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Other Specified Feeding or Eating Disorders (OSFED) was previously known as Eating Disorder Not Otherwise Specified (EDNOS) in past editions of the Diagnostic and Statistical Manual. Despite being considered a ‘catch-all’ classification that was sometimes denied insurance coverage for treatment as it was seen as less serious, OSFED/EDNOS is a serious, life-threatening, and treatable eating disorder. The category was developed to encompass those individuals who did not meet strict diagnostic criteria for anorexia nervosa or bulimia nervosa but still had a significant eating disorder. In community clinics, the majority of individuals were historically diagnosed with EDNOS.
Research into the severity of EDNOS/OSFED shows that the disorder is just as severe as other eating disorders based on the following:
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
EVALUATION & DIAGNOSIS
Changes to the latest edition of the DSM were meant to clarify definitions of anorexia, bulimia, and binge eating disorder to more accurately diagnose eating disorders. Although this reduced the number of OSFED diagnoses, it remains a common diagnosis. In the DSM-5, a person must present with feeding or eating behaviors that cause clinically significant distress and impairment, but do not meet the full criteria for any of the other disorders.
A diagnosis might then be assigned that addresses the specific reason why the presentation does not meet the specifics of another disorder (e.g., bulimia nervosa - low frequency). The following are further examples for OSFED:
Atypical Anorexia Nervosa: All criteria are met, except despite significant weight loss, the individual’s weight is within or above the normal range.
Binge Eating Disorder (of low frequency and/or limited duration): All of the criteria for BED are met, except at a lower frequency and/or for less than three months.
Bulimia Nervosa (of low frequency and/or limited duration): All of the criteria for bulimia nervosa are met, except that the binge eating and inappropriate compensatory behavior occurs at a lower frequency and/or for less than three months.
Purging Disorder: Recurrent purging behavior to influence weight or shape in the absence of binge eating.
Night Eating Syndrome: Recurrent episodes of night eating. Eating after awakening from sleep, or by excessive food consumption after the evening meal. The behavior is not better explained by environmental influences or social norms. The behavior causes significant distress/impairment. The behavior is not better explained by another mental health disorder (e.g. BED).
WARNING SIGNS & SYMPTOMS OF OSFED
Emotional and behavioral
In general, behaviors and attitudes indicate that weight loss, dieting, and control of food are becoming primary concerns
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 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 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
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
Noticeable fluctuations in weight, both up and down
Body weight 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)
Abnormal laboratory findings (anemia, low thyroid and hormone levels, low potassium, low blood cell counts, slow heart rate)
Feeling cold all the time
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 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
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
HEALTH CONSEQUENCES OF OSFED
The health consequences of OSFED depend in part on which eating disordered behaviors are being used. It is important to recognize that OSFED is as serious as other eating disorders and should not be trivialized or underestimated. Health consequences of OSFED can be difficult to pinpoint, as it includes a number of conditions. Watch out for all of the signs already listed. The most important thing to look out for is attitudes about food and weight that conflict with a productive, satisfying life.