What is OSFED?
OSFED is a general name given to eating disorders that don't meet the specific criteria of other disorders. There are several specific subdiagnoses that fall under OSFED, such as purging disorder and night eating syndrome. While it’s a more general diagnosis, OSFED can be just as serious as other eating disorders and can result in hospitalization for the same medical complications as anorexia and bulimia.
Prior to the 2013 publication of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), OSFED was previously known as EDNOS, or eating disorder not otherwise specified. OSFED is the new official diagnostic term, and the two acronyms mean basically the same thing.
OSFED symptoms
Eating disorders look different for everyone, and this is especially true for those struggling with OSFED. Since many OSFED symptoms overlap with symptoms of other eating disorders, it can be tough to differentiate OSFED from other diagnoses. That said, some potential symptoms of OSFED include
Preoccupation with food, weight, or body size and shape
Frequent dieting
Obsession with “clean” eating
Rigid rules and rituals about food, including when, what, or how to eat
Sudden weight loss or gain
Binge eating, or eating objectively large amounts of food in a short amount of time while feeling a loss of control
Self-induced vomiting, excessive laxative use, or extreme exercise
Social withdrawal
Depression, anxiety, or irritability
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Bradycardia
Approximately 5% of the U.S. population is affected by OSFED.
Types of OSFED
Unlike anorexia, bulimia, binge eating disorder, and ARFID, OSFED doesn’t have one particular set of symptoms. It varies from person to person, and one manifestation of OSFED can look completely different from another. However, there are a few specific subdiagnoses that fall under the OSFED umbrella that can be helpful to know about. Atypical anorexia
An eating disorder in which someone meets all the diagnostic criteria for anorexia except for low weight. While this separate diagnosis technically falls under OSFED, it can be misleading, and at Equip, we treat atypical anorexia the same as anorexia nervosa.
Limited or infrequent binge eating disorder
An eating disorder in which someone experiences recurrent binges, but not frequently enough or for long enough to be diagnosed with binge eating disorder.
Limited or infrequent bulimia
An eating disorder in which someone experiences recurrent episodes of binge eating and purging, but not frequently enough or for long enough to be diagnosed with bulimia.
Purging disorder
An eating disorder in which someone experiences recurrent episodes of purging without bingeing beforehand.
Night eating syndrome
An eating disorder in which someone binge eats at night, unconsciously eats while they’re sleeping, or eats upon waking in the middle of the night.
OSFED treatmentUnlike anorexia, bulimia, binge eating disorder, and ARFID, OSFED doesn’t have one particular set of symptoms. It varies from person to person, and one manifestation of OSFED can look completely different from another. However, there are a few specific subdiagnoses that fall under the OSFED umbrella that can be helpful to know about.
People with OSFED are just as likely to die from their illness as people with anorexia or bulimia.
The first step for all eating disorder treatment is weight restoration, if it’s needed. If OSFED has led to malnourishment, it’s important to address any nutritional deficiencies and reach a stable weight before anything else. Without laying the physical groundwork, you or your loved one’s brain and body won’t be able to fully engage with or make progress in treatment.
After any malnutrition is addressed, the next step is to establish regular eating habits. This is generally done by working with a dietitian to develop a meal plan, and beginning to eat regular meals and snacks throughout the day. No matter what sort of OSFED symptoms a person is experiencing, normalizing eating patterns will help to address them.
OSFED treatment will also include individual therapy to work through root causes of the eating disorder, identify triggers, develop healthy coping skills, and address co-occurring conditions like anxiety or depression, among other goals. If loved ones are involved in the patient’s recovery journey, treatment will also include family support to help them better understand OSFED and how they can be helpful in recovery.
What to expect from OSFED treatment at Equip
Treatment at Equip is always individualized to each patient’s needs and challenges, and this is especially true with OSFED. Every patient at Equip is matched with a dedicated, multidisciplinary care team who are trained in identifying and treating OSFED through therapy, nutrition counseling, medical care, psychiatry, and mentorship.
