Treatment for OSFED (Other Specified Feeding and Eating Disorder)

Eating disorders can be difficult conditions to treat, and that’s especially true when the specific condition in question is unclear. 

Other specified feeding and eating disorder (OSFED) is perhaps one of the trickiest eating disorders for which to provide appropriate care. While the diagnosis indicates that a pattern of disordered eating behavior has been recognized, it leaves open specifics, like the cause of the disorder, which could be helpful for developing care programs.

Still, there are some types of OSFED treatment available for people struggling with this type of condition.

What is OSFED?

Healthcare professionals use The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as the authoritative and definitive guide for diagnosing mental health disorders, including eating disorders. The manual lays out specific criteria that must be met in order to diagnose someone with a certain type of eating disorder. 

While the book has listings for a number of well-known mental illnesses, including anorexia nervosa, bulimia nervosa, and binge eating disorder, it also includes a category for “other specified feeding and eating disorder,” or OSFED. While people in these cases display troubling thoughts and behaviors around food and eating, they don’t meet the exact criteria for any other eating disorders. OSFED can also extend to specific types of more well-known eating disorders. Atypical anorexia nervosa, for example, where restrictive eating is present, but significant weight loss is not, may be considered an OSFED case.¹

How is OSFED Diagnosed?

While patients must meet certain criteria to be diagnosed with specific eating disorders, OSFED works almost in reverse. Patients who showcase disordered eating behaviors but don’t meet enough criteria to distinguish one disorder, in particular, are often diagnosed with this mental health condition.

There are also some specific conditions that the DSM-5 currently lists as OSFED, including:²

• Atypical anorexia nervosa
• Subthreshold bulimia nervosa
• Subthreshold binge eating disorder
• Subthreshold purging disorder
• Night eating syndrome

What are the Risks of OSFED?

Like any eating disorder, there are often risks and complications associated with specified feeding and eating disorder. Some of the most common physical effects of the condition include:³

• Heart problems, such as:
  • Slow or irregular heartbeat
  • Heart failure
  • Blood pressure fluctuations
• Nutritional deficiencies
• Osteoporosis or osteopenia
• Irregular menstruation and increased risk of infertility
• Gastrointestinal issues, including:
  • Constipation
  • Diarrhea 
  • Heartburn
  • Indigestion
  • Inflammation of the esophagus
  • Chronic sore throat
• Kidney, liver, or pancreatic dysfunction

As well as physical issues, there are also psychological issues associated with OSFED, such as:³

• Feelings of guilt, shame, or self-loathing
• Obsessive thoughts about food, eating, and body shape or weight
• Distorted/negative body image
• Substance abuse
• Anxious and/or depressive behaviors, social withdrawal
• Self-harm, suicidal thoughts

These risks vary from person to person and can present in any combination. Some people may even show no apparent signs or symptoms.

Learning how to identify these signs early can be crucial for the success of rehabilitation and recovery. Finding the right type of OSFED treatment will depend on individual symptoms.

Levels of Treatment for OSFED

There are several levels of treatment available for patients with OSFED. 

These types of programs are used for people struggling with eating disorders of all kinds, as the varying degrees of care allow for each patient to progress at the rate and intensity they need. 

Acute Medical Stabilization

This is the highest and most intensive level of care for individuals with eating disorders. 

Acute medical stabilization is utilized when people are medically unstable or compromised due to the severity of their condition. Generally, patients requiring this level of care showcase:⁴

• Abnormal vital signs (bradycardia)
• Extreme low body weight
• Arrhythmia
• Hypotension
• Hypothermia
• Electrolyte abnormalities
• Suicidal thoughts

Patients are admitted to the hospital and subject to care 24/7, including intravenous feeding, if necessary.

Once medical stability is reached and refeeding is successful, the patient can then transition to a lower level of care. This process can take 2-3 weeks.

Residential Treatment

When patients enter residential treatment, they live in a facility that offers 24/7 access to care. 

These programs generally involve a strictly regimented daily schedule, with patients adhering to a required meal program tailored to their individual needs. They also include individual therapy, family or group therapy, family visits, outings, or other activities. 

The goal of residential treatment is to help curb and eventually stop harmful or destructive eating disorder behaviors, partly by giving the patient a place to stay that’s free of the triggers in their everyday lives. Patients are generally entered into these programs after acute medical stabilization, or they may enter directly into a residential care facility.

In general, the people who benefit most from this level of care are still struggling with unhelpful thoughts and behaviors and are not yet capable of managing the symptoms of their condition. These types of programs allow for healthy behaviors and habits to be initiated in a supervised and supportive environment.

Partial Hospitalization Program (PHP)

In a partial hospitalization program (PHP), patients don’t live at a hospital or treatment facility. However, the program is often still intensive, taking place between 5-6 days per week, with sessions lasting 8 hours or more.

While at the treatment facility, patients may:

• Attend individual therapy, family therapy, or group counseling sessions
• Receive education about nutrition and healthy eating
• Undergo medication management meetings with doctors

These programs also include meal supervision, with patients eating multiple meals and snacks with the support of supervisors. 

This step in the treatment process is often the best option for patients who no longer need 24/7 care and monitoring but may still struggle with harmful thoughts or behaviors and need more practice with using the skills they’ve learned in therapy.

Intensive Outpatient Treatment (IOP)

Intensive outpatient treatment (IOP) is another intermediary type of treatment, but one that has a more relaxed schedule than a PHP program.

Usually, an IOP will still involve supervised meals, nutrition education, medication evaluations, and regular therapy sessions, whether as an individual or as part of a group. But the programs run on average just a few days a week, for a few hours each day. 

The flexibility built into the program allows patients to live at home and start taking on some social responsibilities while continuing to benefit from the support and structure of a treatment program. 

People who fare best in an IOP setup are generally medically stable, able to independently follow their meal plans, and show better control over their unhelpful thoughts and behaviors, even though lapses may still occur.

Outpatient Treatment

Finally, several types of patients may benefit from outpatient treatment.

At this level of care, patients live at home and maintain regular social commitments, including work or school, while managing regular appointments with members of their care team. This could include weekly therapy sessions, nutritional counseling, or occasional medication evaluations. 

Outpatient treatment is generally recommended for patients deemed medically stable by healthcare professionals who have their symptoms under reasonable control. These patients can function in everyday social situations and make consistent progress in their recovery.

This level of care is most suitable for patients who have progressed through more intensive levels of care or whose symptoms are less severe.

How to Seek Help for OSFED

If you or someone you know struggles with other specified feeding and eating disorder, it’s important to seek help. The process may seem daunting, but there are some good ways to get started, including:

• Reaching out to someone you trust. It’s important to have a support system you can rely on. A trusted friend or loved one can help by listening and finding appropriate next steps.
• Getting in touch with a professional. This is a good idea whether or not you have a loved one to confide in. Whether it’s a doctor, a therapist, or a psychiatrist, someone with expertise can offer additional resources to help you on the path to recovery.
• Finding a treatment option that works for you. While a medical professional will be able to help point you in the right direction for treatment, it can also be helpful to do your own research on treatment options. This is especially crucial for OSFED cases, which can be more difficult to pinpoint. 
• Committing. Mindset makes a big difference. Once you make the decision to get better and see it through, it may feel easier to continue pursuing your goal of getting better and recommitting when obstacles appear.

Eating disorders like OSFED are estimated to affect 28.8 million Americans.⁵ But help is always possible.

With the resources available today, finding the care an individual needs is more accessible than ever before.