Sometimes people experience eating disorder symptoms, but don’t meet the exact criteria for the primary eating disorder diagnoses. You may have seen the term “EDNOS” used to refer to eating disorders that fall into this gray area—but what is EDNOS? EDNOS, an acronym that stands for eating disorder not otherwise specified, is actually a diagnostic term that’s no longer in use, having been replaced by OSFED in 2013 (OSFED stands for other specified feeding or eating disorder). Though EDNOS is no longer an official diagnosis, it’s still used occasionally, so it’s helpful to understand what it means.

Read on to learn more about OSFED (formerly EDNOS), what conditions fall under it, and what to do if you’re concerned about yourself or a loved one.

EDNOS vs OSFED—what changed?

First, it’s important to note that according to the Diagnostic and Statistical Manual of Mental Disorders (DSM), the clinically accepted replacement term for EDNOS is OSFED. Both acronyms mean the same thing, but EDNOS is now an outdated term, which is why we refer to the diagnosis as OSFED.

EDNOS was a diagnostic category from the DSM-IV, which was used for individuals who had significant eating disorder symptoms but did not meet the full criteria for anorexia, bulimia, or binge eating disorder (BED). In 2013, the EDNOS diagnosis was officially retired and replaced in the DSM-V with OSFED and unspecified feeding or eating disorder (UFED).

OSFED is used when a person’s eating disorder symptoms don't meet the criteria of another official diagnosis. It can show up in a wide variety of different ways, but also includes specific examples like atypical anorexia, sub-threshold bulimia or BED, purging disorder, and night eating syndrome, which are all serious but treatable eating disorders. UFED is typically used when there is not enough information to make a more precise diagnosis.

Because EDNOS is now considered an outdated term, those who have previously been diagnosed with EDNOS may either now meet the full criteria for one of the other DSM-5 eating disorders, or are assessed as having either OSFED or UFED.

The meanings of OSFED and UFED: clear definitions

A person with OSFED has significant eating disorder symptoms but does not meet the full clinical criteria for a diagnosis of anorexia, bulimia, or BED. However, just because someone doesn’t meet the criteria for these disorders doesn’t mean their illness isn’t serious; OSFED, like other eating disorders, is associated with significant physical and psychological complications.

Similarly, a person with UFED typically has significant symptoms of an eating disorder but does not meet the full criteria for any specific eating disorder. This diagnosis is used in situations where a clinician doesn’t specify the reason why a person doesn’t meet the full criteria for another diagnosis. That might happen in situations where a clinician doesn’t have enough time or information to make a more specific diagnosis, like in the emergency room, for example.

The main difference between UFED and OSFED is that an OSFED diagnosis requires a clinician to provide a specific reason why the patient doesn’t meet the criteria for any other eating disorder (reasons might include things like a patient’s weight, or how frequently binge episodes occur, for instance). In the case of a UFED diagnosis, a clinician chooses not to specify the reason, usually due to lack of information or time.

Symptoms of OSFED

Because OSFED is an umbrella term for conditions that cause significant distress or impairment but don’t meet the full criteria for other specific eating disorders, the symptoms can vary widely. There are, however, some common symptoms that may be present across various subtypes.

Eating and behavioral symptoms

• Dieting, counting calories, reporting new food allergies and/or avoiding food groups
• Compulsively exercising, even when sick or injured
• Using laxatives, enemas, diuretics or appetite suppressants
• Performing body checking
• Avoiding social activities
• Eating alone or in secret
• Hiding or hoarding food
• Self-inducing vomiting
• Chewing and spitting out food
• Making frequent trips to the bathroom during or after eating
• Showing increased interest in planning, buying, and preparing food for others but not eating it
• Obsessive rituals around food

Cognitive and emotional symptoms

• Preoccupation with eating, dieting, exercising, or body image
• Sensitivity to comments about food, eating, dieting, exercise, or body image
• Increased anxiety or irritability, especially before, during, or after eating
• Shame, guilt, and/or disgust, especially after eating
• Distorted body image or body dissatisfaction
• Low self-esteem, depression, anxiety, and/or suicidality

Physical symptoms

• Significant weight loss or gain
• Experiencing an absence of periods or change in menstrual cycle (for individuals with ovaries)
• Getting sick more frequently
• Showing signs of frequent vomiting, like swelling around the cheeks and jaw, or damaged teeth
• Experiencing fainting or dizziness

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OSFED subtypes

There are many subcategories of OSFED. These categories help define the different kinds of eating disorders that might not meet the standards of other official eating disorder diagnoses. A person’s symptoms don’t need to fit into one of these subcategories to have OSFED—no matter the specific label, any eating behaviors that cause significant impairment and distress deserve and require treatment.

Here a few of the most common OSFED subcategories:

