Other Specified Feeding Or Eating Disorder

Written by BetterHelp Editorial Team

Medically reviewed by Dr. Andrea Cziffer Paul , MD, Dr. April Brewer, DBH, LPC, Julie Dodson, MA, LCSW, and Laura Angers Maddox, NCC, LPC

Overview

Eating disorders are characterized by symptoms that disrupt the feeding and eating process, often involving avoiding food, eating non-food items, binge eating, purging, or eating at unusual times. Eating disorders can cause high levels of emotional distress¹ and are often associated with a fear of weight gain or a warped sense of body image.

Many people may be familiar with four of the more well-known eating disorders: anorexia nervosa, bulimia nervosa, binge eating disorder, and pica. However, there are a number of additional mental health conditions related to feeding and eating.

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V), lists six distinct eating disorders:

Anorexia nervosa: People with anorexia restrict their food intake to avoid gaining weight, often to the point of becoming dangerously underweight.
Bulimia nervosa: With bulimia, a person binges on large amounts of food and then engages in behavior to eliminate the food, called purges. Purging may involve vomiting, using laxatives, or excessively exercising.
Binge-eating disorder: With binge eating disorder, a person binge eats without accompanying purging behaviors.
Avoidant-restrictive food intake disorder (ARFID):² People with ARFID often forget to eat or avoid food for reasons unrelated to weight loss.
Pica: Pica causes individuals to eat non-food items such as hair, paper, or rocks.
Rumination disorder: Rumination disorder causes individuals to regurgitate and re-swallow food involuntarily.

Eating disorders that do not meet diagnostic criteria for one of the disorders listed above may be otherwise explained by a subtype of eating disorders called other specified feeding or eating disorders (OSFED). These disorders often cause symptoms that are not as frequent or do not last for as long as symptoms associated with the above named eating disorders.

Symptoms

People with other specified feeding or eating disorder have symptoms that are similar to one or more eating disorders, but may not meet all the criteria for these conditions. Other specified feeding and eating disorder is referred to as “specified” because when it is diagnosed, one of five subtypes is selected, each with distinct symptoms.

Atypical anorexia nervosa

In the atypical anorexia nervosa subtype, a client meets all of the criteria for anorexia nervosa except the symptom of being significantly or dangerously underweight. A person with atypical anorexia nervosa may have experienced noteworthy weight loss. However, their weight is still within or above what is medically expected based on their height, age, and other relevant factors.

Note that weight does not necessarily signify whether someone is living with an eating disorder. Studies show that people often gain weight initially after restricting food intake. A serious mental health condition, anorexia is characterized by a desire to lose weight to the point that one severely limits what they eat and may participate in purging behaviors like excessive exercise.

Bulimia nervosa of low frequency or limited duration

In this subtype of bulimia, the individual exhibits all the symptoms of bulimia nervosa, primarily binge eating and compensatory behaviors. However, their binging and purging either does not happen frequently (defined as no more than once a week), or the behavior occurs frequently but doesn’t last for more than three months.

Binge eating disorder of low frequency or limited duration

Like the above listed bulimia nervosa subtype, this variant of binge eating disorder involves problematic binge eating that does not occur often or does not last for a significant period. In some cases, binge eating episodes may happen once every few months, with breaks between them.

Purging disorder

Purging disorder is similar to bulimia nervosa in that it involves purging behavior such as misusing laxatives or diuretics or forcing oneself to vomit. However, unlike bulimia nervosa, purging disorder does not include binge eating.

Night eating syndrome

Night eating syndrome involves eating after waking up in the middle of the night or eating excessive food after dinner. To meet diagnostic criteria for this OSFED subtype, the nocturnal eating behavior can’t be linked to substance use, cultural or social norms, or a significant change in a person’s sleep cycle, like starting to work a graveyard shift. Night eating must also cause distress. However, unlike other eating disorders, the distress is not primarily related to weight gain or body shape concerns.

Causes

Other specified feeding and eating disorders, like all eating disorders, are thought to be caused by various biological, psychological, social, and cultural influences.

