From the Guidelines
OSFED, or Other Specified Feeding or Eating Disorder, is a serious eating disorder that requires professional treatment, typically involving a multidisciplinary approach with psychotherapy, nutritional counseling, and sometimes medication, as it can cause significant physical and psychological harm if left untreated. According to the DSM-5 criteria 1, OSFED includes several subtypes such as atypical anorexia, purging disorder, and other clinically significant disordered eating patterns. The American Psychiatric Association practice guideline for the treatment of patients with eating disorders 2 recommends a comprehensive, culturally appropriate, and person-centered treatment plan that incorporates medical, psychiatric, psychological, and nutritional expertise.
Key Features of OSFED
- Atypical anorexia (where someone has anorexic behaviors but maintains normal weight)
- Purging disorder (purging without binge eating)
- Night eating syndrome
- Other clinically significant disordered eating patterns ### Treatment Approach
- Multidisciplinary approach with psychotherapy (particularly cognitive-behavioral therapy)
- Nutritional counseling
- Sometimes medication for co-occurring conditions like depression or anxiety The treatment plan should be individualized and tailored to the patient's specific needs, with a focus on normalizing eating and weight control behaviors, restoring weight, and addressing psychological aspects of the disorder 2. Early intervention is crucial, as OSFED can cause significant physical and psychological harm if left untreated, and it affects people of all genders, ages, and backgrounds, representing a substantial portion of eating disorder diagnoses.
From the Research
Definition of OSFED
- Other Specified Feeding or Eating Disorder (OSFED) is a diagnostic category that describes individuals with clinically significant eating behavioral disturbances that do not meet criteria for full-threshold eating disorder diagnoses 3, 4.
- OSFED includes five example subgroups: atypical anorexia nervosa, sub-threshold bulimia nervosa, sub-threshold binge-eating disorder, purging disorder, and night eating syndrome 4, 5.
Characteristics of OSFED
- Individuals with OSFED show largely similar eating disorder psychopathology and similar decreases in symptoms across treatment as individuals diagnosed with threshold EDs 3.
- OSFED patients have lower eating concerns compared to patients with bulimia nervosa, but similar levels compared to anorexia nervosa and binge eating disorder 3.
- Global symptoms, shape and weight concerns, and restraint symptoms are similar between OSFED and threshold ED groups 3.
Challenges in Diagnosing OSFED
- The existing diagnostic criteria for OSFED are deficient and fall short of accurately describing the complexity and individuality of those with these eating disorders 5.
- Clearer diagnostic definitions for OSFED subtypes are needed, considering indicators of lifetime history of full-threshold conditions, diagnostic drift, and remission criteria 4, 6.
- Different definitions of OSFED contribute to difficulties in study selection and limitation of data aggregation in metanalysis 6.
Prevalence and Treatment of OSFED
- OSFED is a prevalent condition, and effective assessment, intervention, and collaborative treatment are needed to decrease risk factors and increase opportunities for recovery 7.
- OSFED cases remain prevalent despite efforts to reduce less specified eating disorder categories in diagnostic classifications 6.