What is OSFED? A psychologist explains the eating disorder you’ve never heard of

“There is a need for these ‘catch-alls’ because they stop people from slipping through the cracks.”

Content warning: This article discusses eating disorders.

When I was diagnosed with EDNOS, everything finally made sense. I had experienced periods of starvation, over-exercising, bingeing, purging, weight fluctuation and fixations on wellness throughout the end of my early childhood and all of my teenage years. I’d never found a diagnosis that fully encompassed every behaviour or thought process I’d experienced. EDNOS (now referred to as OSFED or UFED) felt like the perfect answer to a question I had spent over 10 years wondering: what’s wrong with me? 

The term EDNOS, which stands for ‘eating disorder not otherwise specified’, essentially acts as an umbrella term. It describes all the conditions on the spectrum of eating disorders that don’t quite fit a specific diagnosis (like anorexia nervosa). At least, that’s how it was explained to me when I was younger. 

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Since first learning about EDNOS, I have put years of effort into recovery. I’ve worked with dietitians, specialists, psychologists, nurses and psychiatrists, delving into anything that might explain some of the thought processes behind my ever-persistent eating disorder. 

Now that, for the most part, I would consider myself recovered (I still have the occasional bad day), I’ve become really interested in what happened to me during my illness. Why did it take so long for me to receive the correct diagnosis? Why did I not believe I was ‘sick enough’, just because my weight fluctuated? 

I’ve now realised feeling invalidated in an eating disorder is not a unique experience. Feeling unseen in your illness can lead to avoidance or reluctance to get help. I didn’t believe I needed help for far too long, because I didn’t completely identify with one single diagnosis. 

I decided to ask a professional to break down the ‘catch-all’ diagnosis of OSFED, to hopefully help people who may be struggling with similar issues to feel seen (and maybe even encourage them to reach out for support). I spoke to Dr Adam Howearth, Psychopsychologist at Howearth Psychology, to understand more about OSFED/EDNOS. 

First of all, what is OSFED or EDNOS? Can you explain how it’s different from other (more well-known) eating disorders? 

Eating disorder not otherwise specified (EDNOS) is an older name and has been replaced in the current iteration of the Diagnostic and Statistical Manual of Mental Disorders. What was formerly EDNOS is now covered in ‘other specified feeding or eating disorder’ (OSFED) and ‘unspecified feeding or eating disorder’. 

EDNOS essentially served as a ‘catch-all’ category to make sure the people who [were] experiencing significant distress… related to eating/feeding habits but did not meet all of the criteria for a specific… problem weren’t being missed in the clinical/diagnostic space. There is a need for these ‘catch-alls’ because they stop people from slipping through the cracks… [and] struggling in silence without any support.

The update [to the name] specified variations to the three well-known eating problems and two other known eating difficulties. The common defining feature is that although they don’t meet a specifically defined eating disorder, they come close to those diagnoses and or are related to difficulties with eating/feeding… OSFED now catches those sub-clinical (not quite) presentations of symptoms, where a person might meet almost all of the diagnostic criteria, but not receive a diagnosis because one [part] has not been met.

OSFED encompasses the following eating problems:

• Atypical anorexia nervosa 
• Bulimia nervosa (of low frequency and/or limited duration) 
• Binge eating disorder (of low frequency or limited duration)
• Purging disorder
• Night eating symptoms
• Unspecified feeding or eating disorder (UFED)  

[The] take-home here is that OSFED/UFED are catch-all diagnoses that give us the ability to make sure that people who are experiencing difficulty… due to problems with their eating/feeding are able to be identified, and helped to overcome the problem.

I actually know a fair few people who have been diagnosed with OSFED and atypical anorexia. If this illness is so common, why is it less recognised?

There are probably many reasons for this, but I think it most likely comes down to the same principles that underpin the power of marketing. Simplicity and sensationalism sell by making things noteworthy and easily memorable.

In my own experience, when I see eating disorders represented in the media, it’s never a high-achieving businesswoman struggling with binge eating disorder or bulimia nervosa, nor a trans person struggling with gender dysphoria and using control over their eating to try to make their body match their gender identity. It’s most often (in my experience) an extremely underweight, often young woman or girl with anorexia nervosa. 

Like in marketing, our emotions are triggered by a relatively simple concept, making it more memorable… because OSFED/UFED diagnoses are more difficult to understand… we have a reduced representation through the common mediums that would lead to people hearing about them. But also, when people do hear about them, it’s probably more difficult for them to remember them.

Would you agree that there is a certain stigma attached to the diagnosis of atypical anorexia or OSFED? 

I’m not aware of any evidence of stigma specific to OSFED/UFED diagnoses, however, there is evidence that people in larger bodies are often viewed as less… deserving of help, and less recognised as having eating disorders. 

Given that atypical anorexia is diagnosed in those who meet the criteria for anorexia nervosa except that their weight is in the normal range (or above), it seems likely that this may influence how others view and treat them… it’s possible that many medical/allied health practitioners who aren’t specifically focused on eating problems are also less aware of OSFED/UFED. I can see how this lack of awareness may lead to assumptions that could be invalidating to a person struggling with eating problems.

[Overall], I can’t say that there is a greater stigma [attached] to OSFED/UFED diagnoses than there is toward eating disorders in general, but there is evidence of stigma surrounding eating disorders… and there are some studies that demonstrate such stigma in healthcare settings.

Is the treatment path for OSFED similar (or the same) to that of other eating disorders such as anorexia and bulimia? 

In my own practice, yes. When treating diagnosed eating disorders, I work in an outpatient context, using enhanced cognitive behavioural therapy… this treatment centres all eating disorders on the overvaluation of weight, shape, or the control of them, and links this to the maintenance of eating disorders by various mechanisms. We identify and address those central factors and maintain mechanisms over the course of therapy.

While the treatment for each person is individualised… it is a very structured treatment with a large amount of research evidence supporting its effectiveness. The severity of a person’s eating disorder will also help dictate the treatment. Some people will be able to engage in therapy… while remaining at home and seeing their therapist/team periodically. Some people with more severe concerns may need to go into in-patient facilities. 

… OSFED/UFED encompasses a broad range of eating disorder presentations, so individual needs, context and severity of the eating disorder will inform the most appropriate treatment for a particular person, and there are many different treatments and programmes available.