What is OSFED?
OSFED is a condition where you exhibit symptoms of an eating disorder (bingeing, purging and/or restricting), but you do not meet the diagnostic criteria for anorexia nervosa, bulimia nervosa or binge eating disorder. The term OSFED first appeared in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) in 2013, but the idea is not as new. Before then, Eating Disorder Not Otherwise Specified (EDNOS) was the diagnosis for anyone who did not meet the narrow diagnostic criteria for specific disorders.
OSFED is relatively unknown compared to anorexia, bulimia, and binge eating disorder in terms of incidence, prevalence, prognosis etc. However, it is dangerous, requires treatment, and can is just as dangerous and intrusive as the other eating disorders.
From a clinical perspective, OSFED is the most common presentation of eating disorder. The specific diagnoses of anorexia/bulimia or binge eating disorder may fit when a patient initiates treatment but during the recovery process they will gain weight and/or have a reduction in symptoms, which will push them out of the diagnostic criteria for the eating disorder they were initially labelled with.
It is also common for patients to move back and forth between different symptoms throughout their eating disorder – for example: someone diagnosed with bulimia can have extended periods of time where they may be free of binge/purge symptoms but may be restricting quite heavily or someone diagnosed with anorexia can be refed up to their normal weight and struggle with alternating periods of bingeing and restricting. In both of these cases, the eating disorder is just as problematic but has shifted forms.
Causes of OSFED
Food is always linked to eating disorders, but it does not trigger the conditions. Eating disorders arise from psychological, biological, and sociocultural factors. The food symptoms are an expression of the internal difficulty the patient is experiencing but they do spiral out of control and need to be managed directly.
Biological factors that can either increase or lower your risk of developing OSFED include:
- Family members with eating disorders
- Neurobiology that regulates internal hunger and satiation signals
Psychological triggers of OSFED arise from life experiences such as:
- Difficulties with transitions and change
- Feelings of loneliness, inadequacy, or loss of control
- Low self-esteem
- Stress, anxiety, and depression
- Borderline personality disorder
- Problems with developmental milestones
Sociocultural causes are the societal norms that advance the development of OSFED. They include:
- Pervasive messaging about an ideal body
- Normalizing a diet culture that eliminates some types of food
- The widespread misconception of weight loss as “healthy” living
- Cultural rhetoric that portrays obesity as a sign of laziness or lack of willpower
OSFED Evaluation and Diagnosis
DSM-5 indicates OSFED if your eating or feeding behaviours cause you significant impairment or distress, but they do not fully meet the criteria for any specific disorder. A diagnosis might address the exact reason why your symptoms do not meet the criteria for another disorder.
OSFED typically presents itself in five ways:
Atypical Anorexia Nervosa:
Your symptoms meet the criteria for anorexia, such as fear of weight gain, restricting food, and significant weight loss. However, your weight remains higher than or within the normal range.
Atypical Bulimia Nervosa:
Your symptoms meet the set criteria for bulimia by binge eating and engaging in inappropriate compensatory behavior. But, the frequency is less than once a week for a duration that is shorter than three months.
Atypical Binge Eating Disorder:
You exhibit symptoms that meet the criteria for binge eating, such as eating when you are not hungry, lack of control, and feeling guilty. However, the frequency is lower (less than once a week), or the duration is shorter (below three months).
This occurs when you influence your shape or weight through frequent and recurrent purging episodes, but without binge eating.
Night Eating Syndrome:
The key feature of this condition is frequently eating after awakening from sleep (night eating). It can also manifest through consuming excessive food after your evening meal or consuming the most significant percentage of your daily calorie intake towards your bed time.
Symptoms of OSFED
The key indicators of OSFED are abnormal eating habits, an extreme consciousness of your weight and shape, and a distorted body image. Your behaviors and attitudes will demonstrate your utmost concern with dieting, weight loss, and control over food. You will exhibit physical, emotional, and behavioural symptoms. It is critical to check for attitudes about weight, food, and dieting that interfere with your productive life.
Emotional and behavioural symptoms include:
- A preoccupation with food, dieting, weight, calories, and fat grams
- Avoiding some food types or eliminating entire food groups
- Dressing in layers of clothes to hide your weight loss
- Frequently checking the mirror for perceived flaws and commenting about how fat or overweight you feel despite losing weight
- Denying feelings of hunger
- Proof of binge eating such as large food amounts disappearing in a short time
- Evidence of purging, such as frequent bathroom trips after eating or excessive use of mints or mouthwash.
- Discomfort or fear of eating with others
- Developing unusual food rituals such as excessive chewing or you do not allow food groups to touch
- Frequent dieting, skipping meals or taking small food portions at regular meals
- Withdrawing from friends and enjoyable activities to create time for binge-purge sessions
- Extreme mood swings
- Maintaining a rigid exercise program
- Drinking water excessively
Physical symptoms include:
- Cold intolerance, abdominal pain, constipation, and lethargy or excess energy
- Noticeable weight fluctuations within the normal range, though sometimes you may be overweight
- Looking bloated due to fluid retention
- Stomach cramps and gastrointestinal problems such as acid reflux and constipation
- Irregular or absent menstruation
- Abnormal lab results such as slow heart rate, low potassium, decreased levels of thyroid hormone, or anemia
- Lower concentration
- Physical evidence of purging such as calluses on the knuckles, the smell of vomit, swelling around the salivary glands, and tooth decay.
- Muscle weakness, dizziness or fainting
- Difficulties sleeping
- Impaired immunity due to deficiency of nutrients
- Dry, brittle head hair and nails
- Dry skin with feathery body hair
Health Effects of OSFED
OSFED is a severe eating disorder that you cannot underestimate. Its effect on your health depends on your disordered eating behaviors. It poses life-threatening mental and physical problems.
Health risks associated with OSFED include:
- Heart disease
- Post-traumatic Stress Disorder
- Severe anxiety
- Substance abuse
OSFED requires similar attention to other eating disorders. Since everybody experiences the disorder differently, we will personalize your treatment plan. We acknowledge your unique challenges and specific recovery needs. The level of care that you receive will depend on the severity of your symptoms.
Your treatment plan will involve an interdisciplinary approach that includes psychotherapy, behavioral therapy, nutritional counseling, and if necessary, medication. During your treatment, our main areas of focus are:
- Psychiatric and medical stability
- Interrupting symptomatic/disordered behavior
- Therapy and support
- Developing your recovery skills
You can Overcome OSFED
You do not have to struggle with OSFED on your own. Many people who have had the disorder have recovered and resumed normal, healthy lives. We will support you in every step of your recovery process. We will design a treatment plan that works for you and help you deal with your emotions. We will work with you to create a daily schedule that encourages positive thoughts, attitudes, and behaviors. Talk to us either by phone or face-to-face consultation and start your recovery process.