Goodbye EDNOS, Hello OSFED

The terms atypical eating disorder, Eating Disorder Not Otherwise Specified (EDNOS) and Other Specified Feeding or Eating Disorder (OSFED) can be used interchangeably. But they can also be very confusing diagnoses, leaving people wondering if they have an eating disorder, trying to make sense of different diagnoses, or thinking that it means that their difficulties are not serious.

Eating Disorder Not Otherwise Specified (EDNOS)

Eating Disorder Not Otherwise Specified (EDNOS) was a diagnosis from the DSM IV (a diagnostic manual used by health professionals in order to diagnose different mental health conditions). It was used to diagnose those who had eating disorder symptoms, experienced significant distress, but who did not meet the full diagnostic criteria for Anorexia or Bulimia.

EDNOS was the most commonly diagnosed eating disorder - accounting for approximately 60% of those who were diagnosed. It was no less serious than anorexia or bulimia, but included people who met all the criteria for anorexia nervosa but who still had regular menstrual periods or whose weight fell in the normal range (despite significant weight loss); those who were bingeing or purging less that 2 times a week or for fewer than three months; or those who were purging after eating a small amount of food.

Other Specified Feeding or Eating Disorder (OSFED)

In The DSM-V, there were a number of changes to the diagnoses of eating disorders, meaning that some of those who previously fell into the EDNOS category will now be diagnosed with anorexia nervosa or binge eating disorder. In addition, the diagnosis of EDNOS was formally changed to Other Specified Feeding or Eating Disorder (OSFED). However, it still remains the most commonly diagnosed eating disorder. Examples of those who fall into the OSFED diagnostic category include:

• Someone who has restrictive behaviours and other symptoms of anorexia, but does not meet the low weight criteria

• Someone who meets the criteria for bulimia or binge eating disorder but binges and/or purges at a lower frequency and/or for a limited period of time (fewer than two times a week, or for less than three months)

• Someone who doesn’t binge, but uses purging behaviours (vomiting/ laxatives etc) to control or change shape and/or weight

• Someone who has recurrent episodes of night eating and which cause significant distress

What does a diagnosis of OSFED mean?

As with EDNOS, there is often the misconception that OSFED is somehow “less serious” than other eating disorder diagnoses. This is particularly problematic as people with eating disorders often underestimate the severity of their disorder. People with the diagnosis OSFED may find themselves thinking that they are not “ill enough” to have a “proper eating disorder”. However, some studies have shown that the mortality rate of EDNOS (now OSFED) was as high as that in anorexia. Everyone with an eating disorder deserves treatment, and those with OSFED experience many of the same risks as those with other eating disorders. If you or a loved one is struggling with OSFED, it is critical that you reach out to seek help and support.

In terms of treatment, the OSFED diagnosis is not particularly helpful. Instead, the NICE guidelines suggest that those who have more restrictive forms of OSFED (restrictive eating/weight loss/ excessive exercise) look at treatment guidelines for anorexia, whilst those with binge/purge forms of OSFED (particularly when weight is in the healthy/overweight/obese range) look at treatment guidelines for bulimia nervosa. If this is something that you are struggling with, our clinicians can explore the treatment options with you at assessment.