Other specified feeding or eating disorders (OSFED), formerly known as ‘eating disorders not otherwise specified (EDNOS)’, is a complex and serious condition. It includes a range of eating disorders that can look similar to other eating disorders, like anorexia nervosa or bulimia nervosa. However, in OSFED, people don't meet all of the diagnostic criteria for these conditions.
While the term 'OSFED' might not be as widely recognised as some other eating disorders, its prevalence in the UK shouldn’t be underestimated. Eating disorder statistics show that OSFED accounts for the majority of all eating disorder cases, and can affect people of all ages, genders and backgrounds. This emphasises the need for understanding, support and effective treatment for OSFED.
Here, we explore different elements of OSFED, including the different types of OSFED, symptoms of OSFED, and the support available through private treatment in the UK.
Types of OSFED
There are a number of different types of OSFED, each with its own unique characteristics and challenges. These include:
- Atypical anorexia nervosa – atypical anorexia nervosa is characterised by significant weight loss and restrictive eating behaviours, similar to typical anorexia. However, people with atypical anorexia might not meet the weight criteria needed to get a diagnosis of anorexia. For example, someone might have lost a substantial amount of weight because of extreme dieting, but are still within what’s considered to be a ‘healthy’ weight range
- Low frequency bulimia and binge eating – this refers to people who frequently binge and purge, but not often enough to get a formal diagnosis of bulimia nervosa or binge eating disorder (BED). Because bingeing and purging episodes happen less frequently and aren’t as obvious, this type of OSFED can be difficult to spot
- Purging disorder – purging disorder is characterised by repeated purging behaviours, such as making yourself sick or abusing laxatives, without binge eating episodes. People with purging disorder might engage in these behaviours to control their weight or shape
- Night eating syndrome – this is when someone eats a significant portion of their daily food intake during the night. People with this disorder often don’t have an appetite in the morning and eat more in the evening and at night
- Pica – pica is a type of OSFED characterised by people consuming non-food substances that have no nutritional value. These could include things like dirt, chalk or paper. This disorder can cause a number of health risks as the person might ingest potentially harmful materials
- Rumination disorder – this involves someone repeatedly regurgitating their food (bringing it back up on purpose), before re-chewing and re-swallowing it, or spitting it out. It’s important to understand that the behaviours associated with rumination disorder aren’t down to another medical condition
- Avoidant restrictive food intake disorder (ARFID) – ARFID is characterised by someone having a highly selective and limited diet. However, unlike anorexia, people with ARFID don’t restrict their diet because of concerns about their body weight and shape. Instead, the restriction often stems from sensory sensitivities, aversions to certain textures or smells, or a general lack of interest in eating. People with ARFID often exclude entire food groups from their diet and can experience nutritional deficiencies and other health issues
These different types of OSFED highlight the diversity of eating disorder presentations. That’s why it’s important to use tailored treatment approaches to address people’s individual needs.
Symptoms of OSFED
OSFED is a complex condition, causing psychological, physical and behavioural symptoms. These can look different for different people, and also depend on the type of OSFED you’re struggling with.
Common symptoms to be aware of include:
- Fluctuating eating patterns – people with OSFED might have inconsistent eating habits, including periods where they restrict food, binge eat, or frequently change their diet
- Concerns about body image – similar to other eating disorders, people with OSFED might have distressing thoughts and concerns about their body image, weight or shape. However, their symptoms don’t fully match the criteria they need to get a diagnosis of eating disorders such as anorexia or bulimia
- Picky or selective eating – some people with OSFED, particularly those with ARFID, may have extremely selective diets, avoiding specific foods or food groups
- Compulsive behaviours – compulsive behaviours, such as counting calories, obsessively weighing food, or having rituals in relation to eating, can be present in OSFED. Rituals may involve things like arranging food on the plate in a particular pattern, taking a certain number of small bites, and chewing each bite an exact number of times
- Physical symptoms – OSFED can lead to people having a range of physical symptoms, including fatigue, dizziness, hair loss, digestive problems and more. These symptoms depend on the type of OSFED you’re struggling with and the behaviours involved
- Mood disturbances – emotional challenges like anxiety, depression or irritability are common in OSFED. These feelings often relate to your eating behaviours and body image concerns, which can cause significant distress
- Social isolation – some people with OSFED might withdraw from social activities or situations involving food, which can lead to isolation. They might do this because they feel self-conscious eating in front of other people, or don’t want other people to notice their eating habits
It’s important to be able to recognise these symptoms so you can get the support and treatment you need for OSFED.
OSFED treatment options
It’s important to understand that OSFED isn’t something you can diagnose yourself; it needs professional assessment and support. The National Institute for Health and Care Excellence (NICE) provide guidelines and evidence-based recommendations for diagnosing and managing eating disorders such as OSFED. Among the specialist eating disorder treatment methods, recommended by NICE guidelines, are:
- Enhanced cognitive behavioural therapy (CBT-E) – CBT-E is a specialised type of cognitive behavioural therapy (CBT), designed to target the thoughts and behaviours associated with eating disorders. CBT-E is an effective tool for treating OSFED, helping people to regain a healthy relationship with food
- Dialectical behaviour therapy (DBT) – DBT is known for its success in addressing emotional regulation and distress tolerance. It can be an important approach for people with OSFED, especially if emotional factors play a role in their eating behaviours
- Family based treatment (FBT) – FBT is an effective treatment approach for adolescents and young people with OSFED. It involves the family in the treatment process, using support and education to facilitate recovery
As well as the above, other techniques such as interpersonal therapy (IPT) and acceptance and commitment therapy (ACT), have been shown to be promising techniques for treating OSFED. These approaches can be tailored to address each person’s unique needs.
Choosing the most suitable treatment option should be based on the type and symptoms of someone’s OSFED, ensuring they receive the most effective and supportive care for them.
Get help for OSFED
If you or someone you know is struggling with OSFED, it's important to understand that you’re not alone; help is available. Getting the support you need as soon as possible increases the chances of you making a strong recovery.
A good starting point is to make an appointment to see your GP. They’ll be able to provide an initial assessment and refer you to appropriate specialists and services, if needed.
In the UK, there are also private providers of eating disorder treatment, such as Priory. We can provide evidence-based treatment for all types of eating disorders, including OSFED and its subtypes. Depending on the severity of your eating disorder and your individual needs, our approach to eating disorder treatment includes:
- Inpatient care for people who need round-the-clock support and monitoring
- Outpatient treatment for people who can continue living at home while receiving therapy
- Day care programmes that offer intensive treatment during the day while allowing you to return home in the evenings
- A multidisciplinary approach, including input from psychiatrists, psychologists, therapists, nurses and dietitians
- Treatment for adults and young people (as part of our private CAMHS)
- Therapeutic tools, techniques and interventions that can be altered according to each person’s specific symptoms, to account for individual differences and variances
Remember, reaching out for help is a significant step towards recovery. There are a whole range of resources and treatment options available to support you to get well again. Contact us today to find out how we can help.