Environmental OSFED risk factors

Below are some of the environmental OSFED risk factors:

Experiencing a significant life change or stressor — for example, some people’s OSFED symptoms may be incited by moving away for college or experiencing a divorce
Growing up in a culture or setting where thinness is valued, such as Western culture or a family system that emphasized dieting and fat-shaming
Working in an occupation that highlights thinness, such as modeling, athletics, acting, or singing
Having a parent or sibling who has an eating disorder
Experiencing physical or sexual abuse in childhood
Lacking meaningful and supportive relationships
Past experiences with bullying

See Resources

Psychological OSFED risk factors

A few psychological risk factors for developing OSFED include the following:

A history of anxiety or obsessive thinking
Loneliness
Low self-esteem
Poor interpersonal skills
A perfectionistic personality
A sense of being out of control
Other mental health conditions, particularly obsessive-compulsive disorder (OCD), depression, and social anxiety disorder³

Biological OSFED risk factors

Below are some of the biological risk factors for OSFED:

Early onset puberty
Childhood obesity
Specific neurobiology, such as how one’s body reacts to being hungry or full

Treatments

The goal of treatment for other specified feeding and eating disorders is to reduce or eliminate problematic eating behaviors, which often involves developing alternative coping mechanisms for processing negative emotions.

Therapy

Cognitive-behavioral therapy (CBT) focuses on the interaction between a person’s thoughts and behaviors and can be effective in treating eating disorders. Psychologists have developed a particular form of cognitive-behavioral therapy, known as CBT-enhanced or CBT-E, specifically to treat eating disorders. CBT-E is not intended to treat any one type of eating disorder but was developed based on the theory that the same maladaptive thought patterns and behaviors underpin all eating disorders, including OSFED.

CBT-E techniques include the following:

Body image skills: Reducing negative thoughts about food and body image.
The “delays and alternatives” method: Because disordered eating behaviors are often coping mechanisms to process negative emotions, the “delays and alternatives” method attempts to break that cycle. When a client experiences a negative emotion and the urge to binge, purge, or restrict, they are instructed to pause, name the emotion, and come up with an alternative means of addressing it, such as calling a loved one, going for a walk, or participating in a creative activity.
Keeping a food diary: With a food diary, the client regularly records what they ate, how much they consumed, and how they felt before, during, and after eating.
Structured meal planning: Meal planning may prevent binges and ensure a patient’s caloric and health needs are met. Meals often include breakfast, mid-morning snack, lunch, afternoon snack, dinner, and evening snack to ensure the client eats at roughly the same times each day.
Reducing body checking: Addressing body checking (focusing on specific body parts in an obsessive or compulsive manner) can be a way to reduce disordered thoughts related to body image.
Food exposure: Food exposure involves learning to eat foods that cause fear or the client labels “forbidden.”

Medication

The only medications that the US Food and Drug Administration (FDA) has approved to treat any form of eating disorder are fluoxetine, specifically to treat bulimia nervosa, and lisdexamfetamine for binge-eating disorder.

Fluoxetine is a selective serotonin reuptake inhibitor (SSRI) that is also used to treat depression and other mental health disorders. Lisdexamfetamine is a stimulant that is used to treat attention-deficit/hyperactivity disorder (ADHD) and binge-eating disorder.

Medication is often not the sole treatment option prescribed for this disorder. Therapy is typically the mainstay of treatment for other specified eating disorders, in addition to medication in some cases.

Consult a medical doctor before starting, changing, or stopping a medication for any condition. The information in this article is not a replacement for medical advice or diagnosis.

The BetterHelp platform is not intended for any information regarding which drugs, medication, or medical treatment may be appropriate for you. The content is providing generalized information, not specific for one individual. You should not take any action without consulting with a qualified medical professional.

