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 of osfed

To be diagnosed with anorexia nervosa according to the DSM-5, the following criteria must be met:

  1. Restriction of energy intake relative to requirements leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health.

  2. Intense fear of gaining weight or becoming fat, even though underweight.

  3. Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.

Even if all the DSM-5 criteria for anorexia are not met, a serious eating disorder can still be present. Atypical anorexia includes those individuals who meet the criteria for anorexia but who are not underweight despite significant weight loss. Research studies have not found a difference in the medical and psychological impacts of anorexia and atypical anorexia.

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

  • 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.)

  • 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

  • Fear of eating in public or with others

  • Drinks excessive amounts of water or non-caloric beverages  

  • Uses excessive amounts of mouthwash, mints, and gum   

  • Maintains excessive, rigid exercise regimen – despite weather, fatigue, illness, or injury—due to the need to “burn off ” calories 

  • Withdraws from usual friends and activities 

  • 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

PHYSICAL

  • Noticeable fluctuations in weight, both up and down

  • 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) 

  • Difficulties concentrating 

  • Abnormal laboratory findings (anemia, low thyroid and hormone levels, low potassium, low blood cell counts, slow heart rate) 

  • Dizziness 

  • Fainting/syncope 

  • Feeling cold all the time 

  • Sleep problems 

  • 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 skin 

  • 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 

  • Muscle weakness 

  • 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.