Other Specified Feeding or Eating Disorder (OSFED)

what is OSFED?

Anorexia nervosa, bulimia nervosa and binge eating disorder are diagnosed when a certain number of behavioural, physical or cognitive symptoms occur over a certain amount of the time. However, often a person’s symptoms do not exactly match any of these diagnoses - and this is when they may be given the diagnosis “other specified feeding or eating disorder” (OSFED).

OSFED is not just about the eating behaviours, but about the thoughts and feelings underlying them, with the eating disorder often being used as a way of managing them. OSFED is every bit as serious as AN, BN or BED, and people suffering from OSFED are equally deserving of and in need of treatment. In fact, the majority of people with eating disorders meet the diagnostic criteria for OSFED.

Examples of OSFED include

• symptoms of anorexia nervosa but with a “normal” body weight

• bingeing and/or purging, when the frequency does not meet the diagnostic criteria for BN or BED

• purging after eating “normal” meals to control shape/ weight

• repeatedly waking and eating at night

treatment for OSFED

NICE Guidelines recommend that when OSFED is more restrictive in nature, treatment guidelines for AN are followed, and that when OSFED involves more bingeing and/or purging, treatment guidelines for BN are followed.

CBT has a strong evidence base in the treatment of eating disorders (both anorexia and bulimia) and as such it is usually also recommended for OSFED. CBT helps individuals to recognise their unhelpful or negative thinking, see the patterns in their behaviours and develop healthy strategies and skills to challenge or cope with these. CBT is a structured skills based therapy that is most suitable for people who want to be guided by their therapist to find new ways of coping. People with OSFED can also be supported in developing a more balanced, healthy eating plan by a dietitian, helping them to break previous habits. This can be done in conjunction with psychological input or with a series of dietetic consultations alone.

Where eating difficulties are the result of a food phobia, or are present due to feared consequences of eating in a different way, individuals may benefit from CBT with exposure and response prevention. Within this, a psychologist can support you to gradually change your eating habits in order to evaluate the accuracy of feared consequences. This can usually be done in just a few sessions, freeing individuals quickly from the rigidity of their previous eating habits.