Woman wearing a red sweaterEDNOS is a term that previously described what is currently known as Other Specified Feeding or Eating Disorder (OSFED). The name changed in 2013 after the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) streamlined the diagnostic criteria for eating disorders. It is an eating disorder classification for people whose symptoms are significantly distressing, but they do not fit into any diagnostic criteria for other eating disorders. It affects both genders and is the most common eating disorder among adults and adolescents. Although it is not as well-known as bulimia, anorexia, or binge eating disorder, it is just as pervasive and it still requires treatment.

The following eating disorders would result in OSFED diagnosis.

  1. Anorexia nervosa: You meet the full criteria for anorexia nervosa, but your weight remains within the normal range or higher.
  2. Bulimia nervosa (low-frequency or limited duration): You meet the full criteria for bulimia nervosa, but your compensatory behaviour occurs less than once per week, and for less than three months.
  3. Binge eating disorder (low frequency or limited duration): You binge less frequently than what the DSM-5 specifies.
  4. Purging disorder: You purge without binge eating episodes
  5. Night Eating Syndrome: You consume excessive amounts of food in the evening or during the night.

Causes of OSFED

Like other eating disorders, OSFED does not have an exact known cause. The reasons for its development vary with individuals and may result from psychological, sociocultural, biological, or a combination of factors.

Psychological causes

Past experiences play a vital role in determining whether you will develop an eating disorder in your lifetime. They include:

  • Low self-esteem
  • Traumatic experiences
  • Stress, anxiety, and depression
  • Feelings of inadequacy and loneliness
  • Feeling out of control
  • Difficulties with developmental milestones
  • Challenges with change and transition

Biological causes

Various biological factors either increase or decrease your potential to develop an eating disorder. They are:

  • Genetics
  • A malfunction in the neurobiology that regulates hunger and satiety signals
  • Temperament
  • A history of eating disorders in the family

Sociocultural causes

These are the societal and media norms that can cause you to develop an eating disorder. They include:

  • Pervasive messages that promote a specific body size or look as ideal
  • Encouraging or normalizing a diet culture, including veganism, juice cleanses, and elimination diets.
  • Widespread persuasion to lose weight as a way of supporting a healthy lifestyle
  • The cultural rhetoric that obesity results from a lack of self-control and laziness

Symptoms of OSFED

If you are struggling with OSFED, you may experience symptoms similar to but not precisely like those of other eating disorders. Some people experience anorexia-like symptoms, while others lean more towards bulimia. Generally, the signs relate to shape and weight concerns, eating behaviours, and changes in social interactions and personality.

The physical symptoms of OSFED include:

  • Significant weight gain or loss, or fluctuating body weight
  • Falling sick often, a sign of a compromised immune system
  • Dizziness and fainting
  • Damage from frequent vomiting such as swollen cheeks or jaws, bad breath, and damaged teeth
  • Loss of libido
  • Loss of periods (amenorrhea) in women and a failure to begin the menstrual cycle in girls.

The psychological symptoms of OSFED are:

  • An obsession or preoccupation with body image, exercise, eating, or dieting
  • Hypersensitivity to comments about eating, food, dieting, body image or exercise
  • Feelings of disgust, shame or guilt especially after eating
  • Heightened irritability or anxiety around mealtimes
  • Extreme dissatisfaction with your body or a distorted body image. You think you are fat even when you have a low body weight
  • Irritability, self-loathing, low self-esteem, anxiety and depression

Behavioral symptoms of OSFED are:

  • Increased interest in your body image, shape, weight loss
  • Obsessive behaviour like pinching your body to measure fat or repeatedly checking your body in the mirror.
  • Dieting behaviour that involves counting calories, avoiding foods that you once enjoyed and reporting newly discovered food allergies
  • Becoming antisocial and withdrawn
  • Eating in solitude and avoiding company during meals
  • Secretive behaviour around food, either lying about eating or hiding uneaten food
  • Unexplained food disappearance
  • Obsessive eating rituals such as eating very slowly or cutting food into tiny pieces
  • Frequent bathroom trips after eating
  • Vomiting less than once per week
  • Increased interest in preparing food for other people without eating it yourself
  • Using appetite suppressants, diuretics, enemas or laxatives

Treatment of OSFED

OSFED requires the same measure of support and treatment as specified eating disorders. Without treatment, it may progress to fully developed bulimia, anorexia, or binge eating disorder. Evidence suggests that early treatment and engaging professionals in different fields produces the best results. The symptoms you present will determine your treatment method.

