According to the DSM-V (Diagnostic and Statistical Manual of Mental Disorders), there is a classification of disordered eating that falls outside of the criteria for Anorexia Nervosa, Binge Eating Disorder and Bulimia Nervosa. This category is referred to as “OSFED” or “Other Specified Feeding or Eating Disorder.” In past editions of the DSM, the category was called “EDNOS” or “Eating Disorder Not Otherwise Specified,” sometimes referred to as “sub-clinical” or “sub-threshold” disorders. The updated criteria were devised to help clinicians more accurately diagnose eating disorders.
Persons struggling with OSFED/EDNOS can exhibit a range of behaviors like weight preoccupation, frequent concern about body size, bingeing, purging, obsessive dieting, compulsive exercising and more.
OSFED doesn’t mean it’s not serious…
Just because a person doesn’t fit the criteria for anorexia or bulimia does not mean they don’t have an eating disorder requiring attention. And don’t be fooled by appearances; most disordered eaters are normal weight or overweight, not skinny. But they still seriously struggle. In fact, many who struggle in the OSFED category are at risk for the same dangers as those who meet criteria for other disorders, including the risk of dehydration, electrolyte imbalance, heart attacks and even death.
DSM-V Technical Criteria for OSFED
With OSFED, symptoms are present that are characteristic of a feeding and eating disorder that cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. The symptoms, however, do not meet the full criteria for other eating disorders.
With a diagnosis of OSFED, the clinician will also indicate why the presentation does not meet the criteria for any specific feeding and eating disorder, using descriptions such as “bulimia nervosa of low frequency.”
Some examples of OSFED:
- Atypical Anorexia — All of the criteria for Anorexia Nervosa are met except that despite significant weight loss, the individual’s weight is within or above the normal range.
- Bulimia Nervosa (of low frequency and/or limited duration) — All of the criteria for Bulimia Nervosa are met, except that the binge eating and inappropriate compensatory behaviors occur, on average, less than once a week and/or for less than 3 months.
- Binge-eating Disorder (of low frequency and/or limited duration) — All of the criteria for Binge Eating Disorder are met, except the binge eating occurs, on average, less than once a week and/or for less than 3 months.
- Purging Disorder — Recurrent purging behavior 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. There is awareness and recall of the eating. 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. (See the article “Night Eating Syndrome” for more information.)
Source: Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, American Psychiatric Association
Signs and Symptoms
Since OSFED encompasses different types of disordered eating, there are a variety of signs and symptoms depending on the issue. For example, a person with “atypical anorexia” may obsessively diet, step on the scale multiple times a day and exercise compulsively, but they are not underweight. Someone with “bulimia nervosa of low frequency” may binge and purge a few times a month in response to stress, but it is not a daily or even weekly occurrence. An individual diagnosed with “Binge-eating Disorder of limited duration” may wrestle with binge eating during the dark days of winter, but stop the practice in the spring. There are countless different scenarios, but all forms of OSFED are damaging to a person’s physical, mental, emotional and spiritual health.
For more details, click on the link(s) above to explore the signs and symptoms that specifically relate to the type of disordered eating you or the person you care about may be struggling with. No matter the type or degree of disordered eating, there are serious risks and consequences for OSFED.
Even if you don’t have a medically diagnosable eating disorder such as OSFED, you may still have a serious problem. See the article “Do I Have an Eating Disorder?” for more information.
The Eating Continuum
When thinking about disordered eating, it is helpful to think of eating as being on a continuum, as pictured here:
Schematic 1.0 “The Eating Continuum”
as featured in Life Inside the Thin Cage, by Constance Rhodes.
Published by Shaw Books. Page 19. Used by permission.
Because eating issues appear as on a continuum, ranging from healthy to life threatening, it is common for some individuals to swing from one end of the continuum to the other. For example, a person who frequently diets might suddenly discover quicker weight loss through the use of purging. The more they engage in this behavior, the farther down the continuum they get from healthy eating. On the other hand, a person who once struggled with anorexia may now be at a healthier weight with regular menstrual cycles (females). But if they remain afraid of eating certain foods, that could place them into the OSFED/EDNOS category, still making their way back to healthy eating.
Thus, it is important to be aware of the ways in which an individual feels about food, so that the seriousness of their issues are clear, in order for that individual to begin making intentional steps toward the healthy end of the continuum. This process is a difficult but worthwhile one, requiring the individual’s desire to change, the therapeutic involvement of others (doctors, nutritionists, counselors, friends) and, most importantly, God.
What To Do?
We’re glad you asked! If you or someone you care about struggles with OSFED or any eating issue, we suggest you spend some more time checking out the videos featured on our site. There are many that address EDNOS/OSFED specifically, as well as several offering insight into how to break free from this and other patterns of disordered eating.
Additional next steps for recovery might include:
- Find someone to talk to who can offer objective and balanced advice, addressing the physical, emotional, intellectual and spiritual aspects of your issues. For tips on who to talk to, read the “Finding Treatment” article on this site. “Finding A Nutritionist” may also be helpful to you.
- Seek community and support.
- Consider taking one of our Lasting Freedom self-study courses, especially Module 1 (not a replacement for one-on-one care with a professional).
- Explore the “Eat Well, Live Well” section of this site, which offers tips and nutrition information to help you find your way back to a healthy balance with regard to eating and weight control.
- Buy or borrow a copy of the book Life Inside the Thin Cage, which specifically addresses OSFED (formerly called EDNOS).
- Search our Books section for more books that apply directly to your unique struggle.
- Give yourself permission to take your time. It took a while to get to where you are — you need to allow yourself to slowly find your way back to balance. The goal is to stop jumping from one extreme to the next, so that you can find the peace of balance. You deserve that!