Other specified feeding or eating disorder or OSFED, is a catch-all category developed for those who do not fit into the diagnostic criteria for anorexia nervosa, bulimia nervosa, or binge eating disorder. Individuals diagnosed with OSFED show symptoms similar to those specified eating disorders, but one or two key features are missing or different.

Research shows that one-third of all people treated for eating disorders are in the OSFED category. Therefore it is the most commonly found eating disorder. Diagnosis of OSFED does not mean that someone has a mild version of an eating disorder. Because there is clinically significant distress and mental impairment that should not be neglected.

In the 4th edition of the diagnostic and structural manual of mental disorders; (DSM-4), this condition was diagnosed as eating disorder not otherwise specified, or EDNOS. But In DSM-5 classification, the diagnosis of EDNOS formally changed to other specified feeding or eating disorder, OSFED.

OSFED symptoms are similar but not readily visible as the ones from specific eating disorders.

Therefore it often goes undetected. Because of that, other specified feeding and eating disorders may develop into life-threatening illnesses. Therefore, early access to OSFED treatment with the support of a specialist is advisable.

Like many other eating disorders, OSFED causes are associated with biological, psychological, and environmental factors. Understanding OSFED risk factors are beneficial in the early prediction and prevention.

 

The following are five subtypes of OSFED:

  1. Atypical anorexia nervosa – People with this disorder exhibit most of the prominent features of anorexia nervosa as restriction of energy intake, but does not show significant weight loss.
  1. Bulimia nervosa (of low frequency and/or limited duration)/ Atypical bulimia nervosa – Similar to bulimia nervosa but with low frequency and duration of overeating.
  1. Binge eating disorder (of low-frequency and/or limited duration)/ Atypical binge eating disorder – Corresponds with binge eating disorder, but the frequency is low. Also, an episode is relatively short.
  1. Purging disorder – People suffering from this disorder follow several behaviours to induce weight loss which is not associated with binge eating.
  1. Night eating syndrome/NES – Individuals with this syndrome consume more than half of their daily food in the late evening or throughout the night.

OSFED

OSFED Symptoms

Since OSFED symptoms are not physically apparent, they can be hard to detect and diagnose.

However, some common symptoms shared by individuals with OSFED include:

  • Depression and anxiety
  • Extreme body dissatisfaction
  • Obsession with food and eating habits
  • Low self-esteem
  • Significant fluctuations in body weight
  • Loss of libido
  • Frequent illnesses due to weak immunity
  • Antisocial behaviour
  • Shame and guilt about eating behaviour
  • Loss of control over eating behaviour

 

Symptoms of atypical anorexia nervosa

The typical anorexia nervosa definition refers to an eating disorder characterized by severe restriction of food intake to avoid gaining weight. Therefore extreme weight loss can be observed in sufferers.

On the contrary, people with atypical anorexia nervosa are not severely underweight. So, the eating disorder may not be quite obvious. It is the main difference between two anorexic disorders. Also, the individual’s BMI is found within or above the normal range. Apart from that, atypical anorexia nervosa carries similar symptoms to typical anorexia nervosa. These can include,

  • Severe restriction of food intake
  • Fear of gaining weight
  • Excessive exercises
  • Skipping meals frequently
  • Denial of Hunger
  • Calculate calorie intake frequently
  • Irritability
  • Insomnia

 

Symptoms of atypical bulimia nervosa.

Bulimia nervosa is characterized by repeated episodes of binge eating followed by compensatory behaviours such as using laxatives, self-induced vomiting, and excessive exercise. Besides, in the atypical form, it has features that closely resemble classical bulimia but does not meet the required frequency and duration of the diagnostic criteria.

Therefore the patient may not witness a significant change in weight or body shape.

Symptoms of atypical binge eating

To be diagnosed as BED, the recurrent episodes of binge eating should occur at least once a week for three months. Also, one bingeing episode should last at least 2 hours. But in atypical BED, The binges do not happen very often, and the duration is not enough to meet the diagnostic criteria. Except that, individuals with BED of OSFED category manifest all symptoms of typical BED including,

  • Consuming an abnormally large amount of food in a specific short period.
  • Eat more quickly than usual.
  • Eat alone or secret because of embarrassment.
  • Feeling shame and guilt after binge eating.
  • Eat without any physical hunger.
  • Eat until the stomach is stretched out and painful.
  • Eating behaviour is out of control of themselves.
  • Hiding food.
  • Loss of sexual desire.
  • Fluctuation of the weight
  • Impaired social and occupational functioning.
  • Poor interpersonal relationships due to distress about their eating and weight.
  • Over concerning about weight.
  • Greater body dissatisfaction.
  • Higher urges to binge in response to negative emotions.

