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. Some of the specific reasons why someone may be diagnosed with OSFED versus another eating disorder could be 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

EDNOS Vs. OSFED

Previously, OSFED was known as an eating disorder not otherwise specified (EDNOS), however that criteria provided less clarity and distinction when diagnosing someone. The diagnosis was changed to OSFED in the 2013 version of the Diagnostic and Statistical Manual of Mental Disorders (fifth edition).¹

Common OSFED Diagnoses

OSFED captures several different eating disorders that have not yet been defined as their own conditions. Some people meet the criteria for OSFED after experiencing a symptom reduction in other eating disorders, like anorexia or bulimia nervosa. All people with OSFED display disordered thoughts and symptoms around food and eating.

Types of OSFED include:

• Atypical anorexia nervosa:  People with this condition engage in restrictive behaviors that mimic anorexia nervosa. However, they are not medically underweight.
• Bulimia nervosa of low frequency and/or limited duration: People with this condition engage in bulimia symptoms at a lower frequency than those with bulimia nervosa.
• Binge eating disorder of low frequency and/or limited duration: People with this condition engage in binge eating disorder symptoms at a lower frequency than those with binge eating disorder.
• Purging disorder: People with purging disorder engage in purging episodes, either through vomiting or other methods like extreme exercise, without displaying signs of binge eating.
• Night eating syndrome: People with this condition engage in chronic episodes of night eating, and the condition isn’t otherwise explained by other variables or diagnoses, such as binge eating.

OSFED Symptoms

With OSFED, people will likely experience both physical and psychological eating disorder 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 awareness of eating and food, 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 OSFED Symptoms

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 doesn’t produce 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 OSFED Symptoms

Psychological symptoms of OSFED can 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 OSFED Symptoms

Behavioral symptoms of OSFED can 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

Outward Warning Signs of OSFED

The outward warning signs of OSFED can mimic that of other eating disorders. People with OSFED may display rigid behaviors around food and eating. They may engage in compensatory behaviors, such as self-induced vomiting, compulsive exercise, and laxative abuse. They may be very critical of their physical appearance. With that, some people do not show any outward warning signs and take significant efforts to conceal their struggles.

Outward signs that someone could be dealing with OSFED could include:

• Avoiding social situations where food is involved
• Fluctuating weight
• Wearing baggy clothing or making efforts to hide the body
• Loss of sex drive
• Getting sick more than usual
• Chronic dieting behavior
• Using the bathroom during or after meals
• Displaying obsessive or strange rituals around food
• Irritability during meals

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 genetic and biological factors such as family history, chemical imbalances, and temperament, as well as environmental triggers including both social and psychological factors.

Genetic Factors for Eating Disorders

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.

Environmental Factors for Eating Disorders

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

Common Co-Occurring Conditions

Research shows that there is an extremely high comorbidity between eating disorders and other mental illnesses. It’s estimated that anywhere from 55-97% of people with an eating disorder meet the criteria for another psychiatric disorder, including mood disorders, anxiety disorders, personality disorders, PTSD, and more. Symptoms of both conditions can exacerbate the other.

Common comorbidities with OSFED include:⁷

• Anxiety: Anxiety disorders are an umbrella term for various conditions, including generalized anxiety disorder, panic disorder, specific phobias, and social anxiety disorder. Many people with eating disorders experience anxiety symptoms.
• Depression: There’s a high correlation between depression and eating disorders, with many people experiencing very low self-esteem and chronic feelings of sadness and/or irritability.
• Impulse control: Many people with eating disorders exhibit poor impulse control and may struggle with other impulsive behaviors around sex, money, or work.
• Substance use: Substance use and eating disorders can go hand-in-hand, and some people may experience an increase in symptoms in one condition when recovering from the other condition.
• Self-harm behaviors: Eating disorders can also coincide with self-harm behaviors, and many eating disorder behaviors themselves mimic self-harm rituals.

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

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.

Typically, the diagnostic process will then start with a licensed 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.

The diagnostic process for OSFED might include:

• 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.

Treatment for OSFED

The treatment of OSFED may benefit from a multi-faceted approach, including the help of 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.

Enhanced Cognitive Behavioral Therapy (CBT-E)

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)

Dialectical behavioral therapy (DBT) may also be beneficial in addressing specific symptoms and underlying issues, including addressing emotion regulation and distress tolerance.

Family-Based Treatment

Because social support can be an important part of OSFED recovery, family therapy may be used. Family-based treatment options like the Maudsley method, developed specifically for eating disorders, 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 Counseling

Nutritional counseling 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. Nutrition 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 other 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 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:

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

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.