OSFED: Why You've Never Heard Of This Common Eating Disorder

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. 

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.

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. 

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. 

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. 

OSFED: Warning Signs And Treatment Options

OSFED, as a diagnostic category, represents the fact that eating disorders are complex, rather than black and white. With such a wide range of possibilities, what would the warning signs be? What are the red flags of OSFED that you may be looking for in yourself or a loved one? They would be extremely general.

• An extreme preoccupation with weight or size. 
• An extreme preoccupation with food.
• Constant weight fluctuations brought on by varied eating habits: eating very little, exercising excessively, or using supplements, diuretics or laxatives to lose weight on the one hand, and general binge-eating or late-night binge eating on the other hand.
• Strict rules around what a person can and cannot eat, and when.
• Compensatory behaviors such as purging and using laxatives. 
• Going from one diet to another.
• A negative body image. 

What is OSFED not? It's not realizing you're a few pounds overweight and taking steps to slim down. It's not deciding to follow a more healthy eating pattern by cutting out snacks and junk foods. It's not losing weight to fit into your wedding dress or for that bikini body in summer. It may, however, be excessive snacking night after night, followed by occasional purging because you feel guilty. It may be deciding one diet program hasn't worked, and moving on to another, and another, and another... despite not being overweight. It may be periods of binge eating followed by fasting or restrictive eating. It may be exercising lots so you can binge eat without putting on weight. It may be using laxatives to maintain your weight. It may be obsessive calorie counting but still not being at the "starvation weight" typically associated with anorexia sufferers.

Diagnosing OSFED

Because OSFED is a rather mixed bag, it is not surprising that diagnosing this disorder is rather difficult to diagnose. Not meeting the diagnostic criteria for more well-known eating disorders may make them feel that they do not have an eating disorder at all, and the same goes for the loved ones of people with OSFED. Furthermore, people suffering from any type of eating disorder tend to go to extreme lengths to conceal that fact. What's more, they are often in denial about having an eating disorder, though they are aware that they have a problematic relationship with food.

See Also: Pica: Not Your Usual Eating Disorder

Treatment

Treatment for OSFED is tailored to the individual, as with all eating disorders. Programs in which people receive therapy and dietary advice as outpatients are available, as well as day and evening programs. Some people with OSFED will require hospitalization, while others will strongly benefit from residential programs in which their eating habits, weight, and compensatory behaviors are strictly monitored. Therapy to assess the underlying reasons for the eating disorder and to learn to adopt healthy eating patterns again should always be an integral part of the treatment plan.