The term “eating disorder” typically conjures images of starvation and emaciation or binging and purging. But eating disorders—like the people who have them—come in all shapes and sizes. And although anorexia nervosa, bulimia nervosa, and binge eating disorder are the most well-known conditions, they’re far from the only ones.
In fact, most people with eating disorders don’t fit the criteria for one of these established diagnoses, despite having several symptoms that substantially affect their health and quality of life. This group, which encompasses 32% to 53% of people with eating disorders, has OSFED. What does OSFED stand for? OSFED is an acronym meaning other specified feeding or eating disorders. Formerly called an eating disorder not otherwise specified (EDNOS), OSFED affects people of all ages, genders, ethnicities, and socioeconomic statuses.
What is OSFED Eating Disorder?
As the acronym suggests, OSFED, by definition, isn’t a single condition. It’s an umbrella term that incorporates a broad array of psychological, behavioral, and physical characteristics associated with disordered eating and body image. According to the National Eating Disorders Collaboration, people with OSFED have many symptoms of other eating disorders but don’t meet the full diagnostic criteria for a particular condition.
Importantly, just because people with OSFED don’t have one of the better-known eating disorders doesn’t mean their experience is any less serious or challenging to cope with. Like anorexia, bulimia, avoidant restrictive food intake disorder (ARFID), or binge eating disorder, OSFED eating disorders can have severe, even life-threatening consequences. Fortunately, OSFED, like similar conditions, is highly treatable with the proper support.
Once you understand the OSFED meaning, it’s crucial to be aware of the symptoms associated with it. People with OSFED exhibit several symptoms of one or more eating disorders, including, but not limited to, a dysfunctional relationship with food, an unhealthy obsession with calories and dieting, and a distorted body image. Like other eating disorders, the condition frequently co-occurs with other ailments, like depression or anxiety disorders, and can significantly impact a person’s physical and mental health, as well as their relationships, ability to function, and quality of life.
Physical Symptoms of OSFED
- Weight fluctuations
- Gastrointestinal symptoms, including cramps, stomachache, constipation, diarrhea, acid reflux, heartburn, or nausea
- Menstrual irregularities, including missed periods
- Anemia, or iron insufficiency
- Feeling cold all the time
- Difficulty sleeping, or sleeping too much
- Irregular hormone levels
- Hair loss and dry, brittle hair
- Dry skin
- Brittle, dry, or cracked nails
- Getting sick often
- Slow wound healing
- Swollen feet and ankles
- Dental issues, including discolored teeth and tooth decay
Behavioral Symptoms of OSFED
- Restricting certain foods, like sugar, carbs, or fats
- Eating in secrecy
- Social withdrawal
- Strict food rules
- Strict or compulsive rituals around food and eating
- Hoarding or hiding food
- Drinking excessive non-caloric liquids
- Skipping meals
- Eating unusually small or large portions at meals
- Denying hunger cues
- Excessive exercise
Emotional Symptoms of OSFED
- Low self-esteem and confidence
- Intense self-criticism
- Obsession with food
- Preoccupation with perfectionism
- Need for approval
Causes of OSFED
No one knows what causes most mental illnesses, including eating disorders. But we do know the reasons are complex and, most likely, multifaceted. Most experts believe a mixture of biological, psychological, and sociocultural factors can increase a person’s risk of OSFED and other eating disorders.
Some biological components that might make a person more likely to develop an eating disorder include:
- Genetics: Studies indicate certain genes might increase a person’s susceptibility to mental health conditions, including eating disorders and ailments that might increase the risk of an eating disorder, like depression and anxiety. Also, there’s evidence people with a family history of eating disorders are more likely to develop one. In part, that’s because family members model disordered behaviors. That said, research with twins indicates genes are a contributing factor, too. Genes can also increase a person’s likelihood of being overweight or obese, which, along with other factors, might increase their risk of body dissatisfaction and disordered eating.
- Brain chemistry: A person’s neurobiology can affect a person’s reward response and the way a person experiences hunger and satiety. Some experts also think brain chemistry, specifically neurotransmitter levels and neuroplasticity, could impact a person’s chances of developing a mental illness.
- Temperament: Scientists believe temperament, which includes characteristics like sensitivity, adaptability, and biological rhythms, is mostly innate and inherited. However, other elements, like your environment and childhood, could influence it, too.
Just as eating disorders can increase a person’s likelihood of developing depression or anxiety, these conditions and a myriad of other psychological challenges can make a person more vulnerable to disordered eating. These include:
- Traumatic life experiences: People who have experienced trauma, including abuse, neglect, or significant loss, are more likely to develop eating disorders and other mental illnesses, including anxiety, post-traumatic stress, and depression.
