Other Specified Feeding or Eating Disorders (OSFED)

OSFED is a feeding or eating disorder that causes significant impairment, but does not meet the criteria for another feeding or eating disorder. Historically, the behaviors described by OSFED were included in the diagnostic category Eating Disorder Not Otherwise Specified (EDNOS).

Examples of (EDNOS), now OSFED, include:

• Eating behavior resulting in substantial weight loss despite normal weight status (Atypical Anorexia Nervosa)
• Binge eating and compensatory behaviors such as purging, laxative abuse, or excessive exercising occuring less frequently than required for the diagnosis of BN (Sub-threshold Bulimia Nervosa)
• Purging without binging (Purging Disorder)
• Recurrent episodes of night eating, defined by excessive consumption of food after the evening meal or eating after awakening from sleep.

OSFED typically begins in adolescence or early adulthood and often has underlying causes such as a catastrophic trauma or attachment trauma. Warning signs are similar to those for related eating disorders. Without treatment, individuals with OSFED may develop other eating disorders described above.

Emotional and behavioral signs of OSFED

• In general, behaviors and attitudes indicate that weight loss, dieting, and control of food are becoming primary concerns
• Dramatic weight loss
• Dresses in layers to hide weight loss or stay warm
• Is preoccupied with weight, food, calories, fat grams, and dieting
• Refuses to eat certain foods, progressing to restrictions against whole categories of food (e.g., no carbohydrates, etc.)
• Makes frequent comments about feeling “fat” or overweight despite weight loss
• Complains of constipation, abdominal pain, cold intolerance, lethargy, and/or excess energy
• Denies feeling hungry
• Evidence of binge eating, including disappearance of large amounts of food in short periods of time or lots of empty wrappers and containers indicating consumption of large amounts of food
• Evidence of purging behaviors, including frequent trips to the bathroom after meals, signs and/or smells of vomiting, presence of wrappers or packages of laxatives or diuretics
• Appears uncomfortable eating around others
• Develops food rituals (e.g. eats only a particular food or food group, excessive chewing, doesn’t allow foods to touch)
• Skips meals or takes small portions of food at regular meals
• Disappears after eating, often to the bathroom
• Any new practice with food or fad diets, including cutting out entire food groups (no sugar, no carbs, no dairy, vegetarianism/veganism)
• Fear of eating in public or with others
• Steals or hoards food in strange places
• Drinks excessive amounts of water or non-caloric beverages
• Uses excessive amounts of mouthwash, mints, and gum
• Hides body with baggy clothes
• Maintains excessive, rigid exercise regimen—despite weather, fatigue, illness, or injury—due to the need to “burn off ” calories
• Shows unusual swelling of the cheeks or jaw area
• Has calluses on the back of the hands and knuckles from self-induced vomiting
• Teeth are discolored, stained
• Creates lifestyle schedules or rituals to make time for binge-and-purge sessions
• Withdraws from usual friends and activities
• Looks bloated from fluid retention
• Frequently diets
• Shows extreme concern with body weight and shape
• Frequent checking in the mirror for perceived flaws in appearance
• Has secret recurring episodes of binge eating (eating in a discrete period of time an amount of food that is much larger than most individuals would eat under similar circumstances); feels lack of control over ability to stop eating
• Purges after a binge (e.g. self-induced vomiting; abuse of laxatives, diet pills and/or diuretics; excessive exercise, fasting)
• Body weight is typically within the normal weight range; may be overweight
• Extreme mood swings

Physical signs of OSFED

• Noticeable fluctuations in weight, both up and down
• Stomach cramps, other non-specific gastrointestinal complaints (constipation, acid reflux, etc.)
• Menstrual irregularities — missing periods or only having a period while on hormonal contraceptives (this is not considered a “true” period)
• Difficulties concentrating
• Abnormal laboratory findings (anemia, low thyroid and hormone levels, low potassium, low blood cell counts, slow heart rate)
• Dizziness
• Fainting/syncope
• Feeling cold all the time
• Sleep problems
• Cuts and calluses across the top of finger joints (a result of inducing vomiting)
• Dental problems, such as enamel erosion, cavities, and tooth sensitivity
• Dry skin
• Dry and brittle nails
• Swelling around area of salivary glands
• Fine hair on body
• Thinning of hair on head, dry and brittle hair (lanugo)
• Cavities, or discoloration of teeth, from vomiting
• Muscle weakness
• Yellow skin (in context of eating large amounts of carrots)
• Cold, mottled hands and feet or swelling of feet
• Poor wound healing
• Impaired immune functioning