Other specified feeding or eating disorder (OSFED) is a
subclinical
In medicine, any disease is classified asymptomatic if a patient tests as carrier for a disease or infection but experiences no symptoms. Whenever a medical condition fails to show noticeable symptoms after a diagnosis it might be considered asym ...
DSM-5
The ''Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition'' (DSM-5), is the 2013 update to the ''Diagnostic and Statistical Manual of Mental Disorders'', the taxonomic and diagnostic tool published by the American Psychiatric ...
category that, along with
unspecified feeding or eating disorder
Unspecified feeding or eating disorder (UFED) is a DSM-5 category of eating disorders that, along with other specified feeding or eating disorder (OSFED), replaced eating disorder not otherwise specified (EDNOS) in the DSM-IV-TR.
UFED is an ea ...
(UFED), replaces the category formerly called eating disorder not otherwise specified (EDNOS) in the
DSM-IV-TR
The ''Diagnostic and Statistical Manual of Mental Disorders'' (DSM; latest edition: DSM-5-TR, published in March 2022) is a publication by the American Psychiatric Association (APA) for the classification of mental disorders using a common langua ...
.
American Psychiatric Association
The American Psychiatric Association (APA) is the main professional organization of psychiatrists and trainee psychiatrists in the United States, and the largest psychiatric organization in the world. It has more than 37,000 members are involve ...
(2000). ''Diagnostic and statistical manual of mental disorders'' (4th ed., text rev.). Washington, DC: Author. It captures
feeding disorder A feeding disorder, in infancy or early childhood, is a child's refusal to eat certain food groups, textures, solids or liquids for a period of at least one month, which causes the child to not gain enough weight, grow naturally or cause any develop ...
s and
eating disorder
An eating disorder is a mental disorder defined by abnormal eating behaviors that negatively affect a person's physical or mental health. Only one eating disorder can be diagnosed at a given time. Types of eating disorders include binge eating d ...
s of clinical severity that do not meet diagnostic criteria for
anorexia nervosa
Anorexia nervosa, often referred to simply as anorexia, is an eating disorder characterized by low weight, food restriction, body image disturbance, fear of gaining weight, and an overpowering desire to be thin. ''Anorexia'' is a term of Gr ...
(AN),
bulimia nervosa
Bulimia nervosa, also known as simply bulimia, is an eating disorder characterized by binge eating followed by purging or fasting, and excessive concern with body shape and weight. The aim of this activity is to expel the body of calories eate ...
(BN),
binge eating disorder
Binge eating disorder (BED) is an eating disorder characterized by frequent and recurrent binge eating episodes with associated negative psychological and social problems, but without the compensatory behaviors common to bulimia nervosa, OSFED, o ...
(BED),
avoidant/restrictive food intake disorder
Avoidant/restrictive food intake disorder (ARFID) is a type of eating disorder in which people eat only within an extremely narrow repertoire of foods. It is a serious mental health condition that causes the individual to restrict food intake by ...
(ARFID),
pica, or
rumination disorder
Rumination syndrome, or merycism, is a chronic motility disorder characterized by effortless regurgitation of most meals following consumption, due to the involuntary contraction of the muscles around the abdomen. There is no retching, nausea, he ...
.
[American Psychiatric Association (2013). ''Diagnostic and statistical manual of mental disorders'' (5th ed.). Arlington, VA: American Psychiatric Publishing.] OSFED includes five examples:
* atypical anorexia nervosa,
* atypical bulimia nervosa of low frequency and/or limited duration,
* binge eating disorder of low frequency and/or limited duration,
*
purging disorder Purging disorder is an eating disorder characterized by the DSM-5 as self-induced vomiting, or misuse of laxatives, diuretics, or enemas to forcefully evacuate matter from the body. Purging disorder differs from bulimia nervosa (BN) because individu ...
, and
*
night eating syndrome
Night eating syndrome (NES) is an eating disorder, characterized by a delayed circadian pattern of food intake. Although there is some degree of comorbidity with binge eating disorder, it differs from binge eating in that the amount of food consum ...
