What is Other Specified Feeding or Eating Disorder (OSFED)?
According to the National Association of Eating Disorders (NEDA)
Other specified feeding and eating disorder (OSFED), formerly known as eating disorder not otherwise specified (EDNOS) in previous versions of the DSM, is less well known than higher-profile diagnoses like anorexia nervosa, bulimia nervosa, and binge eating disorder. Despite its lack of public attention, as a catch-all category that includes a wide range of symptoms, OSFED is actually the most common eating disorder diagnosis, representing an estimated 32% to 53% of all people with eating disorders. It was developed to encompass people who did not meet the full diagnostic criteria for anorexia nervosa or bulimia nervosa but still had a significant eating disorder.
Symptoms
Like other eating disorders, symptoms include behavioral, emotional, and physical aspects.
Behavioral symptoms of OSFED often include a preoccupation with weight, food, calories, fat grams, dieting, and exercise, including:
- Refusing to eat certain foods (restriction against categories of food like no carbs, no sugar, no dairy)
- Frequent comments about feeling “fat” or overweight
- Denial about feeling hungry
- Fear of eating around others
- Binge eating
- Purging behaviors (frequent trips to the bathroom after meals, signs and/or smells of vomiting, wrappers or packages of laxatives or diuretics)
- Food rituals (such as excessive chewing or not allowing foods to touch)
- Skipping meals or eating small portions at regular meals
- Stealing or hoarding food
- Drinking excessive amounts of water (or non-caloric beverages)
- Using excessive amounts of mouthwash, mints, and gum
- Hiding body with baggy clothes
- Exercising excessively (despite weather, fatigue, illness, or injury)
The emotional symptoms of OSFED can include:
- Low self-esteem
- Depression
- Strong need for approval
- Anxiety
- Little motivation to engage in relationships or activities
- Easily irritated
- Extremely self-critical
The physical symptoms of OSFED include:
- Noticeable fluctuations in weight
- Gastrointestinal symptoms (such as stomach cramps, constipation, and acid reflux)
- Menstrual irregularities and amenorrhea (missing periods)
- Difficulty concentrating
- Anemia
- Low thyroid and hormone levels
- Low potassium
- Low blood cell counts
- Slow heart rate
- Dizziness
- Fainting/syncope
- Feeling cold all the time
- Sleep troubles
- Cuts and calluses across the top of finger joints (a result of inducing vomiting)
- Dental problems (such as discolored teeth, 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 or dry and brittle hair
- Muscle weakness
- Yellow skin (from eating large quantities of carrots)
- Cold, mottled hands and feet
- Swelling of feet
- Poor wound healing
- Impaired immune system
Causes
OSFED is a complex illness and, while we don’t know the exact cause, genetics and environmental factors both appear to play a role. When it comes to eating disorders, it’s often said that “genes load the gun, but environment pulls the trigger.”
In other words, in those who are genetically vulnerable, certain situations and events contribute to or trigger the development of an eating disorder.
Environmental factors include:
- Dieting
- Weight stigma
- Bullying
- Abuse
- Illness
- Puberty
- Stress
- Life transitions
- Media influence
Diagnosis
One problem with psychiatric diagnoses, in general, is that many patients do not fit neatly into the typical diagnostic categories. It’s not always clear-cut. Sometimes people meet most but not all of the criteria for a diagnosis.
In the case of eating disorders, a person who does not qualify for a specific eating disorder diagnosis would be classified as OSFED. The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) includes five examples of patients who would be classified as OSFED:
