Other specified feeding or eating disorders (OSFED)

What is OSFED?

OSFED stands for ‘other specified feeding or eating disorder’. People with OSFED have symptoms that are similar to, but not exactly the same as, those for other eating disorders. OSFED was previously referred to as ‘eating disorders not otherwise specified’ (EDNOS).

OSFED is more frequently diagnosed than other eating disorders. It is a complex and serious mental health condition, not a lifestyle choice.

OSFED occurs in people of all ages and genders and is one of the most common eating disorders. If left untreated, OSFED can significantly impact a person’s physical and mental health and wellbeing.

Diagnosis of OSFED

Eating disorders cover a spectrum of conditions and people with OSFED do not fit neatly into a specific group. If you are concerned you may be experiencing an eating disorder, you should visit your GP (doctor) as soon as possible.

A GP who has experience with eating disorders is a good first point of contact. Other healthcare professionals can recognise eating disorders, but may not be able to give you a physical check-up.

There are different diagnoses that can be made within OSFED. These include:

• Atypical anorexia nervosa: All of the criteria are met for anorexia nervosa except that despite significant weight loss, the individual’s weight is within or above the normal range. A person with atypical anorexia nervosa can experience many of the same physiological complications as someone with anorexia nervosa.
• Bulimia nervosa of low frequency and/or limited duration: All of the criteria for bulimia nervosa are met, except that binge eating and compensatory behaviours 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 that the binge eating occurs, on average, less than once a week and/or for less than 3 months.
• Purging disorder: Recurrent purging behaviour to influence weight or shape (such as 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 and the eating causes significant distress to the individual.

To diagnose an eating disorder, a GP will need to do a full physical check-up, carry out blood tests and ask questions to find out what symptoms you are experiencing. Your GP will need to make sure that any changes in body weight are not caused by another undiagnosed health condition.

Symptoms of OSFED

People with OSFED may have many of the symptoms of anorexia nervosa, bulimia nervosa or binge eating disorder but do not meet the full criteria to be diagnosed with these conditions. People experiencing OSFED are likely to be engaging in disordered eating, are experiencing body dissatisfaction or overvaluation of weight and shape, and may fear gaining weight.

Physical symptoms of OSFED

Physical signs and symptoms of OSFED include:

• fluctuating body weight, or significant loss or gain of body weight
• absence of periods or change in menstrual cycle for women
• loss of sex-drive (libido)
• getting sick more often than usual – a possible sign of a distressed immune system
• signs of damage from frequent vomiting, such as swelling around the cheeks and jaw, damaged teeth and bad breath
• fainting or dizziness.

Psychological symptoms of OSFED

Psychological signs and symptoms of OSFED include:

• preoccupation with eating, dieting, exercise or body image
• sensitivity to comments about food, eating, dieting, exercise or body image
• feelings of shame, guilt and disgust, especially after eating
• increased anxiety or irritability around meal times
• distorted body image or dissatisfaction with body size, shape or particular body parts/areas
• low self-esteem, depression, anxiety, suicidality.

Behavioural symptoms of OSFED

Behavioural signs and symptoms of OSFED include:

• dieting behaviour – dieting, counting kilojoules, reporting new food allergies and avoiding food groups
• saying they have eaten when they haven’t
• becoming socially withdrawn and/or not engaging with activities once enjoyed
• eating alone or in secret, avoiding other people at meal times
• hiding or hoarding food
• self-induced vomiting
• chewing and spitting of food
• frequent trips to the bathroom during or after eating
• increased interest in food preparation – such as planning, buying and preparing food for others but not eating it themselves
• preoccupation with body shape/size and weight loss
• obsessive rituals around food – for example, cutting food into very small pieces or eating very slowly
• compulsively exercising, even when unwell or injured
• use of laxatives, enemas, diuretics or appetite suppressants
• behaviour related to body image – constantly checking in the mirror, pinching parts of the body to measure fat.

Long-term effects of OSFED

Ongoing and untreated OSFED carries the risk of a variety of problems, including:

• gastrointestinal issues (including damage to the oesophagus and stomach)
• constipation and diarrhoea
• kidney damage
• weakened bones (osteoporosis)
• slowed growth (in young people)
• infertility in men and women
• heart conditions, including irregular heart rate and low blood pressure.

Treatment of OSFED

Like other eating disorders, recognising the warning signs and seeking support early will give you the best chance of a quick and full recovery. Recovery is possible, even for people who have been living with OSFED for many years.

For OSFED, your individual treatment will depend on the type of symptoms you have. In general, treatment recommendations will be based on the eating disorder that most closely resembles your symptoms (such as anorexia nervosa, bulimia nervosa, binge eating disorder). Examples of treatment approaches include Cognitive Behaviour Therapy for eating disorders (CBT-E) and Family Based Treatment (FBT).

Current evidence suggests that:

• It is best to get treatment started as early as possible.
• Using a team of professionals with expertise in different fields is the best way to get results.

Once OSFED is diagnosed, your GP will organise a multidisciplinary team to help you on the journey to recovery. The types of healthcare professionals who might be involved include:

• psychiatrist
• psychologist
• dietitian
• family therapist
• social worker.

Treatment should focus on both your physical and psychological health. Your healthcare professionals will need to ask a series of questions to help you work out the link between the way you think and your eating behaviour.

Support groups can be helpful as an additional source of support, alongside treatment from healthcare professionals.

Other treatment options include medications and supplements to help with any physical problems and, in some cases, medication for your mental health (for example, antidepressants).

Where to get help

• In an emergency, always call triple zero (000)
• A GP (doctor) experienced in supporting people with eating disorders
• Eating Disorders Victoria Hub. Tel. 1300 550 236 – support from Monday to Friday, 9 am to 5 pm
• Community health centre
• Lifeline Tel. 13 11 14
• SuicideLine Tel. 1300 651 251
• Kids Helpline Tel.1800 55 1800
• Butterfly Foundation’s National Support Line Tel. 1800 ED HOPE (1800 33 4673) – support from 8 am to midnight (7 days)