Other Feeding and Eating Disorders

Other Specified Feeding or Eating Disorder (OSFED) was formerly recognised as Eating Disorder Not Otherwise Specified (EDNOS) in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). According to the DSM-5, a person with OSFED may present with many of the symptoms of other eating disorders such as anorexia nervosa, bulimia nervosa or binge eating disorder but will not meet the full criteria for diagnosis of these disorders.

This does not mean that the person has a less serious eating disorder. OSFED is a serious mental illness that occurs in adults, adolescents and children.

Around 30% of people who seek treatment for an eating disorder have OSFED

People with OSFED commonly present with extremely disturbed eating habits, and/or a distorted body image and/or overvaluation of shape and weight and/or an intense fear of gaining weight (if underweight). OSFED is the most common eating disorder diagnosed for adults as well as adolescents, and affects both males and females.

The risks associated with OSFED are severe. People with OSFED will experience risks like those of the eating disorder their behaviours most closely resemble.

Examples of presentations that can fall under the OSFED diagnosis can include:

Atypical Anorexia Nervosa

All the criteria for anorexia nervosa are met, except that despite significant weight loss, the individual’s weight is within or above the normal range.

Bulimia Nervosa (of low frequency and/or limited duration)

All the criteria for bulimia nervosa are met, except that the binge eating and inappropriate compensatory behaviours occur, on average, less than once a week and/or for less than 3 months.

Binge Eating Disorder (of low frequency and/or limited duration)

All of the criteria for binge eating disorder are met, except the binge eating occurs, on average, less than once a week and/or for less than 3 months.

Diabulimia is an eating disorder which may affect those with Type 1 Diabetes.  Diabulimia is the reduction of insulin intake to lose weight and is considered a dual diagnosis disorder: where one has diabetes as well as an eating disorder. While Diabulimia is generally associated with use of insulin, an individual with diabetes may also suffer from another eating disorder as well.

Diabulimia is very dangerous and can have severe, and sometimes fatal, consequences. Possible signs of Diabulimia can include:

  • Hemoglobin A1C level of 9.0 or higher on a continuous basis
  • Unexplained weight loss
  • Persistent thirst/frequent urination
  • Preoccupation with body image
  • Blood sugar records that do not match Hemoglobin A1c results
  • Depression, mood swings and/or fatigue
  • Secrecy about blood sugars, shots and or eating
  • Repeated bladder and yeast infections
  • Low sodium/potassium
  • Increased appetite especially in sugary foods
  • Cancelled doctors’ appointments, leading to a lack of monitoring the conditions

Orthorxeia Nervosa is not currently recognised as a clinical diagnosis in the DSM-5, but many people struggle with symptoms associated with this term.

Those who have an unhealthy obsession with otherwise healthy eating may be suffering from orthorexia nervosa, a term which literally means a fixation on righteous eating. Orthorexia starts out as an innocent attempt to eat more healthfully, but orthorexics become fixated on food quality and purity. Eventually food choices become so restrictive, in both variety and calories, that health suffers an ironic twist for a person so completely dedicated to healthy eating.  Eventually, the obsession with healthy eating can crowd out other activities and interests, impair relationships, and become physically dangerous.

Pica is when people with the disorder they compulsively eat items that have no nutritional value. An person might eat relatively harmless items, such as ice. Or they might eat potentially dangerous items, likes flakes of dried paint or pieces of metal. In the latter case, the disorder can lead to serious consequences, such as lead poisoning. Other food substitutes may include coal, dirt, and fawner i.e. plants without any commonly known nutritional value and of course if taken without the correct knowledge could also be harmful to digestion and life.

This disorder occurs most often in children and pregnant women and is usually temporary. Pica also occurs in people who have intellectual disabilities. It’s often more severe and long-lasting in people with severe developmental disabilities.

Body Dysmorphic Disorder (BDD) is a disorder in which a person is extremely concerned with their outward appearance, and imagines or self observes severe flaws, or distortions, on their body. Typically these flaws may appear as slight imperfections, or are merely imagined. Flaws in the skin, hair and face are most common, although these flaws can appear anywhere in the body.

The ugliness felt by those with BDD draws them away from social situations that might draw attention to themselves. Body dysmorphic disorder is sometimes considered a social phobia or a form of obsessive compulsive disorder. Those affected with this disorder are at an increased risk for depression and/or suicide. Plastic surgery is also common among those with this disorder.

Muscle Dysmorphia, also known as Bigorexia, is a disorder in which a person constantly worries about being too small and frail looking. Muscle dysmorphia is not currently recognised as a clinical diagnosis in the DSM-5, but many people struggle with symptoms associated with this term. This disorder is said to be the opposite of Anorexia Nervosa. Those with muscle dysmorphia are not frail or underdeveloped at all and typically have large muscle mass. Muscle dysmorphia is often found in body builders and frequent gym-goers.

Inadequacy felt by those with Muscle dysmorphia can have negative effects on all areas of their life, affecting relationships as well as work and school. Obsession with muscle mass and a lean body increases the risk of steroid use and an unhealthy diet which leads to major health complications. Muscle dysmorphia is more common in males than in females.

Night Eating Syndrome is recurrent episodes of night eating, as manifested by eating after awakening from sleep or by excessive food consumption after the evening meal. There is awareness and recall of the eating. The night eating is not better explained by external influences such as changes in the individual’s sleep-wake cycle or by local social norms. The night eating causes significant distress and/or impairment in functioning. The disordered pattern of eating is not better explained by binge-eating disorder or another mental disorder, including substance use, and is not attributable to another medical disorder or to an effect of medication.

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