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OSFED is currently the most commonly diagnosed eating disorder in a clinical setting, so why have you not heard of it before — and exactly what is OSFED?

We've all heard of anorexia and bulimia, but eating disorders are much more varied than you may have imagined. There's binge eating disorder, for instance, but also night eating disorder, pica (eating non-food objects), orthorexia (eating only certain healthy foods), and disorders such as rumination and Prader-Willi Syndrome. 

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What if you don't neatly fit into any of these categories but still suffer from plainly disordered eating? Previously, you may have ended up with a catch-all diagnosis of "eating disorder not otherwise specified". Today, however, that diagnosis has evolved. Now called "Other Specified Feeding or Eating Disorder" or OSFED for short, this diagnosis actually encompasses wildly varied types of disordered eating.

When does a person qualify for a diagnosis of OFSED, and what's next?

What OSFED Actually Is

The DSM-III, the third edition of the Diagnostic and Statistical Manual of Mental Disorders, was the first edition of the DSM to include a version of OSFED. Up to that time, Anorexia Nervosa, Bulimia Nervosa, and Pica were the only recognized eating disorders. "Atypical Eating Disorder" became a category that allowed people with other forms of disordered eating to receive a diagnosis. However, not much research was conducted into "Atypical Eating Disorder", and it was thought to be rare.

As time went on and more cases came to light, it became clear that eating disorders come in many more shapes and forms than previously imagined. The updated DSM-III-R, published in 1987, presented case studies and reflected increased knowledge of eating disorders in general. The 1994 DSM-IV developed "Eating Disorder Not Otherwise Specified" more, coming up with six clinical presentations. The latest version of the DSM, the DSM-5, was published in 2013. It includes a diagnosis of OSFED, with five recognized sub-types. OSFED is now in fact the most commonly diagnosed eating disorder in clinical settings, making you wonder why it's not in the media a whole lot more.

By going through the list, you will notice that the symptoms of these sub-types differ from one another so greatly that the only common factor is "disordered eating". This reflects the fact that the OSFED diagnosis evolved as a dumping ground for eating disorders that aren't developed enough to warrant their own specific diagnosis. 

These are the sub-types of OSFED:

1. Atypical Anorexia Nervosa: A person suffering from Atypical Anorexia Nervosa will display the restrictive behaviors and eating patterns associated with anorexia without having the low weight typically seen in anorexia sufferers.


2. Bulimia Nervosa: These people meet the diagnostic criteria for Bulimia Nervosa, but to a lesser extent. They may binge eat without experiencing the loss of control bulimia sufferers typically would, and then set up compensatory behaviors to prevent weight gain. They may engage in self-induced vomiting, use laxatives or diuretics for weight loss purposes, and exercise excessively or fast. These behaviors occur less frequently than in people who are diagnosed with bulimia, however: for a duration of less than three months at a time, or less than once a week. 


3. Binge Eating Disorder: These patients will meet the criteria for Binge Eating Disorder, but once again display these behaviors less often or for a shorter duration. Binge eating occurs less than once a week or for less than three months at a time.


4. Purging Disorder: This is essentially a sub-type of Purging Disorder, in which individuals will purge through self-induced vomiting, misuse laxatives and diuretics for weight loss purposes, and exercise excessively. These people do not qualify for a Purging Disorder diagnosis because they don't engage in binge eating.

See Also: Keep Calm: "Thinspiration" Can't Convince Us That Anorexia Is A Lifestyle Choice


5. Night Eating Syndrome: People suffering from Night Eating Disorder eat at night after waking, or consume excessive food after their dinner, beyond a typical but occasional urge to engage in late-night snacking. They are aware of their late-night consumption of food and find their sleep-wake cycle adversely affected by late-night eating. 

The fact that these sub-types do not have their own dedicated diagnoses and in some cases arise from not quite meeting the diagnostic criteria for more well-known eating disorders such as anorexia and bulimia does not mean that the eating patterns that qualify a person for an OSFED diagnosis are any less serious than other eating disorders.

In fact, some studies have shown that OSFED sufferers experience risks similar to those of other eating disorders, including the possibility that their eating disorder becomes fatal. OSFED may be a catch-all diagnosis, but it's one that is every bit as serious as other eating disorders. 

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