Eating Disorders Explained – OSFED

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Contributor: Courtney Howard, BA, writer for Eating Disorder Hope

No two eating disorders are exactly alike. Just as behaviors range, so do symptoms. It is important to have a diagnosis for those who exhibit disordered behaviors that cause significant distress, yet might not fit all of the strict criteria for a specific disorder.

Other Specified Feeding and Eating Disorder (OSFED) is an eating disorder classification for those who do not meet the diagnostic criteria for any other eating disorders. The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is used by clinicians to diagnose mental health issues and includes many updates to the Feeding and Eating Disorders section.

For example, OSFED was referred to as Eating Disorder Not Otherwise Specified (EDNOS) in the DSM-IV, lumping together a wide variety of disordered behaviors.

Though the new acronym was met with mixed reviews by those within the eating disorder community, OSFED improves on the diagnostic criteria for eating disorders and range of symptoms.

What is OSFED?

OSFED has five subcategories. These include atypical anorexia nervosa, bulimia nervosa with less frequent behaviors, binge eating disorder with less frequent behaviors, purging disorder, and night eating syndrome.

woman-431658_640Though often associated with extreme weight loss, individuals with anorexia nervosa are not always underweight. Those who exhibit symptoms consistent with anorexia nervosa while maintaining a normal body mass index (BMI) are diagnosed with atypical anorexia nervosa.

Purging disorder is different than bulimia nervosa in that these individuals do not binge prior to a purge. Night eating syndrome is characterized by the majority of an individual’s daily food intake being consumed in the middle of the night, or when an individual’s sleep cycle is interrupted due to food urges.

Disordered food behaviors that cause enough distress to be classified as an eating disorder yet do not fit any of these OSFED subcategories can be classified as Unspecified Feeding or Eating Disorder (UFED).

How is OSFED different than EDNOS?

EDNOS served an important purpose with regard to eating disorder diagnosis and treatment. Individuals who did not fall within the strict criteria for other eating disorders could be diagnosed with EDNOS to receive professional treatment.

Handsome man playing guitar.“Unfortunately,” as Jennifer J. Thomas, Ph.D., co-author of Almost Anorexic, explains, “the pervasive myth that EDNOS was somehow less severe than anorexia or bulimia sometimes prevented people who fit into this category from seeking help, or insurance companies from covering costs.”

If is often difficult for individuals to admit they are struggling with an eating disorder. These feelings that nothing is wrong and they do not have an eating disorder can be wrongfully validated when they do not meet the criteria for a specific eating disorder.

According to the American Psychiatric Association, authors of the DSM-5 “intended for DSM-5 changes to minimize use of the catch-all diagnoses of Other Specified Feeding and Eating Disorder and Unspecified Feeding and Eating Disorder. A primary goal is for more people experiencing eating disorders to have a diagnosis that accurately describes their symptoms and behaviors.”

Importance of OSFED and UFED designations

As Dr. Thomas stated, there was a common misconception that EDNOS was a less significant diagnosis than anorexia nervosa or bulimia nervosa. This was not accurate, as eating disorders that fell under this category in the DSM-IV could be just as damaging to an individual’s mental and physical health.

bigstock-Smiling-mature-woman-outdoor-p-43377808For example, binge eating disorder (BED), or bingeing without the use of compensatory behaviors, was previously diagnosed under EDNOS. It now has its own diagnosis in the DSM-5.

There is a general lack of understanding regarding the severity of OSFED and the importance of professional treatment for those grappling with disorders that fall under this category. Sarah Van de Weert of Project HEAL explains that her own EDNOS (now OSFED) diagnosis came with a stigma that even those within the mental health community often perpetuate.

She felt the need to make herself more sick in order to justify seeking professional help since, she explains, “I have never felt that my diagnosis was valid.”

Individuals with OSFED can engage in self-harm and co-occurring mental health issues or substance abuse, just as with other eating disorders. Regardless of an individual’s severity of symptoms or specific diagnosis, full recovery from eating disorders is possible.


Courtney Howard photoAbout the Author: Courtney Howard is a Certified Life Coach specializing in eating disorders through Lionheart Eating Disorder Recovery Coaching. As a content writer at the Sovereign Health Group while writing freelance through Eating Disorder Hope, Courtney is a passionate advocate for recovery and works to fight the stigma surrounding all mental health disorders. She graduated summa cum laude with a Bachelor of Arts (B.A.) from San Diego State University, holds a paralegal certificate in Family Law, and is a Certified Domestic Violence Advocate.

The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Last Updated & Reviewed By: Jacquelyn Ekern, MS, LPC on February 17, 2016
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About Baxter Ekern

Baxter is the Vice President of Ekern Enterprises, Inc. He is responsible for the operations of Eating Disorder Hope and ensuring that the website is functioning smoothly.