Other treatment options

Other treatment options for other specified eating disorders may include the following:

Hospitalization: In some cases, when an individual has lost a significant or dangerous amount of weight, they may be admitted to the hospital to implement a nutrition plan, tube feeding, or inpatient psychiatric care.
Rehabilitation centers: Rehabilitation centers for eating disorders allow individuals to live in a residential building and receive care from a team of doctors, nutritionists, and therapists.⁴
Support groups: A support group may be beneficial for people with eating disorders, as it can allow them to connect with others experiencing similar challenges.

Self-care

Because OSFED results in unhealthy eating patterns, it is associated with several physical health impacts. One of the most effective ways to combat these effects may be prioritizing physical health in OSFED recovery. Besides developing a regular eating schedule, self-care for OSFED patients could involve ensuring they are drinking enough water and sleeping between seven and nine hours a night.

Some people living with OSFED may benefit from mindfulness practices, such as awareness of one’s five senses, observing the present moment, and focusing on breathing. Since OSFED behaviors such as binging, purging, or restricting are often incited by internal thoughts and emotions, techniques that move a person’s focus from their brain to their body may be helpful.

Resources

Recovering from eating disorders can be a complicated process involving various treatment providers, including physicians, dieticians, family therapists, social workers, and peer support groups. It may be helpful to make an individual’s one-on-one meetings with their therapist as convenient as possible. Online therapy through a legitimate platform like BetterHelp can enable OSFED clients to talk to their counselors from the comfort and convenience of their homes.

Organizations to reach out to

There are various organizations dedicated to providing resources and support for people experiencing eating disorders, including OSFED. The National Eating Disorder Association features screening tools and blogs on topics related to eating disorder recovery. The US Substance Abuse and Mental Health Services Administration (SAMHSA) recently designated a new National Center for Excellence for Eating Disorders at the University of North Carolina, Chapel Hill. The center includes a treatment provider search tool and resources for people with eating disorders and their loved ones.

For those experiencing abuse, contact the Domestic Violence Hotline at 1-800-799-SAFE (7233). Support is available 24/7. Please also see our Get Help Now page for more immediate resources.

Research

Incorrect beliefs about OSFED persist in the medical and therapeutic community, including that it is a less severe condition than any of the named eating disorders in the DSM-V and that it is more challenging to treat. Misinformed beliefs about treatment efficacy may stem from the fact that care providers may not take OSFED as seriously as other eating disorders, so they may not recommend treatment until the disorder has progressed to the point where treatment is less effective. Another misconception about eating disorders, including OSFED, is the belief that each disorder requires specialized treatment plans, and what works to treat one eating disorder may not be effective in treating another.

One study sought to address these misconceptions. The researchers found that individuals with OSFED and people who met the criteria for one of the named eating disorders had similar levels of functional impairment and emotional distress, as well as depressive symptoms, decreased self-esteem, and concerns about eating, weight, and body shape. Additional results indicated that people with OSFED responded to CBT-E treatment at similar rates to people with named eating disorders, which supports a “transdiagnostic” model in which all eating disorders are thought to share the same causes and risk factors and respond to the same treatments.

Short and long term treatment plans

Eating disorders, including OSFED, are associated with high rates of dropout from treatment plans. Hence, exploring ways to make treatment more effective in both the short and long term is often a priority for eating disorder researchers and treatment providers. One study assessing several eating disorder treatment options, including those addressing OSFED, found that providing internet-based treatment may enhance treatment adherence and outcomes. Treatment through software programs, email, text, and telemedicine appointments were all found to increase the effectiveness of therapeutic interventions.

Statistics

Below are several statistics on eating disorders and other specified feeding or eating disorder:

Together, the five subtypes of OSFED make up most of all eating disorder diagnoses.
A study found that almost 14% of adolescent girls meet or have met diagnostic criteria for an eating disorder, including OSFED, by the time they are 20.
Roughly one in four people with an eating disorder also demonstrate symptoms of post-traumatic stress disorder (PTSD).
A study assessing the use of CBT-E in the treatment of eating disorders found that around two-thirds of the clients who completed treatment were able to resolve their eating disorder symptoms fully.

Associated terms

Updated on September 6, 2024.

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