OSFED: the signs, symptoms and treatment

Other specified feeding or eating disorder (OSFED) is a category of eating disorder designed to provide a diagnosis for people whose eating disorder symptoms do not fully align with other eating disorder categories like anorexia, bulimia, or binge eating disorder.

In the past, OSFED was called ‘eating disorder not otherwise specified’ (EDNOS). People may receive an OSFED diagnosis if they don’t meet the full criteria to be diagnosed with another disorder like anorexia, bulimia, or binge eating disorder, or if they are experiencing a combination of symptoms from across the spectrum of eating disorder categories.

This actually happens a lot where someone’s symptoms don’t exactly fit into any one eating disorder diagnosis category, making OSFED the most commonly diagnosed eating disorder. Like all eating disorders, OSFED causes significant and distressing symptoms that impact a person’s life and functioning.

Why do people develop OSFED?

OSFED is a broad diagnosis that is divided into a number of sub-types, each with its own set of symptoms. This means that two people can both be diagnosed with OSFED, but not share any symptoms or experiences in common.

This also means that it’s not always clear why someone develops OSFED, and the specific causes are different for different people. Worries about body image can often play a role, but while OSFED can seem like it’s all about food and body size on the surface, the root causes are usually linked to how the person feels about themselves and what they’re going through in their lives.

Mental health difficulties like anxiety and low self-esteem, a family history of eating disorders, addiction, or traumatic experiences like sexual abuse are all associated with developing OSFED. To better understand how OSFED affects a person, it can be helpful to think of it as a coping mechanism.

Like any eating disorder, OSFED causes a person to control food and their body to manage distress and feel in control when something else in their life is making them feel out of control or unsafe. Understanding this makes it easier to understand how scary it can be to stop engaging in eating disorder behaviours.

OSFED subtypes

OSFED is a broad term that covers a number of different disorder subtypes. Each OSFED subtype comes with a list of symptoms that are similar to, but not exactly the same as, those for other eating disorders.Some examples of OSFED subtypes are:

• Atypical anorexia nervosa: People who experience anorexia have an intense fear of gaining weight, which causes them to significantly restrict their food intake and engage in other behaviours to prevent weight gain, which causes them to become underweight. In this OSFED subtype, a person will experience many symptoms of anorexia, but will not be underweight. 
• Bulimia nervosa of low frequency or limited duration: People who experience bulimia experience episodes of binge eating where they eat a lot of food in one short period where they feel they can’t control what they’re eating. These binge episodes are followed by periods of feeling guilty and trying to compensate for the binge by getting it out of the body as quickly as possible or finding other ways to ‘make up for it’.  A person will be diagnosed with bulimia if they have been experiencing these cycles at least once a week for a period of 3 months or longer. In this OSFED subtype, a person is experiencing all the symptoms of bulimia, but aren’t engaging in binge eating or purging behaviours that often or haven’t been engaging in them for that long.
• Binge eating disorder of low frequency/limited duration – People who experience binge eating disorder experience episodes of binge eating where they eat a lot of food in one short period where they feel they can’t control what they’re eating. A person will be diagnosed with binge eating disorder if they have been experiencing binge eating episodes at least once a week for a period of 3 months or longer. In this OSFED subtype, a person experiences all the symptoms of binge eating disorder, but doesn’t engage in binge eating that often or hasn’t been engaging in them for that long.
• Purging disorder: People who experience bulimia experience episodes of binge eating where they eat a lot of food in one short period where they feel they can’t control what they’re eating. These binge episodes are followed by periods of feeling guilty and trying to compensate for the binge by getting it out of the body as quickly as possible or finding other ways to ‘make up for it’. In this OSFED subtype, a person uses purging behaviours to change their weight or shape, but will not engage in binge eating.
• Night eating syndrome: In this OSFED subtype, a person engages in overeating at night time and also experiences sleeping problems. Sometimes this subtype can cause you to engage in a pattern of behaviour where you eat a lot of food at your evening meal, then have trouble falling asleep or wake up during the night, and then eat more food during the night. People who experience night eating syndrome are often distressed by their night-eating but feel like they have to do it to get to sleep.

