Other specified feeding or eating disorders

Other Specified Feeding or Eating Disorder (OSFED) was formerly recognised as Eating Disorder Not Otherwise Specified (EDNOS) in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).

According to the DSM-5, a person with OSFED may present with many of the symptoms of other eating disorders such as anorexia nervosa, bulimia nervosa or binge eating disorder but will not meet the full criteria for diagnosis of these disorders. Around 30% of people who seek treatment for an eating disorder have OSFED. People with OSFED commonly present with extremely disturbed eating habits, and/or a distorted body image and/or overvaluation of shape and weight and/or an intense fear of gaining weight (if underweight). OSFED is the most common eating disorder diagnosed for adults as well as adolescents, and affects both males and females. 

What are the warning signs of OSFED

Someone with OSFED may display a combination of the following symptoms. Seeking help at the first warning sign is much more effective than waiting until the illness is in full swing. If you or someone you know is exhibiting some or a combination of these signs it is vital to seek help and support as soon as possible.

Someone with OSFED may display any combination of the following warning signs.

Physical Signs

  • Weight loss, weight gain or weight fluctuations

  • Loss of or disturbance of menstrual periods in girls and women and decreased libido in men

  • Compromised immune system (e.g. getting sick more often)

  • Signs of damage due to vomiting including swelling around the cheeks or jaw, calluses on knuckles, damage to teeth and bad breath

  • Fainting and dizziness as a result of dehydration

Psychological Signs

  • Preoccupation with food and eating

  • Preoccupation with body shape and weight (in men this can be a preoccupation with increasing muscle bulk)

  • Extreme body dissatisfaction

  • Having a distorted body image (e.g. seeing themselves as overweight even if they are in a healthy weight range for their age and height)

  • Sensitivity to comments relating to food, weight, body shape or exercise

  • Heightened anxiety and/or irritability around meal times

  • Depression, anxiety or irritability

  • Low self-esteem and feelings of shame, self-loathing or guilt

  • 'Black and white’ thinking - rigid thoughts about food being ‘good’ or ‘bad’

Behavioural signs

  • Dieting behaviour (e.g. fasting, counting calories/kilojoules, avoiding food groups such as fats and carbohydrates);

  • Evidence of binge eating (e.g. disappearance or hoarding of food)

  • Frequent trips to the bathroom during or shortly after meals which could be evidence of vomiting or laxative use

  • Compulsive or excessive exercising (e.g. exercising in bad weather, continuing to exercise when sick or injured, and experiencing distress if exercise is not possible)

  • Eating at unusual times and/or after going to sleep at night

  • Changes in food preferences (e.g. claiming to dislike foods previously enjoyed, sudden preoccupation with ‘healthy eating’, or replacing meals with fluids)

  • Obsessive rituals around food preparation and eating (e.g. eating very slowly, cutting food into very small pieces, insisting that meals are served at exactly the same time every day)

  • Anti-social behaviour, particularly around meal times, and withdrawal from social situations involving food

  • Secretive behaviour around food (e.g. saying they have eaten when they haven’t, hiding uneaten food in their rooms)

  • Increased interest in food preparation (e.g. planning, buying, preparing and cooking meals for others but not actually consuming; interest in cookbooks, recipes and nutrition)

  • Increased interest and focus on body shape and weight (e.g. interest in weight loss websites, books, magazines or images of thin people)

  • Repetitive or obsessive behaviours relating to body shape and weight (e.g. weighing themselves repeatedly, looking in the mirror obsessively and pinching waist or wrists)

  • Increased isolation, spending more and more time alone and avoiding previously enjoyed activities

What are the risks associated with OSFED?

The risks associated with OSFED are severe. People with OSFED will experience risks similar to those of the eating disorder their behaviours most closely resemble:

  • Inflammation and rupture of the oesophagus and stomach from frequent vomiting

  • Chronic constipation or diarrhoea

  • Kidney failure

  • Osteoporosis - a condition that leads to bones becoming fragile and easily fractured

  • Irregular or slow heart beat which can lead to an increased risk of heart failure

  • Loss of or disturbance of menstrual periods in girls and women

  • Increased risk of infertility in men and women

While the goal of diagnosis is to accurately describe symptoms and seek the right help for them, a large number of people have other significant eating and feeding issues and distorted body image which are not covered by these categories.

Treatment

As a result of the atypical nature of OSFED, it is most effective to follow the treatments recommended for the eating disorder that most closely resembles the individual person’s eating problem. For example, if a person presents with many but not all of the symptoms of bulimia nervosa, it is recommended for that person to seek the same treatment approaches recommended for people with bulimia nervosa.

Find out more about specific treatment approaches.

Atypical presentations

Orthorexia:

While not formally recognized in the Diagnostic and Statistical Manual, awareness of Orthorexia is increasing.

Orthorexia, while having some similarities with anorexia nervosa, is an obsession with "pure" or "healthy" food, although what this means will differ from one person to another. 

The eating behaviour involved - "clean" or "healthy" may mean cutting out food seen as unhealthy or unsafe and feeling highly anxious and/or guilty when healthy food is not available. 

Getting help

If you suspect that you or someone you know has OSFED, it is important to seek help immediately. The earlier you seek help the closer you are to recovery. Contact your GP for a referral to a practitioner with specialised knowledge in eating disorders.

Find help in your local area.

 

 

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