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A Closer Look at Other Specified Feeding and Eating Disorders (OSFED)


Formerly categorized as Eating Disorder Not Otherwise Specified (EDNOS), the Other Specified Feeding and Eating Disorder diagnosis is applied when an individual’s symptoms cause significant distress but do not fit neatly within the strict criteria for anorexia, bulimia, ARFID or binge eating disorder.  Previously, EDNOS encompassed a very large and varied group of individuals and was by far the most commonly diagnosed eating disorder. Approximately 40-60% of cases in eating disorder treatment centers fell into the EDNOS category and about 75% of individuals with eating disorders seen at non-specialty community settings had EDNOS.

More recently, this diagnostic category was revised and refined in the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition and is now termed Other Specified Feeding or Eating Disorder, or OSFED.  Because of changes to all eating disorder criteria, this "catch-all" category is no longer quite as expansive. 

Diagnostic examples of Other Specified Feeding or Eating Disorders

The Diagnostic & Statistical Manual (DSM-V) currently lists the following five clinical examples of OSFED. 

  1. Atypical anorexia nervosa: All criteria for anorexia nervosa are met; despite significant weight loss, the individual's weight is within or above the normal range 
  2. Bulimia nervosa of low frequency and/or limited duration
  3. Binge eating disorder of low frequency and/or limited duration
  4. Purging disorder
  5. Night Eating Syndrome

It’s important to note that this list in not exhaustive, and there are other situations and variations of symptoms that would also warrant an OSFED diagnosis or the alternative, Unspecified Feeding or Eating Disorder

Signs & Symptoms of OSFED

Reviewing the signs and symptoms listed for anorexia, bulimia and binge eating disorder would be helpful if you suspect someone you love may have OSFED.  In general you will see warning signs related to 1) weight and shape concerns, 2) food & eating behaviors and 3) changes in personality and social behavior.

OSFED Concerns & Misconceptions

OSFED is sometimes misinterpreted as a “subclinical” or “sub-threshold” diagnosis. This can be misleading in terms of severity. In the past, studies have shown that individuals who were diagnosed with EDNOS experience eating pathology and medical consequences that are just as, if not more, severe than individuals who receive a formal anorexia or bulimia diagnosis. Furthermore, one study found that 75% of individuals with EDNOS had co-occurring psychiatric disorders and 25% endorsed suicidality (Le Grange, et al. 2012).  

This diagnosis is not to be taken lightly, and individuals with OSFED often require the same level of treatment and support as those with anorexia, or bulimia.  Without treatment, a significant number of individuals with OSFED may go on to meet full criteria for anorexia, bulimia or BED at some point during the course of their illness.

Many people have very serious eating disorders yet don’t meet the full criteria for anorexia or bulimia.  If you think you or a loved may be exhibiting symptoms of an eating disorder, it’s important to seek help.  Please call us at (410) 427-3886 and one of our intake coordinators would be happy to answer any questions you have about eating disorders and treatment.


References:

Le Grange D, et al (2012). Eating disorder not otherwise specified presentation in the US population. 
Int J Eat Disord. 2012 Jul;45(5):711-8.

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