Other specified feeding or eating disorder, otherwise known as OSFED has replaced Eating Disorder Not Otherwise Specified (EDNOS) in The Diagnostic & Statistical Manual (DSM-IV). These eating disorders are diagnosable eating disorders that do not meet the specific requirement for anorexia nervosa, binge eating disorder, bulimia nervosa, pica, avoidant/restrictive food intake disorder (ARFID) and rumination disorder. OSFED, although not as common as binge eating disorder, which is the most common eating disorder, affects six percent of the population and has a 5.2 percent mortality rate. OSFED is similar to other eating disorders in that individuals also have a higher likelihood of having co-occurring conditions. According to statistics, nearly half of individuals with OSFED have a mood disorder such as depression or bipolar disorder and one in ten individuals with OSFED have a co-occurring substance abuse disorder.

Anorexia nervosa vs. atypical anorexia nervosa

According to the DSM-5 criteria, individuals with anorexia nervosa must meet the following criteria:

  • Persistent restriction of energy intake leading to significantly low body weight (in context of what is minimally expected for age, sex, developmental trajectory, and physical health).
  • Either an intense fear of gaining weight, becoming fat, or persistent behaviors that interfere with weight gain.
  • A disturbance in the way an individual views their body, weight or shape.
  • There are two subtypes of anorexia nervosa, the restricting type and the binge eating/purging type.

Atypical anorexia nervosa is one of the five disorders known as OSFED and meets all the criteria for anorexia nervosa with the exception of the low weight criteria. Individuals with atypical anorexia nervosa engage in binging/ purging and/or restricting behaviors, have an intense fear of gaining weight and carry a disturbance in their self-image however they are of average weight as opposed to being under weight.

Bulimia nervosa

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM5), defines bulimia nervosa by the five following criteria:

  • Eating excessive amounts of food in a two-hour period (binging) accompanied by feelings of loss of self control
  • Repetitive inappropriate self-induced compensated behaviors such a vomiting, diuretic use, laxative use and extreme exercise (purging) in order to avoid weight gain potentially causes by the binging episodes
  • These behaviors occur at least once a week for at least three months in duration
  • Body shape and weight are the main influencing factors of this binging and purging behavior
  • These behaviors do not occur specifically with anorexia nervosa and these disorders must be completely separated
  • Bulimia nervosa that does not meet this criterion is classified under the OSFED disorders because although the individual may meet the qualitative criteria for binge eating disorder, they do not meet the frequency/duration of binging episodes. For example, individuals with binge eating disorder classified under OSFED engage in binging and purging episodes less than once a week and/or for duration shorter than three months.

Binge eating disorder

In order for binge-eating disorder to be diagnosed an individual must partake in binging episodes on average at least once a week for a three-month duration, the individual must have feelings of marked distress over these binging episodes and have a loss of control over the amount of food they eat. Additionally, at least three of the following factors must be present:

  • Rapid eating
  • Eating until feeling uncomfortably full
  • Feeling disgusted with oneself, depressed, or very guilty afterward
  • Eating alone because of feeling embarrassed by how much is being eaten
  • Eating large amounts of food when not feeling physically hungry

Individuals with binge eating disorder classified under OSFED meet the qualitative criteria for binge eating disorder however they engage in binging episodes less frequently and/or for a more limited duration than what is set by the criteria. They binge eat less than once a week and/or for less than a three month duration.

Purging disorder

Purging disorder is an OSFED classification and is diagnosed when an individual engages in purging behaviors but does not engage in binging behaviors nor meets the criteria for anorexia nervosa. Purging is not just about self-induced vomiting but also includes excessive exercise, and the use and/or abuse of diuretics, laxatives and diet pills. There are no other specific requirements for this dNight eating syndrome

Psychologists and the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) characterizes sleep eating disorders as abnormal eating patterns during the night. For most of the population, individuals sleep in their beds at night however for this particular population, many individuals will raid their refrigerator, pantry and even will prepare food on the stove. Night eating syndrome (NES) is classified under OSFED and individuals with NES are conscious and therefore aware they are eating during the night. Individuals with night eating syndrome eat the majority of their food at night and may or may not eat an excessive amount of food in a short period of time. Individuals with night eating syndrome feel ashamed of their behavior and may even try to hide food or engage in behaviors similar to binge eating, however this disorder does not have to reflect any characteristics of binge eating disorder.