• Atypical anorexia nervosa: This term is used when a person meets all the diagnostic criteria for anorexia except low weight. Atypical anorexia is just as serious and carries many of the same health risks as anorexia, which is why, at Equip, we refer to it simply as anorexia.
• Bulimia nervosa (of low frequency and/or limited duration): Bulimia nervosa is a condition that involves eating large quantities of food (binge eating) followed by purging to get rid of it. Like binge eating disorder, a bulimia diagnosis has certain frequency and duration criteria (i.e., the number of times bingeing and purging occurs in a certain time frame, and how long it’s been going on). If you don’t meet these criteria, you might not be able to receive a bulimia diagnosis, despite experiencing the symptoms. For low-frequency or limited duration bulimia, getting an OSFED diagnosis means that you can still receive the treatment you need.
• Binge eating disorder (of low frequency and/or limited duration): A binge eating episode is defined as eating an amount of food that is definitely larger than most people would eat under similar circumstances, while feeling a lack of control over eating. For someone to get a BED diagnosis, they must binge a certain number of times per week, and that behavior must have been going on for a certain number of months. When people experience binge eating but don’t meet that frequency or duration criteria, they are diagnosed with this form of OSFED.
• Purging disorder (purging without bingeing): Purging refers to behaviors that involve intentionally “getting rid of” food from your body. Laxative misuse, excessive exercise, and self-induced vomiting are all common types of purging. Bulimia is another disorder that involves purging, but a bulimia diagnosis is also dependent on the presence of “bingeing” behaviors. When someone experiences purging but not bingeing, their symptoms may align more closely with purging disorder. Purging can start out as a coping mechanism for a different condition, and progress into a harmful habit.
• Night eating syndrome: This condition is specifically related to disordered eating habits that take place at night. That could mean eating more heavily in the evening or in the middle of the night upon waking. Some people are even still asleep (and therefore not conscious) when they take part in night eating.

Is OSFED/EDNOS less serious than other eating disorders?

It’s crucial to understand that eating disorders are complex conditions, and so a person’s symptoms don't always line up exactly with the specific symptom profile of a more commonly known disorder. Having OSFED (or EDNOS) isn’t an indication that someone’s condition is any less real or serious. OSFED can be severe and requires professional treatment, just like any other eating disorder diagnosis.

In fact, research shows that OSFED can carry similar psychopathology to other eating disorders, and similarly improves with treatment. This is why early diagnosis and intervention are so important—evidence-based treatment can and does help those with OSFED heal and recover.

Effective treatments for OSFED

As with other eating disorders, treatment for OSFED includes evidence-based modalities like enhanced cognitive behavioral therapy (CBT-E), or family-based treatment (FBT). The specific approach that’s right for you or your loved one will depend on which eating disorder behaviors are present as well as other factors, including age. Whatever treatment is used, it will have a common goal of establishing normal eating routines and building new coping skills.

• In children, adolescents, and young adults, FBT is considered the gold standard, first-line treatment. It was created for eating disorders involving food restriction, but can also be effective for eating disorders where restriction plays a minimal role (although restriction is a root cause of most eating disorders). FBT is a targeted, structured treatment approach that requires parents and other family members to take on a central role in recovery.
• In adults, CBT-E—a specialized form of CBT designed specifically for eating disorders—is considered the first-line treatment for OSFED. Dialectical behavioral therapy (DBT) skills are also important for emotion regulation, as is nutrition rehabilitation and, sometimes, medical monitoring.

Since it’s not as well known as other eating disorders, having an OSFED diagnosis can be an isolating experience. That’s why support groups can also be a key to recovery for anyone with OSFED. Connecting with others who have received similar diagnoses often helps people feel less alone, and serves as motivation for recovery.

Treating an eating disorder promptly and with evidence-based care is vital, even if your or your loved one’s symptoms don’t line up with a traditional diagnosis. At Equip, we provide personalized treatment to all patients, which can be particularly helpful if you’re struggling with OSFED (or have been previously diagnosed with EDNOS), since OSFED symptom profiles can be so unique and varied. With treatment tailored to your needs, your provider team can help you heal your relationship with food, and find lasting eating disorder recovery.

FAQs

What does EDNOS stand for? What is it called now?

EDNOS stands for eating disorder not otherwise specified. In the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), EDNOS was replaced with two new diagnostic categories to provide more specific and clinically useful diagnoses: other specified feeding or eating disorder (OSFED) and unspecified feeding or eating disorder (UFED).

What does OSFED mean?

OSFED stands for other specified feeding or eating disorder. It’s a diagnosis for individuals who have significant eating disorder symptoms that cause distress but do not meet the full criteria for a specific diagnosis like anorexia or bulimia. The diagnosis is used when a clinician can specify why the full criteria were not met. Examples include atypical anorexia nervosa (in which all criteria for anorexia are met, but the person is not clinically underweight) and purging disorder (which involves recurrent purging without binge eating).

What’s the difference between OSFED and UFED?

Both OSFED and UFED are diagnoses for individuals who have significant eating disorder symptoms that don't meet full criteria for other disorders. However, in OSFED a clinician can specify the reason the criteria are not met and in UFED, a clinician chooses not to specify the reason, often due to a lack of information or time (such as in an emergency room setting).

Is OSFED a real eating disorder?

Yes. OSFED is a real and clinically significant eating disorder that is recognized as a formal diagnosis in DSM-5. The diagnosis was created to ensure that individuals with serious, life-threatening symptoms receive appropriate care, even if they don't meet the full criteria for diagnoses like anorexia or bulimia. OSFED is not considered a less severe form of an eating disorder.

What are the OSFED subtypes?

OSFED has five distinct subtypes (but people can also be diagnosed with OSFED without falling into one of these subtypes):

• Atypical anorexia nervosa: All criteria for anorexia are met, but the person is not underweight.
• Bulimia nervosa of low frequency and/or limited duration: Exhibiting symptoms of bulimia but not meeting all clinical criteria.
• Binge eating disorder (of low frequency and/or limited duration): Binge eating that doesn’t meet the frequency or duration for BED diagnosis.
• Purging disorder (purging without bingeing): Recurrent purging behaviors to influence weight or shape, without binge-eating.
• Night eating syndrome: Recurrent episodes of eating after waking up from sleep.

How is OSFED treated?

In children, adolescents, and young adults, family-based treatment (FBT) is considered the gold standard, first-line treatment for OSFED. In adults with OSFED, enhanced cognitive behavioral therapy (CBT-E) is considered the first-line treatment.