What You Need to Know About OSFED

Other Specified Feeding and Eating Disorders (OSFED) is one of most common diagnoses in eating disorder treatment, and yet, many people have never heard of it. This term is the “catch-all” for eating disorders that don’t fit the specific criteria for anorexia nervosa, bulimia nervosa, or binge eating disorder. As nutritionist Elaina Efird, RDN, CD, CEDRD, CSSD explains in a recent YouTube video, just because a patient’s symptoms don’t neatly fall under an easy diagnosis “doesn’t mean that these people aren’t dealing with eating disorders. It just means that their eating disorder is manifesting in a different way.”

In today’s blog post, we’re going to discuss a brief overview of OSFED as well a case study showing how this diagnosis can impact a patient’s health. 

Behavior That Falls Under An OSFED Diagnosis

Oftentimes, the eating disorder convinces patients that they’re “not sick enough” — as in they’re not underweight enough to have anorexia or they don’t purge enough to have bulimia. Regardless of body size or frequency of behaviors, these mindsets are unhealthy and require treatment. 

So what conditions fall under the OSFED diagnosis? Using the Diagnostic and Statistical Manual, Fifth Edition (DSM-5), the following psychiatric diagnoses are categorized as OSFED:

• Orthorexia, or an obsession with nutrition and healthy eating

• Atypical anorexia nervosa, which occurs when someone severely restricts their food intake but doesn’t have a low weight or abnormal lab work

• Low frequency binge eating, which occurs when a patient struggles with binge eating but not often enough to diagnose it as binge eating disorder

• Compensatory behavior, such as vomiting, excessive exercise, diet pills, or laxatives 

• Purging disorder, which occurs when a patient purges without first binging or as a coping mechanism for anxiety or another mental health disorder

• Night eating syndrome, which occurs when someone repeatedly wakes up and eats in the middle of the night

Note that while this disordered behavior may seem harmless, it is not. 

OSFED Patient Case Study

Next, let’s look at a case study of a patient diagnosed with OSFED, which allows us to better understand how this disorder impacts both metabolism and body composition. This woman is 5 feet, 5 inches and weighed 140 pounds. She was restricting her intake to 1,000 calories per day and exercising for 1.5 to 2 hours each day. If she went over her calorie limit, she would purge, but this behavior was very inconsistent (i.e. once a week, once a month, or even once every few months). 

Through metabolic testing and body composition analysis, we discovered that her metabolic rate was only 960 calories per day — much lower than the expected rate of 1,475 calories. Additionally, her protein substrate was 12 percent above normal. As these results show, just because her size and behaviors don’t fit the criteria for anorexia or bulimia doesn’t mean she doesn’t have an eating disorder. 

To talk to a professional about eating disorder diagnosis, treatment, and recovery, please reach out to our staff or schedule an appointment at The Kahm Clinic.