Once your doctor diagnoses you with OSFED, they will put together a treatment team that might include a:

  • psychologist
  • psychiatrist
  • dietician
  • social worker
  • family therapist

Treatment for OSFED does not focus on a specific diagnosis. Instead, it aims at achieving four main goals:

  1. ​Psychiatric and medical stabilization
  2. Interrupting maladaptive behaviour
  3. Therapeutic support to examine what sustains your disordered eating
  4. Developing recovery skills

Treatment will target both psychological and physical health. Your healthcare practitioners will ask you numerous questions to help you identify the link between your thought patterns and your eating behaviour. The level of care will depend on the severity of your symptoms. It can be inpatient, partial hospitalization, or outpatient care. You get a customized treatment plan that appreciates your distinctive challenges and recovery needs.

While specialist psychotherapy and family therapy are useful, other behavioural therapy and psychotherapy options also produce desirable outcomes. Support groups may also be beneficial, but they cannot replace treatment from professionals. The treatment modalities available for OSFED are:

  • Cognitive Behavioral Therapy (CBT): This form of therapy helps you to identify, terminate, and substitute distorted thought patterns and the attendant compensatory behaviors with positive thoughts.
  • Dialectical Behavior Therapy (DBT): It combines CBT methods with mindfulness to help you discover new ways of managing your emotions and promote your sense of self-worth.
  • Family-Based Treatment (FBT): This technique is specifically for adolescents, and the clinical team includes the parents and the family. They work together to restore healthy weight and build a positive identity in the child through a systematic approach.
  • Other treatment methods include:
    • Nutritional counselling
    • Group and individual counselling
    • Expressive therapy
    • Medications and supplements for mental health
    • Relapse prevention

The Difference Between EDNOS and OSFED

EDNOS was a diagnosis for eating disorders in the years preceding publication of DSM-5 in 2013. It encompassed subthreshold and atypical eating disorders. The advantage was that a diagnosis of an eating disorder was possible even when you did not meet the comparatively narrow criteria for bulimia and anorexia. The downside was that patients with varying symptoms got the same diagnosis, which impeded access to specialized care. Additionally, the misconception that EDNOS was less severe than bulimia or anorexia prevented patients with the disorder from seeking help.

With the publication of DSM-5, OSFED replaced EDNOS. It sought to address the issues and weaknesses associated with EDNOS. Although the two are mostly the same, OSFED provides diagnoses within itself and has more defined and structurally sound criteria. With OSFED, patients can seek help, and insurance companies can cover treatment costs.

EDNOS, the Catch-all Diagnosis for Eating Disorders

Before the inception of OSFED, EDNOS was the official diagnosis for anyone who did not fit the narrow diagnostic criteria for Bulimia or Anorexia. It evolved into a catch-all, diagnostic dumping ground for patients whose symptoms did not match the rigid criteria for any defined eating disorder. Although the symptoms caused patients significant distress, they did not have official recognition as critical eating disorders. This classification gave EDNOS the erroneous reputation of being less severe and the patients feeling as if their eating disorder is not real.

The Stigma Attached to Eating Disorders

Eating disorders are mental conditions that affect a significant portion of the population. However, internally and externally imposed stigma surrounds them. People with eating disorders stigmatize themselves and feel responsible for their illness. It is also common for the public to trivialize eating disorders as being conditions of volition, primarily due to peer pressure and media campaigns for girls to achieve unrealistic beauty standards. Additionally, there is the widespread misconception that eating disorders are a choice, and they only affect vain, young girls.

Stigma relating to eating disorders also differs between eating disorder diagnoses and other mental conditions. Both bulimia and anorexia face more stigmatization than depression. More unsettling is that stigma in eating disorders sometimes includes a certain level of spite. The stigma related to anorexia often links to the perception that anorexia is a choice and a way of seeking attention. Similarly, the shame and social disgrace associated with the binge-purge cycle is detrimental to the recovery of bulimia patients.

Stigma and stereotypes make patients hesitant to seek intervention. It is more difficult for patients with OSFED to break the barriers and seek help for a condition that does not fit the expected definition of an eating disorder. People suffering from OSFED do not present behavioural symptoms limited to a single eating disorder. Due to this inconsistency, it only causes subtle physical signs without the person seeming “sick enough.” This perspective underscores the social misconception that mental illness is a priority only when the symptoms are apparent.

Getting Help for OSFED

With proper interventions and care, you can recover from OSFED. You need to get help before the disorder worsens. Specialized treatment that will address your specific needs is available. Talk to a professional who will help you restore your self-esteem and engage in healthy eating behavior.