Other specified feeding or eating disorder (OSFED)

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OSFED is an eating disorder that appears in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR). Clinicians created the OSFED diagnosis to include people with atypical eating disorder symptoms.

Other eating disorders, such as anorexia, bulimia, and binge eating disorder, have strict diagnostic criteria in the DSM-5-TR. This means that, to receive a diagnosis of one of these disorders, people need to have a certain set of symptoms.

But not everyone with an eating disorder has the same symptoms. People may have some symptoms but not others, or they may have all the symptoms but not experience them all the time.

OSFED encompasses people in this group. Previously, OSFED had other names, including “eating disorder not otherwise specified (EDNOS).”

Sometimes, people misinterpret OSFED as a term for subclinical eating disorders, which may be less severe. However, OSFED can be just as severe as other eating disorders, causing disruption in many aspects of life.

Additionally, without treatment, OSFED can progress to other diagnoses.

Some examples of OSFED include:

• Atypical anorexia: People with this form of OSFED may severely limit their calorie intake and lose weight but may not have a BMI in the “underweight” category.
• Binge eating (low frequency and/or limited duration): Binge eating involves eating large amounts of food in one sitting and finding it hard to stop. In OSFED, this behavior occurs infrequently or for periods lasting less than 3 months.
• Purging disorder: This disorder involves engaging in behaviors that purge food from the body in order to lose weight, such as making oneself vomit, fasting, exercising excessively, or misusing laxatives, diuretics, or enemas.
• Bulimia (low frequency and/or limited duration): Bulimia involves a cycle of binge eating and purging. People who experience this cycle of behavior infrequently or for less than 3 months may fall into this category.
• Night eating syndrome: This involves eating a large amount of food after the evening meal or waking up in the night to eat large amounts of food. To qualify as OSFED, the behavior must not be due to social norms, environment, or another mental health condition.

Because OSFED can present in several ways, it has many potential symptoms. A person with OSFED may:

• think excessively about their body weight and shape
• have a preoccupation with calories, fat, or sugar
• feel that weight loss, dieting, and food control must be their main priority
• think they look “fat” despite significant weight loss
• feel shame, disgust, or guilt about themselves or about eating food
• experience mood swings, especially around meal times
• feel anxious about eating in front of others

OSFED can also cause behavior changes. A person may:

• skip meals or restrict portion sizes
• disappear after meals, often into a bathroom
• make drastic changes to their diet, such as following fad diets or cutting out large food groups
• frequently check themselves or their reflection for flaws in appearance
• use mouthwash, breath mints, or gum very frequently
• drink excessive amounts of water or low calorie drinks to feel full
• steal food or hoard food in unusual places
• eat large amounts of food in short periods of time
• regularly buy or use laxatives, diuretics, or enemas
• hide their body with layers or loose clothing

The physical symptoms of OSFED can include:

• fluctuations in body weight
• constipation
• abdominal pain
• a frequent cold feeling
• sleep problems
• dizziness or fainting
• tiredness and fatigue
• dry, thin, or brittle hair
• fine hair on the body
• swelling in the cheeks or jaw area
• slow or poor wound healing
• impaired immunity
• cold and mottled hands or feet
• cuts or calluses on the hands from making oneself vomit
• enamel erosion, cavities, or sensitive teeth
• a lack of menstrual periods or the occurence of periods only while taking hormonal birth control

Eating disorders are complex. People of any shape, weight, or background can develop one, and it is not always for the same reasons. Personal risk factors include:

• significant dissatisfaction with appearance or body image
• a history of anxiety
• perfectionism

However, people’s feelings about their bodies do not exist in a vacuum. People can internalize ideas about beauty, or a belief that they must tightly control their lives, from many sources.

External risk factors for eating disorders include:

• weight stigma or anti-fat bias in society
• bullying, especially about appearance
• past psychological trauma
• food insecurity
• social isolation and lack of support

Weight stigma can also tie in to other systemic issues. For example, acculturation occurs when one culture becomes exposed or subjected to another. This can introduce harmful standards of beauty to a society.

The new, dominant culture may value the characteristics of its own people above those of others. This may be a result of racism, colorism, restrictive gender norms, or other causes of inequity.

Learn more about racial trauma.

A healthcare professional will diagnose OSFED by taking a medical history and asking a person about their symptoms. They may ask:

• what the symptoms are
• how often they occur
• how long they last
• whether they cause distress

They may compare the answers to the criteria for OSFED in the DSM-5-TR or use a questionnaire.

Speaking with a primary care doctor who has experience diagnosing eating disorders can be a good place to start, as they will be able to rule out other causes for the symptoms, such as nausea, loss of appetite, sensory issues, or dementia.

A doctor may also detect signs of OSFED during a physical examination or on diagnostic tests. For example, a person may have unexplained:

• anemia
• nutritional deficiencies
• low thyroid or hormone levels
• low blood cell count

If the doctor suspects an eating disorder and the person has not volunteered this information, the doctor may ask some questions to determine whether it is a possibility.

It is important to be honest with the doctor if this happens. Although some people view OSFED as less serious than other eating disorders, it can still cause significant health complications if a person does not receive treatment.

People with OSFED require the same level of treatment and support as those with other eating disorders. Recovery can involve working with a team of professionals to address both mental and physical health concerns. This team may include:

• primary care doctors
• personal or family therapists
• dietitians
• social workers

The first priority is to address any urgent medical needs, such as deficiencies. Next, health professionals establish a regular routine for eating meals. Intensive therapy addresses the underlying beliefs that are causing the behavior and may go on to address coexisting mental health conditions such as anxiety.

Depending on how severe a person’s symptoms are, they may receive treatment as an outpatient, in a residential clinic, or as an inpatient in a hospital if they need medical care.

Outwardly, OSFED may appear to be less serious than other eating disorders, but this is not the case. The condition has a significant effect on health. It is also treatable.

Seeking support can improve a person’s mental and physical well-being, improve their quality of life, and prevent long-term complications. A person does not need to have lost a lot of weight or have other dramatic physical changes in order to get help.

If a person is concerned that they or their child may have OSFED, they should make an appointment with a doctor as soon as they can.

OSFED is a type of eating disorder. It applies to people who have symptoms of other eating disorders, such as bulimia, anorexia, and binge eating disorder, but do not meet all the criteria for those disorders.

This does not mean that OSFED is less severe. A person may have the same symptoms as someone with another disorder but without significant weight loss or gain. Alternatively, they may have the same symptoms only some of the time. This may make the condition harder to identify, but the mental and physical effects remain.

People who have any concerns about OSFED should speak with a doctor who has experience in this area. The sooner a person has support, the sooner they can begin to recover.