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Decoding OSFED: In the Realm of Eating Disorders

If you’re not familiar with the term OSFED, don’t worry, you’re not alone. OSFED stands for Other Specified Feeding or Eating Disorders, and it might not be a household acronym. But before we delve into the nitty-gritty of this mental health challenge, it’s crucial to remember: you are NOT your diagnosis. It’s something you struggle with, and there is help, hope, and healing available.


Please never say, “I am Anorexic” or “I am Bulimic” or “I am a Binge Eater” or “I am a OSFEDer.” I have never heard anyone say the last one, but why not throw it in there since that is what we are talking about!


What is OSFED?


In simple terms, if you or someone you know is facing significant distress but doesn’t perfectly fit into any other eating disorder category, OSFED might be the diagnosis. As an Eating Disorder Recovery Coach, I don’t diagnose, but I’ve assisted many navigating the complexities of OSFED.


People dealing with OSFED often carry the belief of “I am not sick enough” or “I don’t really have a problem,” even when they are undeniably suffering.


OSFED vs. EDNOS: A Name Change


Previously known as Eating Disorders Not Otherwise Specified (EDNOS), OSFED used to be the catch-all label in the Diagnostic and Statistical Manual. Unfortunately, this has led to some challenges like insurance denial, deeming it less severe. However, it’s crucial to recognize that OSFED/EDNOS is a serious and treatable eating disorder with potentially life-threatening consequences.


In the past, community clinics often diagnosed individuals under the EDNOS label. The recent DSM-5 underwent changes to refine the diagnosis of anorexia, bulimia, and binge eating disorder, aiming for more accurate categorization. Despite these changes, OSFED remains a common diagnosis. In the DSM-5, meeting the criteria for significant distress from feeding or eating habits, without fitting perfectly into any other disorder, points towards OSFED.


Examples of OSFED from DSM-5:


  1. Atypical Anorexia Nervosa: Meeting all criteria except weight remaining within or above the normal range after significant loss.
  2. Binge Eating Disorder (of low frequency and/or limited duration): Meeting BED criteria but at a lower frequency or for less than three months.
  3. Bulimia Nervosa (of low frequency and/or limited duration): Meeting bulimia nervosa criteria, but binge eating and compensatory behaviors occurring at a lower frequency or for less than three months.
  4. Purging Disorder: Recurrent purging without binge eating.
  5. Night Eating Syndrome: Recurrent episodes of eating after sleep, causing significant distress/impairment.


Red Flags of OSFED:


The predominant indicators and behaviors strongly suggest a primary focus on weight reduction, adherence to dietary regimens, and meticulous control of dietary intake. Here are just 10 Behavioral Red Flags:


  1. Major weight drop
  2. Fixation on weight, food, calories, fat grams, and dieting
  3. Adoption of new food trends or fad diets, refusal of specific foods, progressing to bans on whole food groups
  4. Consistent feelings of being “fat” despite weight loss
  5. Complaints about constipation, abdominal pain, cold intolerance, lethargy, and/or excess energy
  6. Ignoring hunger cues
  7. Signs of purging, such as frequent bathroom visits or evidence of laxatives/diuretics
  8. Discomfort when eating around others
  9. Fear of eating publicly or with company
  10. Consuming excessive water or zero-calorie drinks


Health Implications and the Path to Recovery:


Discussing the health implications of OSFED revolves around the specific eating behaviors at play. It’s crucial to understand that OSFED is as serious as any other eating disorder, and underestimating it is a mistake. Identifying the health consequences of OSFED can be intricate due to its diverse conditions. While watching for behavioral red flags is essential, the primary focus should be on recognizing attitudes toward food and weight that hinder the pursuit of a productive and fulfilling life.


In the journey towards recovery, remember that help is available, hope is real, and healing is possible. If you or someone you know is grappling with OSFED, seeking professional assistance is a crucial step toward reclaiming a healthy and fulfilling life.


With Love & Light,

Sarah Lee

Certified Eating Disorder Coach, CCIEDC 1008

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