIs) and antidepressants have shown helpfulness in decreasing binging and self-induced vomiting.⁸ Some medications may also assist in stimulating appetite or maintenance of weight.⁸ More research is needed on the use of medications in the treatment of eating disorders, including OSFED.

Hospitalization & In-Patient Treatment

In cases of severe symptoms, hospitalization or in-patient treatment care may be an option. This type of stay may entail stabilization of any urgent medical needs along with a treatment team consisting of therapists, dietitians, psychiatrists, and other healthcare providers. The treatment team will likely provide plans to follow including therapeutic support in the group and individual settings, a meal plan, and medication management. Additionally, support with meals may occur.

Self-Coping Methods

In addition to working with various professionals, individuals with OSFED may  alleviate some symptoms by adopting self-coping exercises. Self-coping exercises may take the form of mental or physical activities.

A person experiencing OSFED may benefit from engaging in one or a combination of these self-coping techniques:

• Yoga
• Mindfulness
• Meditation
• Journaling
• Peer-led eating disorder support groups
• Use of positive-affirmations

How to Find Treatment for OSFED

Acknowledging the need for help is the first step toward recovery from OSFED. Finding and gathering a support team to help in the process is key to future success and relief from an eating disorder. Finding a therapist from an online therapist directory that specializes in eating disorders can be beneficial, as well as finding local support groups and reaching out to family members or friends. There are also online treatment options, such as Equip Health, which offer virtual eating disorder treatment.

If you are concerned for yourself or if you’re a legal guardian concerned about a child or adolescent, make an appointment. There are no specific criteria that need to be met to reach out for help.

In My Experience

In my experience, early intervention and treatment are important to recovery from an eating disorder, and it is important to talk to the healthcare professionals in your life and follow their recommendations. Many individuals suffer in silence because they don’t believe their symptoms are “bad enough” to warrant help.

Any difficulties you experience in your relationship with food, exercise, and your own body are worth discussing with someone you trust. Whether you start by talking to your doctor or therapist, it’s important to find somewhere you feel safe and supported. Recovery from an eating disorder, including OSFED, is possible, but it takes time, and you are not expected to recover alone.