 

Symptoms of Purging disorder

A person with purging disorder engages in various purging behaviours to influence body shape or weight but does not binge. Here are some of the warning signs of purging disorder.

  • Going to the bathroom after every meal
  • Frequently use emetics and laxatives
  • Severe dehydration
  • Exercising for extended hours of time
  • Scarring on hands due to self induce vomiting
  • Dry skin and brittle nails
  • Dental problems such as enamel erosion and cavities
  • Impaired immune functioning

 

Symptoms of night eating syndrome (NES)

Those with night eating syndrome may exhibit following signs.

  • Eat the majority of their food in the late evening or throughout the night
  • Eat little or nothing in the morning
  • Hide food out of embarrassment
  • Eat when they are not hungry
  • Eat until they are uncomfortable full
  • Avoid eating with others

 

OSFED causes

The medical community does not fully understand the OSFED causes. But, several possible factors combine to trigger symptoms.

  1. Psychological causes – Some psychological traits cause a person to develop OSFED. People with poor coping skills tend to follow unusual eating habits to distract themselves.
  1. Biological causes – Genes and certain chemicals in the brain that control hunger, appetite, and digestion can contribute to the onset of OSFED. Those who have a family member with an eating disorder are at greater risk to develop this condition. Additionally, studies show that genes associated with obsessive thinking and emotional instability are highly heritable. Hence it increases an individual’s vulnerability to developing an eating disorder like OSFED.
  1. Environmental causes – Internet users worldwide spend a great deal of time on social media platforms. In these sites, people are led to compare themselves with an unattainable, ideal body image. Therefore, society is under a lot of pressure caused by body dissatisfaction which predisposes them to OSFED.

Also, parents and caregivers should not be overly involved with the eating habits of their children. In those situations, OSFED can be developed in an attempt to escape from parental pressure.

Traumatic life experiences can be a reason for a person to develop OSFED. Untreated traumas cause impaired regulation of the nervous system. Consequently, the sufferer fails to control their emotions. Therefore OSFED can be developed as a method to deal with the tension.

 

OSFED Risk factors

Some of the psychological, biological, and environmental risk factors that are associated with OSFED are the following.

Psychological risk factors

  • Poor self-esteem
  • Depression
  • Anxiety
  • Obsessive thinking
  • Perfectionist thinking

Biological risk factors

  • Family history of eating disorders
  • The temperament of a person
  • Neurobiology of a person

Environmental risk factors

  • Teasing someone about their weight
  • A traumatic event such as car crashes, fires, and suicides
  • Sexual abuse during childhood
  • Pressure from family to look thin
  • Unrealistic body images from media

 

OSFED Complications

Other specified eating disorder or OSFED is the most common of all eating disorders. It accounts for up to 50% of all eating disorders. But their symptoms are not extreme as other eating disorders. So it can be hard to detect if someone is struggling with eating problems related to OSFED.

OSFED can cause life-threatening complications if left untreated. Also, people with this condition will experience issues of both physiological and psychological aspects.

Physiological complications

Complications with atypical anorexia nervosa.

Individuals with atypical anorexia nervosa will experience physical health complications mainly due to malnutrition. The lack of essential nutrients cause serious health issues including,

  • Cardiovascular complications
  • Low blood pressure
  • Reduced heart muscle mass
  • Electrolyte imbalances
  • Low heart rate
  • Uneven heartbeat

Depleted counts of red blood cells and white blood cells predispose an individual to more frequent infectious diseases. Also, cardiovascular complications are the most common cause of death due to atypical anorexia nervosa.