- Other mental illnesses: Having another mental illness, such as depression, anxiety, bipolar disorder, or borderline personality disorder, can increase a person’s risk of developing an eating disorder.
- Low self-esteem: A lack of self-esteem is a common symptom of all eating disorders and may be a significant contributing factor.
- Loneliness and isolation: Social bonds are essential for overall health and well-being, and without them, some people turn to food to fill that void, which could lead to disordered eating. Loneliness and isolation can also contribute to precursors of eating disorders like depression.
- Major life changes: Some people develop eating disorders when they feel extremely stressed, out of control, or as though they can’t cope with life. These feelings frequently arise around times of major transition, like moving to a new place, going to college, going through puberty, or starting a new demanding job.
Most societies and cultures have an “ideal” standard of beauty, which can make people feel pressured to fit in and feel bad if they don’t. Portrayals of these paradigms on social media, and in the media generally, can intensify that pressure and the feelings of shame or unworthiness for those who don’t conform. Examples of sociocultural elements that might contribute to OSFED and similar disorders include:
- Normalizing diet culture: While eating healthily and caring for your body are positive things, “dieting” in general is rarely helpful and often harmful, in part because it encourages an unhealthy, problematic relationship with food. Trends that profess quick, extreme weight loss and those that encourage people to eliminate various “unhealthy” foods can contribute to disordered behaviors.
- Messaging reinforcing the idea of an “ideal” body type or lifestyle: Images on social media, in the movies, and media generally that portray thin, muscular bodies as ideal buttress the notion that anything else is subpar. Worse are messages that explicitly stigmatize different body types.
Some people with OSFED have trouble getting diagnosed because not all healthcare providers are familiar with these conditions. That’s why it’s best to see a provider who is experienced in treating an unspecified eating disorder.
Generally, to diagnose an eating disorder, including OSFED, a healthcare provider will take your medical history and perform a physical checkup, noting metrics like your height and weight, blood pressure, and heart rate. They’ll also look for signs of malnutrition, like dry, brittle nails, swollen feet and ankles, and discolored teeth and skin.
They’ll need to rule out other conditions contributing to your symptoms. For instance, someone might not want to eat because a medication has decreased their appetite or made them nauseous. Or, they might have a thyroid disorder that’s caused them to lose or gain a significant amount of weight.
Once the physician has ruled out other possible causes, they’ll check to see if you fit the diagnostic criteria for a known eating disorder like anorexia or binge eating disorder. If you don’t but exhibit many symptoms that significantly impact your health and well-being, they might diagnose you with OSFED.
For instance, if a person demonstrates extremely restrictive behaviors and a preoccupation with thinness associated with anorexia but has an average or above-average body-mass index (BMI), they might be diagnosed with atypical anorexia, an OSFED. That’s because a typical anorexia diagnosis requires a low BMI (body mass index), which essentially equates to a healthy weight-to-height ratio. Purging disorder, where someone purges but doesn’t binge, is another example of OSFED since people with bulimia usually binge before purging.
Orthorexia is also in the OSFED category. People with orthorexia are obsessed with only eating foods deemed “healthy” or “clean,” and feel highly distressed when “safe” foods aren’t available. They’re often also preoccupied with other “wellness” practices, be it exercise or meditation, to the point where it takes over their life and is more harmful than helpful. People who binge or binge and purge less than once a week or who’ve been doing so for less than three months, could also be diagnosed with OSFED.
Eating disorders are complex and unique to each individual. That’s why successful eating disorder treatment should be holistic and personal, addressing a person’s physical, psychological, and emotional needs. Multiple people are usually involved in OSFED treatment to meet these needs.
First, a provider will ensure you or your loved one with OSFED are physically stable. Eating disorders can wreak havoc on the body and lead to serious, even life-threatening consequences, so this is a crucial starting point.
Then, a psychiatrist or other mental health professional can help you become more emotionally stable. Doing so might involve medications, counseling, or a combination of the two in the short term. Generally, therapy is recommended for long-term eating disorder recovery to help a person understand and address the causes and triggers of their disorder and develop coping strategies. Cognitive behavioral therapy (CBT) has been shown to be particularly effective in eating disorder treatment, but many people also benefit from forms of talk therapy.
A registered dietician will also be involved in your care. More than telling you what and how to eat, a dietitian will help you heal your relationship with food and eating. Along with your mental health provider, they can help you recognize problematic thoughts and behaviors and replace these with healthier ones. They can also determine your dietary needs and support you in achieving better health and well-being through education and meal planning assistance.
Nourish provides compassionate, comprehensive, fully individualized care to help people with OSFED and other eating disorders throughout their recovery journey, including one-on-one nutritional counseling and a vast library of self-help resources, all available through an on-demand digital platform.
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