(NES).
Classification
The five OSFED examples that can be considered eating disorders include atypical AN, BN (of low frequency and/or limited duration), BED (of low frequency and/or limited duration), purging disorder, and NES. Of note, OSFED is not limited to these five examples, and can include individuals with heterogeneous eating disorder presentations (i.e., OSFED-other). Another term, Unspecified Feeding or Eating Disorder (UFED), is used to describe individuals for whom full diagnostic criteria are not met but the reason remains unspecified or the clinician does not have adequate information to make a more definitive diagnosis.
;Atypical anorexia nervosa: In atypical AN, individuals meet all of the criteria for AN, with the exception of the weight criterion: the individual's weight remains within or above the normal range, despite significant weight loss.
;Atypical bulimia nervosa: In this sub-threshold version of BN, individuals meet all criteria for BN, with the exception of the frequency criterion: binge eating and inappropriate compensatory behaviors occur, on average, less than once a week and/or for fewer than 3 months.
;Binge-eating disorder of low frequency and/or limited duration: In this sub-threshold version of BED, individuals must meet all criteria for BED, with the exception of the frequency criterion: binge eating occurs, on average, less than once a week and/or for fewer than 3 months.
;Purging disorder: In purging disorder, purging behavior aimed to influence weight or shape is present, but in the absence of binge eating.
;Night eating syndrome: In NES, individuals have recurrent episodes of eating at night, such as eating after awakening from sleep or excess calorie intake after the evening meal. This eating behavior is not culturally acceptable by group
norms, such as the occasional late-night munchies after a gathering. NES includes an awareness and recall of the eating, is not better explained by external influences such as changes in the individual's sleep-wake cycle, and causes significant distress and/or impairment of functioning.
Though not defined specifically in ''DSM-5'', research criteria for this diagnosis proposed adding the following criteria (1) the consumption of at least 25% of daily caloric intake after the evening meal and/or (2) evening awakenings with ingestions at least twice per week.
Treatment
Few studies guide the treatment of individuals with OSFED. However,
cognitive behavioral therapy
Cognitive behavioral therapy (CBT) is a psycho-social intervention that aims to reduce symptoms of various mental health conditions, primarily depression and anxiety disorders. CBT focuses on challenging and changing cognitive distortions (suc ...
(CBT), which focuses on the interplay between thoughts, feelings, and behaviors, has been shown to be the leading evidence-based treatment for the eating disorders of BN and BED.
[ Fairburn C.G., Cooper Z., Shafran R. (2003). "Cognitive behaviour therapy for eating disorders: a 'transdiagnostic' theory and treatment". ''Behaviour Research and Therapy'', ''41''(5), 509-28.] For OSFED, a particular cognitive behavioral treatment can be used called
CBT-Enhanced (CBT-E), which was designed to treat all forms of eating disorders. This method focuses not only what is thought to be the central cognitive disturbance in eating disorders (i.e., over-evaluation of eating, shape, and weight), but also on modifying the mechanisms that sustain eating disorder psychopathology, such as
perfectionism, core low
self-esteem
Self-esteem is confidence in one's own worth or abilities. Self-esteem encompasses beliefs about oneself (for example, "I am loved", "I am worthy") as well as emotional states, such as triumph, despair, pride, and shame. Smith and Mackie (2007) d ...
, mood intolerance, and interpersonal difficulties.
CBT-E showed effectiveness in two studies (total N = 219) and well maintained over 60-week follow-up periods. CBT-E is not specific to individual types of eating disorders but is based on the concept that common mechanisms are involved in the persistence of atypical eating disorders, AN, and BN.
Epidemiology
Few studies to date have examined OSFED prevalence. The largest community study is by Stice (2013), who examined 496 adolescent females who completed annual diagnostic interviews over 8 years. Lifetime prevalence by age 20 for OSFED overall was 11.5%. 2.8% had atypical AN, 4.4% had subthreshold BN, 3.6% had subthreshold BED, and 3.4% had purging disorder. Peak age of onset for OSFED was 18–20 years. NES was not assessed in this study, but estimates from other studies suggest that it presents in 1% of the general population.