Gastrointestinal complications

  • Constipation
  • Diarrhoea
  • Liver diseases
  • Bloating
  • Superior mesenteric artery syndrome

Endocrine complications

  • Mood swings as a result of elevated cortisol level
  • Type 2 diabetes can be developed as a result of impaired insulin secretion
  • Changes in libido and infertility due to altered sex hormone levels
  • Bone mineral metabolism changes due to thyroid abnormalities
  • Growth disturbances

Dermatological complications

  • Dry skin
  • Brittle hair
  • Cold intolerance

Neurological complications

  • Seizures
  • Dizziness
  • Brain atrophy
  • Sleep disturbances In hands, feet and other extremities

 

Complications of atypical bulimia nervosa

Bulimic individuals may force themselves to vomit or abuse laxatives to purge. These activities can cause long term damages to the organs of the body. The following are some of the medical complications associated with bulimia nervosa in the OSFED category.

  • Persistent acid reflux cause oesophagal erosions, dental caries, and enamel erosions
  • Damages to vocal cords by frequent vomiting
  • Irregular heartbeat
  • Risk of cathartic colon syndrome from laxative abuse

Complications of atypical binge eating disorder

Most of the complications of binge eating disorder in the OSFED category often result from being obese.

  • Diabetes
  • High blood pressure
  • High cholesterol
  • Gallbladder diseases
  • Cancer

Gastrointestinal problems such as abdominal pain, nausea, irritable bowel syndrome, and diarrhoea are the other complications that are not necessarily associated with obesity.

 

Complications of purging disorder

Purging disorder can cause many serious medical complications including,

  • Feeling faint
  • Throat swelling
  • Facial swelling
  • Severe dehydration and electrolyte imbalances
  • Scarred hands
  • Irregular heartbeat
  • Malnutrition
  • Enamel erosion

 

Complications of night Eating syndrome

Diseases associated with obesity can be identified as complications of night eating syndrome.

Psychological complications

Other specified feeding and eating disordered individuals typically struggle with one or more of the following psychological issues.

  • Anxiety and self-doubt
  • Feelings of alienation and loneliness
  • Guilt and shame
  • Feelings of failure

Additionally, the great difficulty of living with an eating disorder without receiving proper treatments may lead an individual to suicidal actions.

 

OSFED Diagnosis and tests

As mentioned in the diagnostic and statistical manual of mental disorders 5th edition, the other specified feeding or eating disorder is used when the clinical presentation does not meet the criteria for any specific feeding and eating disorder.

Diagnosis of atypical anorexia nervosa

To be diagnosed as atypical anorexia nervosa following diagnostic criteria should be met without

marked weight loss.

  • Persistent energy intake restriction
  • Intense fear of gaining weight after eating or becoming fat

 

Diagnostic criteria for atypical bulimia nervosa

To be diagnosed as atypical bulimia nervosa, binge eating and inappropriate compensatory behaviour should occur on average less than once a week and/or for less than three months.

Also, the following requirements must be met.

  • Self-evaluation is unduly influenced by body shape and weight.
  • The eating disturbance does not occur exclusively during episodes of anorexia nervosa.

 

Diagnostic criteria for Binge eating

The bingeing should occur on average less than once a week and/or for less than three months.

But the following essential diagnostic features also should be met.

  • Eat a considerably large amount of food within a discrete period.
  • Lack of control over overeating.
  • Three or more of the following symptoms should be visible in episodes of binge eating.

-Eating faster than normal

-Eating until they are uncomfortable full

-Feeling disgusted after eating

-Eating when not hungry

-Eating alone due to embarrassment

  • There is significant stress associated with binge eating.
  • There is no compensatory behaviour to avoid weight gain as in bulimia nervosa.
  • Also, it should not occur concurrently with bulimia nervosa and anoxia Nervosa.

The diagnostic criterion for purging disorder

Repeated purging behaviour to influence weight or shape in the absence of binge eating.

Diagnostic criteria for night eating syndrome

Recurrent episodes of night eating manifested by,

  • Eating after awakening from sleep.
  • Excessive food consumption after the evening meal.
  • There is awareness and recall of the eating.
  • Significant distress and social impairment.

After considering the above diagnostic method, your clinician will run several examinations and tests to identify other related medical complications caused by OSFED.

1.Physical examinations to check,

  • Heart rate
  • Blood pressure
  • Temperature
  • Diabetes
  • Height and weight
  • Skin condition

2.Lab tests such as,

  • Complete blood count
  • Urine test
  • X-ray
  • Ultrasound
  • Electrocardiogram

After gathering basic facts, the therapist does a psychological examination also. This assessment

May include,

  • Eating habits and feelings about food
  • Feelings about shape and weight
  • Emotions
  • Exercise habits
  • Past or current substance abuse
  • Sexually active level
  • Past experiences about depression and anxiety

 

OSFED Treatment

OSFED treatment includes a combination of medications and psychological therapies.

