NEDA Hotline

OSFED or Other Specified Feeding or Eating Disorder was first established in the 2013 release of the DSM-5. The DSM-5 stands for the 5th Edition of the Diagnostic and Statistical Manual of Mental Disorders, a manual that is released by the American Psychological Association.

But, OSFED isn’t actually new. People who met the criteria for OSFED before – i.e. people who met most but not quite all of the criteria for Anorexia Nervosa or Bulimia Nervosa – used to be given a different diagnosis, EDNOS (Eating Disorder Not Otherwise Specified).

The problem with this, though, is that EDNOS soon became a diagnostic “dumping ground,” as Laura Rois, a director at Walden’s Worcester Clinic puts it. EDNOS served as a catch-all for doctors whose patients didn’t meet the exact criteria for any one eating disorder.

Pretty soon, EDNOS got a reputation of being “less severe” than other eating disorders – which led many patients to believe that they didn’t have a “real eating disorder.” Let’s be very clear right now – EDNOS was not any less severe than another eating disorder diagnosis. An eating disorder is an eating disorder. All eating disorders can be fatal.

However, because of the imposter syndrome generated by EDNOS, the American Psychological Association decided to get rid of EDNOS and replace it with OSFED, an eating disorder diagnosis with much more distinct criteria.

Like any eating disorder diagnosis, OSFED can be fatal – and associated risks include but are not limited to electrolyte imbalance (re-feeding syndrome, a potentially life threatening shift in electrolytes), osteoporosis, cardiac abnormalities, dental erosion, poor circulation, lanugo, hair loss, etc. Increased anxiety around meals and obsessive compulsive exercise are also common symptoms.

It is also of importance to recognize that the associated risks listed above are not required to be diagnosed with OSFED. OSFED is a very broad category, and contains multiple sub-diagnoses. Therefore, someone who is experiencing OSFED may not necessarily experience all of/any of the associated risks.

Now, here’s an important thing to understand about OSFED: it’s not a catch-all. There are 5 primary presentations that are linked with an OSFED diagnosis.

1. Atypical Anorexia – when all the behaviors (restrictive eating, intense fear of weight gain) of Anorexia Nervosa are present but the weight criteria (less than 85% of what’s expected) is not met
2. Atypical Bulimia Nervosa – when all the behaviors (binge eating, inappropriate compensatory behavior) for Bulimia Nervosa are present but the frequency and duration (at least once a week for 3 months) is not met
3. Purging Disorder – frequent and recurring episodes of purging without binge eating
4. Atypical Binge Eating Disorder – occurs when all the behaviors (lack of control, eating while feeling full, eating when not hungry, feelings of guilt) for Binge-Eating Disorder are present but the frequency/duration for BED are not met (at least once a week for 3 months)
5. Night Eating Syndrome – when someone consumes most of their daily food/caloric intake at night

Today, this is much more specific criteria for OSFED and its subcategories. This enhanced criteria provides a much more distinct treatment plan for people experiencing OSFED, and assists treatment teams supporting lasting recovery.