A few studies have compared the prevalence of EDNOS and OSFED and found that though the prevalence of atypical eating disorders decreased with the new classification system, the prevalence still remains high. For example, in a population of 215 young patients presenting for ED treatment, the diagnosis of EDNOS to OSFED decreased from 62.3% to 32.6%. In another study of 240 females in the U.S. with a lifetime history of an eating disorder, the prevalence changed from 67.9% EDNOS to 53.3% OSFED. Although the prevalence appears to reduce when using the categorizations of EDNOS vs. OSFED, a high proportion of cases still receive diagnoses of atypical eating disorders, which creates difficulties in communication, treatment planning, and basic research.
History
In 1980, ''
DSM-III
The ''Diagnostic and Statistical Manual of Mental Disorders'' (DSM; latest edition: DSM-5-TR, published in March 2022) is a publication by the American Psychiatric Association (APA) for the classification of mental disorders using a common langua ...
'' was the first ''DSM'' to include a category for eating disorders that could not be classified in the categories of AN, BN, or pica. This category was called Atypical Eating Disorder. Atypical Eating Disorder was described in one sentence in the ''DSM-III'' and received very little attention in the literature, as it was perceived to be uncommon compared to the other defined eating disorders. In ''DSM-III-R'', published in 1987, the Atypical Eating Disorder category became known as Eating Disorder Not Otherwise Specified (EDNOS). ''DSM-III-R'' included examples of individuals who would meet criteria for EDNOS, in part to acknowledge the increasingly recognized heterogeneity of individuals within the diagnostic category.
In 1994, ''DSM-IV'' was published and expanded EDNOS to include six clinical presentations.
These presentations included individuals who:
* met criteria for AN, but continued to
menstruate
Menstruation (also known as a period, among other colloquial terms) is the regular discharge of blood and mucosal tissue from the inner lining of the uterus through the vagina. The menstrual cycle is characterized by the rise and fall of horm ...
,
* met criteria for AN, but still had weight in the normal range despite significant weight loss,
* met criteria for BN but did not meet frequency criterion for binge eating or purging,
* engaged in inappropriate compensatory behavior after eating small amounts of food, or
* repeatedly chewed or spit out food, or who binged on food but did not subsequently purge.
A disadvantage of ''DSM-IV''
's broad EDNOS category was that people with very different symptoms were still classified as having the same diagnosis, making it difficult to access care specific to the disorder and conduct research on the diversity of pathology within EDNOS.
[Eddy K.T., Le Grange D., Crosby R.D., Hoste R.R., Doyle A.C., Smyth A., Herzog D.B. (2010). "Diagnostic classification of eating disorders in children and adolescents: how does DSM-IV-TR compare to empirically-derived categories?". ''''. ''49''(3), 277-87.] Furthermore, EDNOS was perceived as less severe than AN or BN, despite findings that individuals diagnosed with EDNOS share similarities with full-threshold AN or BN in the degree of eating pathology, general psychopathology, and physical health.
[Thomas, Jennifer J. (2013, August 21). Goodbye EDNOS, Hello OSFED ]log post
Log most often refers to:
* Trunk (botany), the stem and main wooden axis of a tree, called logs when cut
** Logging, cutting down trees for logs
** Firewood, logs used for fuel
** Lumber or timber, converted from wood logs
* Logarithm, in math ...
Retrieved from http://www.jennischaefer.com/blog/eating-and-body-image/goodbye-ednos-hello-osfed-subthreshold-and-atypical-eating-disorders-in-dsm-5/ This perception prevented people in need from seeking help or insurance companies from covering treatment costs.
''DSM-5'', published in 2013, sought to address these issues by adding new diagnoses and revising existing criteria.
References
External links
{{Medical resources
, DiseasesDB =
, ICD10 = {{ICD10, F50.89
, ICD9 = {{ICD9, 307.59
, ICDO =
, OMIM =
, MedlinePlus =
, MeSH =
, GeneReviewsNBK =
, GeneReviewsName =
Eating disorders