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 for co-occurring conditions. This diagnosis replaced the older term EDNOS (Eating Disorder Not Otherwise Specified) in the DSM-5, as noted in the study by 1. OSFED includes several subtypes such as atypical anorexia, purging disorder, night eating syndrome, and other clinically significant disordered eating patterns.
Key Characteristics of OSFED
- Atypical anorexia: anorexic behaviors with normal weight
- Purging disorder: purging without binge eating
- Night eating syndrome: excessive eating at night
- Other clinically significant disordered eating patterns Despite being considered "other specified," OSFED can have a serious prognosis, with potential medical complications affecting multiple body systems, as highlighted in the American Psychiatric Association practice guideline for the treatment of patients with eating disorders 1.
Treatment Approach
The treatment approach for OSFED typically involves:
- Psychotherapy, particularly cognitive-behavioral therapy
- Nutritional counseling
- Medication for co-occurring conditions like depression or anxiety Early intervention is crucial for better outcomes, as eating disorders can become more entrenched and difficult to treat over time. A comprehensive treatment plan should incorporate medical, psychiatric, psychological, and nutritional expertise, as recommended by the American Psychiatric Association 1.
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 2, 3.
- OSFED includes five example subgroups: atypical anorexia nervosa, sub-threshold bulimia nervosa, sub-threshold binge-eating disorder, purging disorder, and night eating syndrome 3, 4.
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 2.
- OSFED patients have lower eating concerns compared to patients with bulimia nervosa, but similar levels compared to anorexia nervosa and binge eating disorder 2.
- Global symptoms, shape and weight concerns, and restraint symptoms are similar between OSFED and threshold ED groups 2.
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 4.
- Clearer diagnostic definitions for OSFED subtypes are needed, considering indicators of lifetime history of full-threshold conditions, diagnostic drift, and remission criteria 3, 5.
- Different definitions of OSFED contribute to difficulties in study selection and limitation of data aggregation in metanalysis 5.
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 6.
- OSFED cases remain prevalent despite efforts to reduce less specified eating disorder categories in diagnostic classifications 5.