OSFED is a broad diagnosis and these subtypes are just a few common examples of how this condition can affect people. You may be experiencing a completely different combination of symptoms to those listed above but what you’re experiencing may still be classified as a form of OSFED.

Treatment for OSFED

Thinking that you might be experiencing OSFED can be a scary thought. If you have recognised that you’re experiencing some of the symptoms listed above you might be tempted to ignore them or try to avoid the subject, but you deserve to reach out for help and support. No matter how hard it may seem, it is possible to make a recovery.

Recovery is not always linear. It can be one step forward and one step back sometimes, and what recovery means to you might be different to what it means for someone else. Everyone’s recovery journey is different and it may take time, but you can recover from OSFED.

Getting help for OSFED

If you think you may have OSFED, going to your GP as soon as you can and letting them know what’s going on is an important first step. They will be able to point you in the right direction to get the best treatment for your needs. Sometimes the idea of speaking to your GP about concerns around eating habits can be daunting. If you feel like you’re not ready to take that step just yet, you could call the Bodywhys helpline. Their helpline is open to anyone, and is delivered by a team of trained volunteers. It offers non-judgemental and confidential support and information about eating disorders.

If you are worried about a friend or family member, talk to them about it and encourage them to go see their GP. You can also offer to go with them if they don’t want to go alone. 

Trying to recover from OSFED, or any eating disorder, by yourself can be really isolating and hard.  Reaching out for support from professionals, family, and friends can make all the difference and help to get you through. 

How treatment works

As there is such a diverse range of symptoms associated with OSFED, the types of treatment you receive can depend on your situation. In general, the treatment will help you address the behaviours that are affecting your food intake and body size, but also work on the thoughts, feelings and experiences that are driving these behaviours.

Getting treatment that is evidence-based and specialised for eating disorders makes a substantial difference to a person’s recovery and quality of life. Most people will engage in a mix of talking therapy to help with the psychological side of OSFED and nutritional support to promote physical health recovery. 

Talking therapy and family therapy

Talking therapy or group therapy is usually a part of treatment for OSFED. Some people will take part in individual talking therapy, while others (especially young people) might do family-based treatment with members of their family. The aim of talking therapy is to help you understand the root causes of your eating disorder, and to work towards feeling more comfortable with food. 

A form of Cognitive Behavioural Therapy (CBT) called CBT-E is often used to support recovery from OSFED. CBT-E has been enhanced in certain areas, and particular strategies have been added to specifically address eating disorders and their core symptoms.

CBT-E looks at the ways that our thoughts affect our behaviours and feelings. Through CBT-E, you can develop strategies to help you build self-awareness and identify triggers, create helpful routines, and manage compulsive thoughts and unhelpful behaviours. 

If you’re younger, you may take part in family-based treatment (FBT), involving you and your family talking with a therapist. FBT will look at how you have been affected by your OSFED, and what your family can do to support you in getting better. 

Other sources of support for OSFED

You can reach out to Bodywhys for advice or information on OSFED. Bodywhys is the Eating Disorders Association of Ireland and provides confidential support, information, understanding and a listening ear to those affected by eating disorders. You do not need a diagnosis to talk to Bodywhys.

How friends and family can help

Setting out on a recovery journey can be daunting, but you don’t have to do it alone. Recovering from OSFED can be made easier if the people around you take the time to learn about the condition, how it impacts you, and how they can show understanding and support you. If you found the information in this article helpful, it could be a good idea to share it with some of the people in your life.   

Feeling overwhelmed and want to talk to someone?

• Get anonymous support 24/7 with our text message support service
• Connect with a trained volunteer who will listen to you, and help you to move forward feeling better
• Free-text SPUNOUT to 50808 to begin
• Find out more about our text message support service

If you are a customer of the 48 or An Post network or cannot get through using the ‘50808’ short code please text HELLO to 086 1800 280 (standard message rates may apply). Some smaller networks do not support short codes like ‘50808’.