OSFED

OSFED (other specified feeding or eating disorder) is characterised by disturbed eating behaviours, body image concerns, fears around weight gain, and over-evaluation of weight and shape. It is an eating disorder where the symptoms do not fit neatly into a single diagnostic box.

OSFED is the most common eating disorder diagnosis amongst adults and adolescents (1, 2), which makes sense given that most things in real life are complicated and don’t fit neatly into boxes. It can affect any gender, and it can appear across the lifespan. OSFED is a complicated and potentially life-threatening eating disorder which carries all the same risks as other eating disorders. When someone is diagnosed with OSFED, they will share many features of another disorder, but will not meet full diagnostic criteria, for reasons specified by their clinician. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), Fifth Edition lists the following specifiers for OSFED:

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Atypical anorexia nervosa:
 

All symptoms of anorexia nervosa are present, while BMI lies outside of the clinically underweight category.
This eating disorder Involves an intense fear of gaining weight or becoming fat, disturbance in the experience of body weight or shape, and excessive influence of body weight or shape on self-evaluation. Rapid weight loss, rigid dietary restraint, dietary restriction, driven exercise and/or rapidly declining medical stability may also be present. Menstrual cycles may have ceased, and other physical and psychological complications are likely to occur.

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Bulimia nervosa of low frequency and/or limited duration

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All symptoms of bulimia nervosa symptoms are present, with episodes of binge eating and compensatory behaviours occurring less than once per week or for a duration less than three months.

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Binge eating disorder of low frequency and/or limited duration
 

All symptoms of binge eating disorder are present, with episodes occurring less than once per week or for a duration less than three months.

 

Purging disorder

Recurrent purging behaviour to influence weight or shape (E.g., self-induced vomiting: misuse of laxatives, diuretics, or other medications) in the absence of binge eating.
 

Night eating syndrome

Recurrent episodes of night eating, as manifested by eating after awakening from sleep or by excessive food consumption after the evening meal. The night eating is not better explained by external influences such as changes in the individual’s sleep-wake cycle or by local social norms. The night eating causes significant distress and/or impairment in functioning. The disordered pattern of eating is not better explained by binge-eating disorder or another mental disorder, including substance use, and is not attributable to another medical disorder or to an effect of medication.

Unspecified Feeding or Eating Disorder (UFED)

This is a diagnosis that is given when a person presents with feeding or eating disorder symptoms that do not meet the full criteria for any diagnostic class, for reasons that have not been specified by the clinician.

This diagnosis may be given where there is insufficient information to make a more specific diagnosis, for example, in emergency settings.

Symptoms and Causes

Symptoms of OSFED and UFED can manifest behaviourally, psychologically and/or physically. While they are not always noticeable on the outside, here are some things to look out for (3, 4):
 

Behavioural:

• Repetitive dieting behaviour such as counting calories, skipping meals, fasting or avoidance of certain foods or food groups

• Evidence of binge eating such as disappearance or hoarding of food

• Evidence of vomiting or misuse of laxatives, appetite suppressants, enemas and/or diuretics

• Frequent trips to the bathroom during or shortly after meals

• Compulsive or excessive exercising

• 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 (i.e. eating very slowly, cutting food into small pieces, insisting that meals are served at exactly the same time every day).

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

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

• Increased interest in food preparation (e.g. planning, buying, preparing and cooking meals for others but not actually eating them; 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 time alone and avoiding previously enjoyed activities.
  
   

Psychological:

• Preoccupation with eating, food, body shape or 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)

• Heightened anxiety or irritability around mealtimes

• Heightened sensitivity to comments or criticism (real or perceived) about body shape or weight, eating or exercise habits

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

• Body dissatisfaction or negative body image

• Depression, anxiety, irritability, self-harm or suicidality

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

Physical:

• Sudden weight loss, weight gain or weight fluctuations

• Inability to maintain normal body weight for age and height, failure to grow as expected

• Loss or disturbance of menstruation

• Loss of sex-drive (libido)

• Fainting or dizziness due to dehydration

• Sensitivity to the cold

• Bloating, constipation, or the development of food intolerances

• Fatigue or lethargy

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

Signs of vomiting such as swollen cheeks or jawline, calluses on knuckles or damaged teeth


​There is no single known cause for OSFED, and every case emerges from a unique combination of psychological, biological and social factors. Nevertheless, a person with OSFED can obtain a thorough understanding of their own eating disorder formulation through their ongoing collaborations with a trained professional.

What are the risks?

The risks of OSFED will depend on the symptoms present and the eating disorder they most closely align with. Here are some of the potential risks [ED risk infograph].

Treatment

The risks of OSFED will depend on the symptoms present and the eating disorder they most closely align with. Here are some of the potential risks [ED risk infograph].

Most people with OSFED respond very well in a community-based treatment setting, where the treatment team typically consists of a GP, a mental health professional, and a dietitian. In cases where more intensive medical or psychiatric care is needed, in-patient treatment will be required.

At Treat Yourself Well Sydney, our treatments draw from evidence-based modalities which have been shown to be effective in the treatment of eating disorders, some of which include:
 

• Enhanced Cognitive Behaviour Therapy (CBT-E)

• Radically Open Dialectical Behaviour Therapy (RODBT)

• Acceptance and Commitment Therapy (ACT)

• Adolescent-Focused Therapy (AFT)

• Schema Therapy 

• EMDR 

• DBT

​No two people are the same, and every eating disorder is different. We recognise that our clients are individuals, and for this reason, we tailor our treatment plans to the unique needs of each individual client, and we involve our clients in all decision-making related to their treatment. We work within a wider treatment team, which typically includes a GP, dietitian, and a psychiatrist, which means that our clients are supported in every way possible. While we don’t offer family-based therapy, we do encourage family involvement where appropriate and particularly for our younger clients.

Our goal is to walk alongside you, supporting you on your pathway to recovery...
 
To read more on treatment modalities and specific eating disorders types, please see our ‘approaches’ and ‘interest areas’ sections on our website.