Other specified feeding or eating disorders (OSFED)

What is OSFED?

Previously known as EDNOS (eating disorders not otherwise specified), OSFED is currently the most prevalent eating disorder in the UK. This category includes a wide-ranging group of different eating disorders that do not fall into the specific and rigid criteria for a diagnosis of anorexia, bulimia or binge eating disorder.

It is important to note that OSFED is not a ‘lesser’ eating disorder and still carries significant risks to mental and physical health. Professional help and support should always be sought.

NOTE: Due to the number of conditions involved, and their varied symptoms, we have provided a summary of the key points to be aware of but acknowledge there are others. If you are concerned you or a loved one may have an eating disorder but aren’t sure if you meet the criteria for OSFED please ensure you seek clinical advice by talking to your GP. Remember, we are all unique and experience eating/food related problems in different ways.

OSFED includes:

  • Atypical anorexia – this presents with similar physical symptoms and problems to anorexia nervosa, but those affected can be of normal weight or overweight. As a result, the condition can be harder to spot and diagnose. Those affected will still have a fear of gaining weight, and/or have specific, often damaging, rituals and behaviours towards food and calorie consumption. Restriction will still feature as a key part of their behaviours even though it may not lead to weight loss. They may go to extreme lengths to avoid situations or events involving food and will experience many of the physical problems associated with anorexia.
    Given the perception of anorexia resulting in extreme weight loss, those affected by atypical anorexia may not seek help and support from clinical professionals and can feel an additional sense of shame or stigma. Atypical anorexia should not be underestimated and is a serious disorder that requires professional intervention and support.
  • Binge eating disorder (lower frequency and/or limited duration) – where the condition is of a lower frequency in terms of the number, regularity, and intensity of bingeing cycles. In this situation, the full criteria for binge eating disorder has not been met and so a diagnosis of OSFED may be made instead.
  • Bulimia nervosa (lower frequency and/or limited duration) – where the condition is of a lower frequency in terms of the number, regularity and intensity of bingeing cycles and inappropriate compensatory behaviour. If the person’s symptoms and behaviours do not meet the criteria for bulimia, a diagnosis of OSFED may be made instead.
  • Night eating syndrome – a disorder that results in someone overeating at night together with sleep problems. The sufferer may also wake in the night to eat, experience insomnia, and have a lack of appetite earlier in the day.
  • Purging disorder – where someone uses purging or laxatives to eliminate calories/food consumed but a pattern of binge/purge cycles is not present.
Signs and symptoms of OSFED

Signs of OSFED include:

  • Attitudes towards food, weight, dieting or control of food intake being a primary focus
  • Secretive around food and eating, for example not wanting to eat in front of others
  • May restrict or refuse to eat certain foods for fear of gaining weight
  •  Evidence of bingeing and/or purging food, including compensatory behaviours such as excessive exercising, self-induced vomiting or laxative abuse
  • Abnormal approach to eating and food intake, for example, regularly waking in the night to eat
  • Problems sleeping, irritability and extreme tiredness
  • Social withdrawal, problems with self-esteem, feelings of guilt or shame
  • Development of unusual food rituals or rules, such as excluding food groups without reason, obsessive following of fad diets, extreme restriction or consumption
    Symptoms of OSFED include:
  • Abnormal weight loss, weight gain, or fluctuating weight
  • Weight may also remain at normal levels, despite the presence of other symptoms
  • Stopping of periods, or irregularities
  • Concentration problems, dizziness, feeling faint/fainting
  • Feeling unusually cold much of the time
  • Regular constipation or other gastro-intestinal issues
  • Dental problems including cavities or enamel erosion (from frequent vomiting)
  • Dry skin and hair, brittle nails, poor wound healing, and impaired immune functioning
Treatment for OSFED

Treatment options for OSFED will match the treatment offered for the symptoms and problems experienced. That means someone with a diagnosis of OSFED/bulimia will be offered similar treatment to those with a diagnosis of bulimia nervosa. Those diagnosed with OSFED/anorexia nervosa will be offered the treatment options available to those with anorexia nervosa.

If you are concerned that you, or someone you care for, may have OSFED, we are here to help. Please book a 1:1 support call or take a look at our peer support groups. Our team of staff and volunteers have lived experience of eating disorders. They can listen to your worries and provide practical guidance to help you take positive steps towards getting help and recovery.

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