Most believe that anorexia and bulimia are the most common eating disorders, and that ED victims are typically underweight wealthy white females in their teens. In reality, only 6% of people with eating disorders are underweight. Also, EDs are equally as common, if not more common, in individuals outside of this demographic.

Another reality of eating disorders? A vast number of individuals don’t match up with the exact criteria set forth in the DSM-5 for disorders like anorexia or bulimia. People who fall outside of specific categories may be diagnosed with Other Specified Feeding and Eating Disorder, or OSFED for short.

Many people view OSFED as a miscellaneous category for people whose eating disorders don’t fit neatly into a single box. Or, who simply have minor symptoms that don’t pose as great a risk. In reality, OSFED is a serious disorder. It’s likely that it is under diagnosed or underreported due to these preconceived notions.

OSFED Definition

OSFED isn’t a single disorder. It’s a group of disorders that do not meet the criteria for the more well-known eating disorders. OSFED is not less serious or dangerous than other eating disorders. It shares characteristics with other eating disorders, but lacks some of the specific indicators of those other disorders.

OSFED Categories

Within the diagnosis of OSFED, there are different subcategories that define the behaviors a person with OSFED displays. Eating disorder sufferers that don’t match all the symptoms of the main disorders will likely be assigned within one of these subcategories. Common subcategories under OSFED include:

Atypical Anorexia Nervosa

Atypical anorexia is a diagnosis describing someone who meets the criteria for anorexia nervosa, but are not underweight. For a diagnosis of classic anorexia nervosa, weight must be at least 15% under the expected weight for their age, sex, and height. If someone restricts calories and avoids food, but doesn’t meet this weight requirement, they qualify to be diagnosed with the OSFED subcategory of atypical anorexia.

Binge Eating Disorder Of Low Frequency And/Or Limited Duration

Binge eating disorder (BED Learn More) is a common eating disorder where an individual binge-eats. They eat a larger than normal amount of food in a two-hour period. In the DSM-5, someone must binge eat at least once a week for three months to receive a diagnosis of typical BED. If someone exhibits binge-eating behaviors, but does not meet the frequency or duration criteria, the diagnosis may go to OSFED.

Bulimia Nervosa Of Low Frequency And/Or Limited Duration

Like BED, bulimia nervosa is characterized by episodes of binge-eating. But, bulimia is also characterized by episodes of purging, which is an attempt to compensate for the food they binge-eat. Types of purging include: self-induced vomiting, excessive exercise, and laxative abuse. In order to receive a diagnosis of bulimia, bingeing and purging must occur at least once a week for three months. Not meeting the frequency or duration criteria of bulimia will likely be diagnosed with OSFED.

Purging Disorder

A person can purge without exhibiting binge eating behavior. If someone purges without bingeing, they do not qualify for a diagnosis of bulimia nervosa or BED. But, they do qualify for the diagnosis of OSFED/purging disorder. (Learn More)

Night Eating Syndrome

Another type of eating disorder that doesn’t fall under other diagnoses, but does fall under OSFED, is night eating syndrome (Learn More). This describes the behavior of repeatedly and excessively eating after waking in the middle of the night, or after an evening meal. This behavior is not better explained by another disorder, such as binge eating disorder. It must also cause significant distress and impairment.

Conclusion

OSFED is not a new eating disorder. It’s a recognition and expansion of the layers of symptoms that define EDs. Sirona Therapy applauds the American Psychiatric Association (APA) for recognizing grey areas in ED diagnoses, and adding OSFED to the DSM-5. This provides a necessary tool to psychology and healthcare professionals to diagnose and assign proper treatments for all ED sufferers. Without an officially recognized diagnosis, many have been denied the therapy they need. Curing eating disorders is at the core of our mission at Sirona Therapy, and we welcome OSFED as part of our diagnostic toolkit.

What You Can Do To Help

Use this new knowledge of OSFED to expand your understanding of eating disorders. Realize there are more subtle variations of EDs than you’re typically made aware of. See if you notice these behaviors in those you care about. All eating disorders are a serious threat to a person’s well being and development. If you’re concerned a family member or friend is showing ED behaviors, don’t confront in hysterical or threatening ways. Loving compassion that focuses on them is the best chance at getting through. Find and recommend an experienced and dedicated psychotherapist. People can’t cure eating disorders on their own.

If you would like more information about our programs, or need help:

Jennifer L. Zauner, LCSWR
Clinical Director

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