Until recently, Eating Disorder Not Otherwise Specified (EDNOS) was listed in the Diagnostic & Statistical Manual (DSM- IV), the old version of the DSM. This eating disorder was an umbrella term encompassing all forms of eating disorders and abnormal eating patterns which did not meet the strict criteria for Anorexia Nervosa, Bulimia Nervosa, Binge eating disorder or Avoidant-Restrictive Food Intake Disorder (ARFID). Recently, EDNOS has been modified and is known as Other Specified Feeding and Eating Disorder (OSFED) which is now included in the current version of the DSM (the DSM-V).
OSFED has often been misinterpreted as a subclinical diagnosis, where there are no symptoms or signs that the individual is presenting with a specific eating disorder, but it is as serious as Anorexia, Bulima or other recognizable binge eating disorders. Individuals suffering from OSFED are equally as deserving and in need of comprehensive clinical treatment. Despite Anorexia Nervosa being perhaps the most widely publicized and recognizable, OSFED is in fact the most common eating disorder; estimated to affect between 32-53% of all individuals affected by eating disorders. OSFED therefore needs to be taken seriously as it can result in severe medical complications as well as other psychiatric illnesses, including distorted body image (body dysmorphia) anxiety, depression and in some cases, even suicide.
What are the signs, symptoms and subtypes of OSFED?
- Bulimia Nervosa: An individual meets the criteria for bulimia but binges or purges less frequently and/or for a limited period of time.
- Binge Eating Disorder: An individual meets the criteria for binge eating disorder, but again these behaviors occur less often and for briefer periods of time. During these episodes, the person eats rapidly in a short period of time, consuming an amount of food considered significantly larger than what is deemed normal, yet feels unable to control their actions.
- Atypical Anorexia Nervosa: An individual exhibits the restrictive behaviors and other symptoms associated with Anorexia, however they do not always meet the unhealthy weight criteria range.
- Purging disorder: Purging behaviors are common and may include vomiting, exercise excessively and abusing laxatives and other medications with the aim to control one’s weight.
- Night Eating Syndrome: Recurrent episodes of consuming the majority of one’s daily food intake at night accompanied by extreme feelings of guilt and shame.
Signs and symptoms
The following are signs and symptoms associated with OSFED as well as other eating disorders recognized by the DSM-V.
- Obsessive thoughts concerning food, weight loss and body image.
- Losing and gaining weight in an unhealthy manner.
- Self-induced purging behaviors including vomiting, laxative abuse, diuretic abuse and excessive exercise.
- Hiding food, often due to shame felt by the individual.
- Overeating to the point where one is uncomfortably full.
- Overeating and hiding food to be consumed during the night.
- Using food as a stress reliever and means to mask or soothe emotions.
- Abnormal or missed menstrual periods.
- Dental cavities or enamel erosion as a result of induced vomiting.
- Feeling a sense of deep remorse and shame after eating large amounts of food.
- Metabolic abnormalities, such as electrolyte imbalances.
- The appearance of fine body hair (lanugo).
- Dry skin.
- Brittle nails.
- Loss of muscle mass.
- Feelings of emptiness where individuals use food to self-medicate.
- Wearing baggy or shapeless clothes to conceal weight loss.
Consequences of OSFED
Individuals suffering from OSFED often experience severe negative health consequences. They depend to a large extent on which behaviors the individual is engaging in. The effects on health due to OSFED are difficult to pinpoint, as they often include a number of conditions. Important signs to look out for are unhealthy attitudes in relation to food and weight which prevent the individual from living a physically and emotionally healthy and productive life.
Another concerning aspect of OSFED is that repeated vomiting depletes the body of important chemicals called ‘electrolytes’. These chemicals play an vital role in carrying out most of the body’s functions; particularly contraction of the muscles and transmission of nerve impulses. Electrolyte imbalances can have severe consequences including irregular heartbeat leading to resultant heart failure and death.
About OSFED treatment
At Rise Treatment Centre we offer a residential clinical programme for treatment of OSFED. Our programme is evidence-based and covers the overall health and well-being of our clients who suffer from any form of an eating disorder. We help them understand the root causes of their OSFED and combine psycho-education, mindfulness, group sessions, individual therapy and family support to guide them towards a sustainable recovery.