Anorexia and bulimia are eating disorders almost everyone has heard of. They can wreck lives, leaving a host of physical and psychological damage. Sometimes these eating disorders are fatal. But the eating disorder that kills most often is little known. It’s both more common than the other disorders and more deadly. It used to be called eating disorder not otherwise specified, or EDNOS. The Diagnostic and Statistical Manual (DSM), which is the bible for diagnosing psychiatric disorders, now refers to it as OSFED. This stands for “other specified feeding or eating disorder.” It’s important to be aware of EDNOS symptoms (or OSFED symptoms) because the disorder can be life-threatening.

OSFED Symptoms in Context

Although anorexia and bulimia tend to get the attention, OSFED comprises up to 70% of the 24 million eating disorders diagnosed in the U.S. A person with EDNOS/OSFED may be diagnosed as such because they don’t fully meet the criteria for anorexia or bulimia. They may have some symptoms of one or both disorders but do not warrant either diagnosis.

The DSM recognizes only anorexia, bulimia nervosa and binge eating as eating disorders. Anyone who meets some but not all of the criteria for these may be diagnosed with OSFED. Someone with OSFED symptoms may also meet some of the bulimia or anorexia criteria partly but not completely. For instance, one criterion for bulimia is binging and purging more than twice a week for at least three months. If you binge and purge less than twice a week, you may not meet the requirements for a bulimia diagnosis. But a psychiatrist could diagnose you with OSFED.

One of the dangers of OSFED symptoms is that they may seem less serious than anorexia or bulimia symptoms. The label, especially the “not-otherwise-specified” portion, could make you feel as if your disorder isn’t as serious, as common or even as important as the more well-known disorders. But more people suffer from OSFED symptoms than both anorexia and bulimia combined. And these people struggle with the same feelings of fear, self-loathing, shame and obsession. OSFED sufferers also engage in many of the same risky behaviors. Because OSFED symptoms are so much more common, the condition is the leading killer among disordered eaters.

An Overview of OSFED Symptoms

OSFED symptoms are more common in women, especially young women, than in men. But like anorexia and bulimia, OSFED can occur in anyone of any age or sex. Most typically, the eating disorder begins in adolescence or young adulthood.

The signs and symptoms of OSFED are very similar to those for bulimia and anorexia. They include:

  • Obsession with, or anxiety related to, food, calorie counting, exercise, weight and body image
  • Distorted body image (body dysmorphic disorder)
  • Behaviors that are meant to compensate for eating, which can include:
    • Vomiting
    • Using laxatives or diuretics
    • Exercising
  • Restricting food intake and calorie consumption
  • Cycles of restricting food, binging, feelings of shame and guilt and then purging
  • Rules and rituals about food – This may include foods that can never be eaten, times of day to avoid eating, and others.

Binging or compensating may not be initially obvious. Signs include:

  • The disappearance of food in large quantities
  • Spending a lot of time alone
  • Spending a long period of time eating

The Risks Associated with OSFED Symptoms

The medical risks and complications associated with OSFED symptoms are serious. They are just as much cause for concern as the symptoms that go along with bulimia and anorexia. Purging can cause dehydration and electrolyte imbalances, and even heart problems and death. In extreme cases, binging can cause stomach rupture. Restricting calories can result in:

  • Heart failure
  • Low blood pressure
  • Reduced heart rate
  • Hormonal imbalance
  • Bone weakening
  • Mental and emotional issues

Treatment for Symptoms of OSFED

Because the behaviors associated with OSFED are varied, specific treatment plans for the disorder are hard to find. Treatments similar to those used for bulimia and anorexia are typically applied to OSFED symptoms. These include:

Cognitive Behavioral Therapy (CBT)

This form of talk therapy helps OSFED patients understand the relationship between thoughts, feelings and behaviors. CBT encourages you to become mindful of how your thoughts affect your feelings and behaviors (and how behaviors influence your thoughts and feelings). You work on changing unhealthy patterns.

Individual Counseling

One-on-one sessions with a psychotherapist can help you gain deeper insight into your condition. Individual counseling can address issues that may contribute to OSFED symptoms, such as:

  • Upbringing
  • Bullying
  • Trauma
  • Abuse or neglect

Individual counseling can also address any co-occurring mental health disorder that may be affecting a person’s eating disorder, such as depression, PTSD or anxiety.

Group Therapy

OSFED patients can benefit from group therapy in a variety of ways. Group therapy can:

  • Help you realize you’re not alone
  • Facilitate the giving and receiving of support from others who have similar struggles
  • Allow you to become aware of your own feelings during a discussion and express them
  • Help you relate to yourself and others in a healthier way
  • Provide a safety net – You’ll get to report back to a group of people who care about you.

All these treatments focus on changing distorted thinking patterns and helping you self-monitor and change unhealthy behaviors. Therapy is also often combined with nutritional counseling and sometimes with prescription medications.

Because OSFED symptoms are so prevalent in the realm of eating disorders, prevention is important. Not enough people know about the disorder, and there are likely millions who are currently undiagnosed. When more people understand that they do not have to have anorexia or bulimia to have a dangerous mental illness, more lives can be saved.

If you think you have OSFED (formerly known as EDNOS) or another eating disorder, reach out to The Ranch at 844-876-7680 to learn about our comprehensive eating disorder treatment programs.

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Krisi Herron

Medically Reviewed by

Krisi Herron, LCDC

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