The first focus of treatment is stopping disordered behaviors, establishing regular eating habits, and achieving weight restoration if needed. Once you’ve been able to normalize your eating habits and make progress toward restoring your weight (if necessary), the focus of treatment can shift to other areas. That might mean working on interpersonal relationships, setting goals outside of the eating disorder, learning to handle triggers in your daily life, or understanding potential root causes of the eating disorder.
All our treatments are delivered virtually, so you’ll be working on changing your behaviors and processing your feelings in the environments where you live and eat. Equip is flexible enough to meet you and any supporting friends or family members wherever you are.
Treatment modalities at Equip
We use the following evidence-based treatment modalities to treat patients with OSFED:
Enhanced cognitive behavioral therapy is a form of CBT designed specifically for treating eating disorders. It’s a flexible and powerful framework that helps you reflect on how strategic behavioral changes impact your OSFED symptoms and thought patterns.
Dialectical behavioral therapy helps you learn skills that make intense or distressing emotions more manageable. DBT skills provide you alternative ways of coping with challenging moments, rather than turning to disordered behaviors.
Exposure and response prevention is an approach that helps you face any fears contributing to your eating disorder in a safe space. Through ERP, you’ll build emotional resilience and self-compassion as you understand those fears and the behaviors they’re linked to.
Family-based treatment is the leading approach for treating eating disorders in young people. It empowers healthy family members to take a central role in their loved one’s eating disorder treatment, providing the accountability and support they need to recover at home.
OSFED is serious—but treatable
OSFED is a serious and deadly condition, but lasting recovery is possible. If you think your loved one might be struggling with anorexia, finding treatment promptly is vital.
Our patients are experiencing an early and sustained response to Equip treatment
Patients requiring weight restoration who reached their target weight
After 16 weeks
49%
Average weekly weight gain for those who need it
After 1 year
75%
Average weekly weight gain for those who need it
Average decrease in eating disorder symptoms
After 16 weeks
47%
Average weekly weight gain for those who need it
After 1 year
66%
Average weekly weight gain for those who need it
Our patients are getting better
After the first 8 weeks of treatment, Equip patients are well on their way to recovery
1lb
Average weekly weight gain for those who need it
8 in 10
Patients report a decrease in eating disorder behaviors
74%
Of patients report improvements with depression or anxiety
Common questions about OSFED
As frustrating as it is, there is rarely one identifiable cause of OSFED. Instead, it typically stems from a combination of neurobiological and environmental factors. This means someone may have a genetic predisposition to certain disordered eating behaviors, which are then “activated” by environmental influences. Read more about what causes eating disorders here.
Because there is a range of how OSFED presents, the treatment approach will be personalized to a patient's unique symptoms. However, typically the initial focus of treatment is on normalizing eating habits, stopping eating disorder behaviors, and weight restoration, if necessary.
We focus on these behavioral and nutritional goals first in order to ensure the patient is adequately nourished. When the body and brain are under or malnourished, people may experience depressed mood, anxiety, and difficulties paying attention. Once a patient has made progress with normalizing their eating and gaining weight (if necessary), the focus of treatment can shift to other areas. That might mean working on interpersonal relationships, setting goals outside of the eating disorder, learning to handle triggers, or understanding potential root causes of the eating disorder.
To accomplish all this, our clinicians use a variety of different evidence-based treatment modalities, including CBT-E (a form of cognitive behavioral therapy designed specifically for eating disorders), DBT (dialectical behavioral therapy), and ERP (exposure and response prevention). For younger patients who live with their family, we generally use FBT (family-based treatment).
EDNOS, which stands for Eating Disorder Not Otherwise Specified, is the term formerly used to describe OSFED, which stands for Other Specified Feeding and Eating Disorder. OSFED replaced EDNOS in the DSM-IV in 2013.
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References
- Le Grange, Daniel et al. “Eating disorder not otherwise specified presentation in the US population.” The International journal of eating disorders vol. 45,5 (2012): 711-8. doi:10.1002/eat.22006
- OTHER SPECIFIED FEEDING OR EATING DISORDER." National Eating Disorder Association, www.nationaleatingdisorders.org/learn/by-eating-disorder/osfed. Accessed 6 Feb. 2023.