What is OSFED?

Since OSFED can involve symptoms from one or several other eating disorders, there are many different ways it can present for diagnosis. According to the National Eating Disorder Association, the following are examples of OSFED symptoms that would result in a formal diagnosis:

• Atypical anorexia, in which all of the criteria for anorexia are met, but the individual’s weight is within or above the “normal” range.
• Bulimia nervosa (of low frequency and/or limited duration), in which all of the criteria is met for bulimia nervosa, except that the patient uses inappropriate compensatory behaviors less frequently and for a shorter amount of time than the DSM criteria specify.
• Binge eating disorder with binging taking place less frequently than the DSM criteria specify (at least once a week for at least three months).
• Purging disorder, in which a person purges without the presence of binge eating.
• Night eating syndrome, which is excessive consumption of food after dinner or during the middle of the night.

When looking out for symptoms, individuals suffering from OSFED may exhibit:

• Disturbed eating habits and an intense fear of weight gain
• Weight loss, gain and/or fluctuation
• Dehydration
• Compromised immune system due to nutrient deficiency
• In females, amenorrhea, which is the absence of a menstrual period

Psychological signs of OSFED often include:

• Preoccupation with food and body shape
• Distorted body image
• Dieting
• Eating food at unusual times or in a ritualistic manner
• Compulsive exercising

Several factors increase the risk of developing OSFED:

• Dieting and weight concerns: Engaging in dieting, especially extreme or restrictive diets, and having concerns about weight, body shape, or appearance can increase the risk of developing OSFED. These behaviors may lead to various eating-related issues, including subthreshold anorexic or bulimic behaviors.
• Psychological factors: Psychological factors such as depression, anxiety, low self-esteem, and a history of trauma or abuse can contribute to the development of OSFED. These factors may lead to disordered eating patterns, emotional eating, or changes in appetite.
• Sociocultural influences: Sociocultural factors, such as societal pressures to conform to certain beauty ideals and weight stigma, can contribute to body dissatisfaction and disordered eating behaviors. These pressures may lead to various manifestations of OSFED.
• Genetics: Genetic factors may play a role in the development of OSFED, particularly if there is a family history of eating disorders or mental health conditions. Genetics can contribute to an individual's susceptibility to disordered eating behaviors
• Medical conditions or medication: Certain medical conditions, such as gastrointestinal disorders or thyroid dysfunction, can affect appetite or metabolism and contribute to changes in eating behaviors. Medications that affect appetite or weight can also be a factor in the development of OSFED.

It's important to note that OSFED is a broad category that encompasses various eating-related issues, and individuals with OSFED may have different combinations of risk factors. The specific presentation of OSFED can vary significantly from person to person.

No matter who you are, the sooner you get help for OSFED, the better.

Some people believe that OSFED is less serious than better-known eating disorders, such as anorexia, bulimia or binge eating disorder. However, OSFED poses significant risks to a person’s medical and mental health that are equally as serious, ranging from osteoporosis to heart conditions.

Many people with OSFED have other co-occurring conditions, such as depression, severe anxiety or post-traumatic stress disorder (PTSD). Adolescents with eating disorders like OSFED are also more likely than the general population to have issues with drug or alcohol abuse (Micali et al., 2015).

Studies have found that people with OSFED have the same degree of symptom severity as other eating disorder diagnoses (Withnell et al., 2022). Unfortunately, treatment strategies and outcomes are much less studied among people with OSFED compared to people with other eating disorders. One study found that people with OSFED have low motivation to change and have high treatment drop-out rates, similar to people with other eating disorders (Riesco et al., 2018). Another study found that people with OSFED benefit similarly to other eating disorder patient groups from standard eating disorder treatments (Schmidt et al., 2008). These studies emphasize that OSFED is a serious diagnosis on par with other eating disorder diagnoses, and that people with OSFED should receive a standard of care that is similar to people with other eating disorders.

Over the last five years, Monte Nido & Affiliates have tracked the treatment outcomes of our clients with OSFED after six months of residential treatment. While the OSFED diagnostic category includes several diagnoses, the majority of our clients with OSFED have atypical anorexia. Our clients with OSFED report the following improvements after six months of residential treatment at a Monte Nido program:

• 93% of clients reported reduced eating disorder symptoms in the Eating Disorder Examination Questionnaire
• 81% of clients reported reduced eating disorder symptoms in the Eating Disorder Inventory self-report
• 82% of clients reported improvement in their quality of life
• 85% of clients reported improvements in depression
• 77% of clients that had PTSD upon admission reported reduced trauma symptoms