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Contributor: Courtney Howard, BA, writer for Eating Disorder Hope
Not all disordered eating behaviors fit the mold of anorexia nervosa, bulimia nervosa, or binge eating disorder (BED). For this reason, there are various diagnoses categorized under other specified feeding and eating disorder (OSFED), formerly known as eating disorder not otherwise specified (EDNOS), including atypical disorders.
What happens when an individual’s thoughts and behaviors do not line up with any of these criteria, either? This scenario calls for an unspecified feeding or eating disorder (UFED) diagnosis, which also falls under the OSFED spectrum.
What is UFED?
UFED is diagnosed when an individual’s symptoms do not line up with those of another disorder, or when there is simply not enough information to determine a more specific diagnosis. This UFED label can change once more information is gathered, or as symptoms change over time.
The presence of disordered thoughts and behaviors regarding food and body image is not enough to warrant an eating disorder diagnosis. These thoughts and behaviors must be severe enough to cause significant distress to the individual.
The exact prevalence of UFED is unknown, though it is not believed to be common among the eating disorder community. As Jennifer J. Thomas, Ph.D., confirms, “In our study of DSM-5 changes at the Klarman Eating Disorders Center, just 1 of 150 patients had UFED. This patient struggled with bingeing and purging but didn’t have the intense shape and weight concerns that are required for a bulimia diagnosis.”
Dr. Thomas also explains the reasoning behind the various changes from EDNOS to OSFED in the DSM-5, stating, “I appreciate that UFED is kind of a strange name… the new names were part of DSM-wide changes, meaning that OSFED and UFED are in good company with ‘Other Specified Depressive Disorder’ and ‘Unspecified Anxiety Disorder,’ among others.”
Disordered Eating Behaviors
Symptoms of UFED include disordered eating behaviors that cause significant distress or impairment. Disordered behaviors can vary greatly. Common behaviors include restriction, bingeing, and/or purging.
Restriction is characterized by limiting caloric intake to an extreme. This is one of the primary symptoms of anorexia nervosa, though it is a common facet of many eating disorders.
Binge eating occurs when an individual consumes a large quantity of food, typically in secret and until uncomfortably full. Bingeing is often uncontrollable and leaves the individual feeling guilty and shameful. In some cases, this leads to compensatory behaviors, such as self-induced vomiting or laxative abuse.
An individual can engage in compensatory behaviors, otherwise known as purging, regardless of the size of the meal. Bingeing and purging is characteristic of bulimia nervosa, and bingeing without the use of compensatory behaviors would likely be diagnosed as BED. Purging following a small or “normal” meal might fall under the category of anorexia nervosa or purging disorder. This is dependent on the other symptoms and their severity.
Purging can take many forms, including compulsive exercise. This occurs when an individual has an obsession with burning calories recently consumed, and does so through excessive exercise. Compulsive exercise is a common symptom present in many eating disorders.
There are many disordered behaviors that are less common and therefore not as openly discussed within the eating disorder community.
Chewing and spitting is a behavior in which individuals chew their food to get the sensation of eating, then spit it out to avoid the caloric intake or feeling full. This is different than rumination disorder, in which an individual swallows, then regurgitates and typically re-chews the food.
Pica is an eating disorder characterized by eating non-food substances, such as carpeting or paper products. The ingestion of hair is known as trichophagia, closely connected to the hair-pulling disorder trichotillomania.
An obsession with “clean” eating and a “healthy” lifestyle to the point of extreme restriction and exercise can be labeled as orthorexia. This disorder is not included in the DSM-5, meaning behaviors associated with orthorexia might fall under a UFED diagnosis.
What to Do With a UFED Diagnosis
Any combination of these eating disorder behaviors that does not fit the specific diagnostic criteria for an eating disorder in the DSM-5 would be categorized as UFED. Similarly, UFED can be diagnosed if combinations of these behaviors are present, or if they have only recently presented in the individual.
There is a stigma attached to any OSFED diagnosis, including UFED, even to mental health professionals and individuals struggling with associated disorders. It is important to remember that a UFED diagnosis should be taken just as seriously as one for any other eating disorder, and that full recovery is possible.
Community Discussion – Share your thoughts here!
Have you struggled with UFED and are now in recovery? What hope do you have to share with others that are battling this illness?
About the Author: Courtney Howard is the Administrative Assistant for Eating Disorder Hope and Addiction Hope. She graduated summa cum laude with a B.A. from San Diego State University, holds a paralegal certificate in Family Law, and is a Certified Domestic Violence Advocate. After obtaining her certification as a life coach, Courtney launched Lionheart Eating Disorder Recovery Coaching in 2015 and continues to be a passionate advocate for awareness and recovery.
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 March 8, 2016
Published on EatingDisorderHope.com