Other Specified Feeding or Eating Disorders (OSFED) is a diagnostic category of disordered eating. Previously known as “Eating Disorder Not Otherwise Specified” or EDNOS (the category was updated in 2013 with the release of the newest edition of the DSM, the DSM-5), it encompasses those people who do not meet strict diagnostic criteria for anorexia nervosa, bulimia nervosa, or binge eating disorder but still have a clinically significant eating disorder.
OSFED is the most widely diagnosed eating disorder in outpatient settings. Often, OSFED can be mistaken as non-serious or sub-clinical disordered eating; however, OSFED is a serious and life-threatening disorder that requires clinical treatment. Research has illustrated this with the following findings:
- 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
According to 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 may be assigned that specifies the reason why the presentation does not meet the criteria of another disorder. For example, “bulimia nervosa of low frequency.”
The following are examples for OSFED:
- Atypical Anorexia Nervosa (AN): All criteria for AN are met, except significant weight loss, the individual’s weight is within or above the normal range.
- Binge Eating Disorder (BED) 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 (BN) of low frequency and/or limited duration: All of the criteria for BN 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).
Like other eating disorders, OSFED has psychological, behavioral, and physical signs and symptoms. While these signs and symptoms can vary based on which disordered eating behaviors are being used, it is important to recognize that OSFED is as serious as other eating disorders and should not be minimized or underestimated. These signs and symptoms include:
Psychological and behavioral signs and symptoms
- In general, behaviors and attitudes indicate that weight loss, dieting, and control of food are becoming primary concerns
- Attitudes about food and weight conflict with a productive, satisfying life
- 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 the 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 the 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
- Frequently diets
- 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
Physical signs and symptoms
- Noticeable fluctuations in weight, both up and down
- Bodyweight 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)
- Difficulties concentrating
- Abnormal laboratory findings (anemia, low thyroid and hormone levels, low potassium, low blood cell counts, slow heart rate)
- 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
Sources: National Eating Disorder Association. Learn: What are eating disorders? Information by eating disorder. OSFED. Retrieved from https://www.nationaleatingdisorders.org/learn/by-eating-disorder/osfed on Dec 8, 2019.  Fairburn, C. G., Cooper, Z., Bohn, K., O’Connor, M. E., Doll, H. A., & Palmer, R. L. (2007). The severity and status of eating disorder NOS: implications for DSM-V. Behaviour research and therapy, 45(8), 1705–1715. doi:10.1016/j.brat.2007.01.010  American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA: American Psychiatric Association.
About Our Sponsor:
Fairhaven Treatment Center is a leading eating disorder treatment center that provides treatment for adult women and adolescent girls struggling with Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder and Other Specified Feeding or Eating Disorder (OSFED).
Fairhaven specializes in working with eating disorders with co-occurring post-traumatic stress disorder (PTSD), trauma and attachment disorder, and a history of addiction and substance use disorder.
About the Author:
Chelsea Fielder-Jenks is a Licensed Professional Counselor in private practice in Austin, Texas. Chelsea works with individuals, families, and groups primarily from a Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT) framework.
She has extensive experience working with adolescents, families, and adults who struggle with eating, substance use, and various co-occurring mental health disorders. You can learn more about Chelsea and her private practice at ThriveCounselingAustin.com.
The opinions and views of our guest contributors are shared to provide a broad perspective on eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a 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.
Published December 11, 2019, on EatingDisorderHope.com
Reviewed & Approved on December 11, 2019, by Jacquelyn Ekern MS, LPC