A treatment plan for OSFED generally consists of psychiatrists, nutritionists, medical and dental specialists, and family members. Also, immediate hospitalization may be required if your life is in danger due to heart rhythm disturbances, electrolyte imbalances, or severe dehydration.

Medications for OSFED

Medications can be used to treat both physical and mental complications that are a result of OSFED.

Atypical anorexia nervosa

Atypical antipsychotics, such as Olanzapine have shown some benefits to support people with anxiety and depression.

Bulimia nervosa

Prozac is the first specifically authorized medication by the FDA(Food and drug administration) to treat patients with bulimia nervosa.

Binge eating disorder

The three main drugs used in the treatment of binge eating disorder are,

  • Prozac – an antidepressant
  • Topomax – an anticonvulsant
  • Vyvanse – an ADHD medication

Purging disorder

Antidepressants are prescribed to treat concurrent mood disorders such as anxiety and depression.

Night eating syndrome(NES)

Selective serotonin reuptake inhibitors or SSRIs, including Paxil, Luvox box and Zoloft, are prescribed to treat NES.

Apart from these psychiatric medications, medical complications are also needed to be addressed by a specialist to restore physical fitness.

Psychological therapy

Psychologically speaking, evidence-based interventions are more effective in treating OSFED. The most established treatment methods are enhanced cognitive behavioural therapy, interpersonal psychotherapy, and family-based Treatment(FBT).

Enhanced cognitive-behavioural therapy

The primary focus of the treatment is to address the way our thoughts influence by our behaviours.

Interpersonal psychotherapy

A type of psychotherapy in which the main focus is on the importance of interpersonal relationships in determining behaviour.

Family-based treatment

FBT is a psychiatric treatment method in which the whole family is actively engaged in solving their patient’s eating disorder through effective communication.

 

OSFED Coping and support

Learning healthy ways to cope and getting support from loved ones can help avoid OSFED triggers. Therapists, nutritionists, family members, and friends should offer strategies to stay motivated during the recovery process.

  • Stop feeling bad/guilty about what you eat.
  • Stop being obsess with food calories or exercise
  • Embrace distractions
  • Be confident
  • Learn how to be in the moment

 

Lifestyle and home remedies

Your lifestyle determines your choices and, these choices decide whether you make progress or not. You can begin to make the following healthy lifestyle changes to achieve your recovery goals.

  • Reduce stress
  • Try meditation and yoga
  • Keep a journal
  • Learn to manage anger by writing down your emotions
  • Try to boost your self-esteem by using your talents
  • Find some hobbies that are fun for you
  • Join new clubs and groups
  • Take your medicines as advised

 

Preparing for your appointment

It is advisable to seek help immediately if you suspect that you or someone you know has OSFED. You may find it hard to talk about your issue with your clinician. Therefore, be well prepared before seeing the therapist.

You may prepare a list of,

  • Questions you want to ask from the therapist
  • Your unusual eating habits and their frequencies
  • Family history of eating disorders
  • Your medical history
  • Any special needs you have
  • Your lifestyle activities

 

Prevention methods

  • Become more aware of your eating habits
  • Cut back on social media time
  • Find ways to handle stress
  • Get enough sleep
  • Get regular medical checkups
  • Avoid alcohol and other recreational drugs
  • Spend more time with family and friends

 

References and citations

  • Diagnostic and statistical manual of disorders; Fifth edition
  • EATING DISORDERS EXAMINING ANOREXIA, BULIMIA, AND BINGE EATING
    Marylou Ambrose And Veronica Deisler

 

  • https://centerfordiscovery.com/conditions/osfed/
  • https://www.nationaleatingdisorders.org/health-consequences
  • https://spunout.ie/voices/experiences/my-eating-disorder-hard-disgnose
  • https://www.magnolia-creek.com/eating-disorder-recovery-blog/purging-disorder-symptoms/
  • https://www.mayoclinic.org/diseases-conditions/eating-disorders/in-depth/eating-disordertreatment/art-20046234
  • https://www.ccjm.org/content/87/3/172
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