OSFED is an acronym that stands for Other Specified Feeding or Eating Disorders, an eating disorder diagnosis that includes a wide range of eating challenges that do not fit neatly into other clinical diagnoses. Because of the wide range, identifying OSFED symptoms isn't as straightforward as identifying the symptoms of other eating disorders—but there are red flags you can look out for.
First, what is OSFED?
A lot of people aren't even aware of the term OSFED, let alone its symptoms. Once reason that the diagnosis may be less familiar to both medical professionals and the general public is that it's relatively new. In 2013, OSFED officially replaced the term EDNOS (Eating Disorder Not Otherwise Specified) in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). Despite the formal change in the name, some people continue to use the name EDNOS.
Because OSFED can be viewed as a “catch-all” term, many people falsely assume this diagnosis isn’t as severe as more commonly known eating disorders, such as anorexia nervosa, bulimia nervosa, or binge eating disorder. It’s important to know that OSFED is just as serious as other eating disorder diagnoses.
There are several specific diagnoses that fall under the OSFED umbrella:
- “Atypical Anorexia Nervosa” (AAN): This term, which is believed by many to be outdated and stigmatizing, describes an eating disorder in which all anorexia nervosa criteria are met except that the patient isn't considered medically “underweight.” It’s important to know that anorexia in any body size is dangerous. Although it was once thought that anorexia in “normal” or higher weight bodies was less serious, we now know that patients with AAN often have more severe symptoms and may have often lost an even larger percentage of body weight.
- Subthreshold Binge Eating Disorder: Meets all the criteria for binge eating disorder, except that the binge episodes occur at a lower frequency and/or for less than three months.
- Subthreshold Bulimia Nervosa: Meets all of the criteria for bulimia nervosa, except that the binge eating and purging behavior occur at a lower frequency and/or for less than three months.
- Purging Disorder: Recurrent purging behavior (e.g., vomiting, abusing laxatives, excessive exercise) in an attempt to change weight or shape but without binge eating.
- Night Eating Syndrome (NES): Recurring episodes of night eating that may include eating after awakening from sleep or binge eating after the evening meal. The night eating causes significant distress/impairment and is not better explained by environmental influences or social norms. NES is diagnosed when the behavior is not better explained by another mental health disorder (e.g., binge eating disorder).
Because OSFED is an umbrella term encompassing several different diagnosis, the symptoms of OSFED can vary widely. Depending on which sub-diagnosis a person has, their symptoms may besimilar to those of anorexia, bulimia, or binge eating disorder.
Given that, some OSFED symptoms to look out for include:
- A preoccupation with body weight or shape
- Negative body image
- Rigid rules around food
- Frequent dieting
- Avoiding meals with others
- Excessive exercise
- Feeling cold, even in a warm environment (associated with atypical anorexia)
- Using the bathroom after meals (associated with subthreshold bulimia)
- Abusing laxatives (associated with subthreshold bulimia)
- Depression and/or anxiety
- Mood changes
- Lack of expected growth in children and adolescents
- Digestive issues
- Frequent illness or injury
- Loss of regular periods in someone who should be menstruating
What are the health effects of OSFED?
As with other eating disorder diagnoses, OSFED can cause serious harm to both physical and mental health. The entire body can be affected by OSFED, with particular risk to the brain, the heart, and the digestive system. Having OSFED can also trigger depression, anxiety, and obsessive-compulsive disorder, or worsen those conditions if they existed before the eating disorder. Eating disorders, including OSFED, also increase the vulnerability to substance use disorder and heighten suicide risk.
OSFED interferes with the ability to connect fully with family and friends. This social-emotional toll can intensify mental health struggles and drive further eating disorder behaviors.
How is OSFED treated?
As with all eating disorders, treatment for OSFED focuses on helping patients eat regular meals and snacks throughout the day and eliminating purging or other eating disorder behaviors. For Night Eating Syndrome, treatment also seeks to address any disruption in the wake-sleep cycle. For other OSFED types, treatment would resemble approaches for similar diagnoses; for instance, the treatment for subthreshold bulimia nervosa would be the same as for bulimia nervosa. For all types of OSFED, having the support of family and friends–in addition to a clinical treatment team–offers the best chance for a robust recovery.
Restricting, bingeing, and purging are harmful in any amount — even when they don’t meet official clinical thresholds for the more commonly known eating disorders. The good news is that eating disorders are treatable, and anyone suffering in their relationship with food should seek out effective treatment options, such as Equip. No matter how someone’s eating disorder manifests, they deserve the support they need to experience life in recovery.
- Withnell, S. et al. How Different Are Threshold and Other Specified Feeding and Eating Disorders? Comparing Severity and Treatment Outcome. Frontiers in Psychology, VOLUME 13, 2022 doi: 10.3389/fpsyg.2022.784512
- Jenkins, Zoe M et al. “What is OSFED? The predicament of classifying 'other' eating disorders.” BJPsych open vol. 7,5 e147. 12 Aug. 2021, doi:10.1192/bjo.2021.985
- Keel, Pamela K. “Purging disorder: recent advances and future challenges.” Current opinion in psychiatry vol. 32,6 (2019): 518-524. doi:10.1097/YCO.0000000000000541