Symptoms of OSFED

PTSD TherapyAs discussed in Psychology Today, in Western culture the act of intentionally depriving oneself of food dates back at least to the 12th and 13th centuries. One of the most well-known examples is of St. Catherine of Siena who reportedly denied herself food in order to attain greater spiritual development. The practice continued through history, and from the 17th to 19th centuries was described in medical literature as the “wasting disease.” By the 1970s, the illness entered mainstream public awareness. At that point, clinical research began to focus on eating disorders including anorexia nervosa, bulimia, binge eating, and obesity. Today, the understanding of eating disorders has expanded to include an important additional category – other specified feeding or eating disorder (OSFED).

The Diagnostic and Statistical Manual of Eating Disorders (DSM) is the diagnostic “bible” of mental health professionals. Recognition of a disorder in this manual equates to the condition being recognized in the mainstream medical community and also paves the way for insurance coverage. In the DSM-IV (i.e., the fourth edition), the term “eating disorders not otherwise specified (EDNOS)” was used to describe subclinical cases of disorders, such as anorexia nervosa and bulimia nervosa. However, the DSM-V changed the term to “other specified feeding or eating disorder (OSFED). As the National Association of Anorexia Nervosa and Associated Disorders explains, when a clinician concludes that a patient has an eating disorder but the behavior does not fulfill the requirements of a traditional disorder, such as anorexia nervosa, the patient may be diagnosed as having an OSFED.

Like the traditional eating disorder categories, the main feature of OSFED is food control. There are numerous restrictive practices, with varying intensity, which persons with eating disorders can manifest. While it may be difficult to self-diagnose an eating disorder, one hallmark is that the disordered behavior and thinking about food impairs psychosocial functioning (interrelation of social roles and internal thoughts). In other words, a person with a clinical eating disorder does not have an “issue” with food as much as a systematically unhealthy relationship with it. Most often, eating disorders are not about caloric intake per se but a range of psychological and genetic factors underlying the behavior.

As laid out in the DSM-V, there are five major types of OSFED:

  • Bulimia nervosa: To receive this diagnosis within the OSFED category (rather than in the standalone bulimia nervosa category), a person will exhibit the behaviors of traditional bulimia nervosa but experience fewer episodes or limited periods of abuse.  An additional feature is that after eating, the person takes compensatory action to avoid weight gain, such as vomiting, compulsively exercising, fasting, and/or misusing laxatives and diuretics.
  • Atypical anorexia nervosa: The diagnosed individual will display restrictive eating practices without having a low weight.
  • Binge eating: The criteria for binge eating, such as excessive eating and feeling out of control, are met, but the episodes occur at a lower rate or for a more limited period of time.
  • Purging:The sufferer self-induces vomiting, excessively exercises, or misusing laxatives and/or diuretics in order to remove calories from the body (does not have to include binge eating behavior as a precursor).
  • Night eating: The patient engages in ongoing episodes of excessive eating after dinner, or wakes in the night from sleep and eats excessively.

While persons with OSFED may be suffering from subclinical forms of other disorders, it is critical not to downplay the many dangers of this disorder. Dr. Jenny Schaefer, of Harvard Medical School and co-author of Almost Anorexic, advocates for OSFED sufferers and the public to take this illness seriously. She implores the public that OSFED is a legitimate eating disorder. Writing for Project Heal, Schaefer provides the following insightful facts and statistics (note that at the time of her writing, the DSM-IV was current and ENDOS was the clinical term in use):

  • According to the National Association for Anorexia and Associated Disorders, the mortality rate for EDNOS (now OSFED) was 5.2 percent.
  • Per the Center for Eating Disorders at Shepherd Pratt, approximately 50 percent of eating disorder clients in treatment were diagnosed with EDNOS (now OSFED).
  • Persons with EDNOS (now OSFED) have symptoms that are just as severe, if not more severe, than anorexia nervosa and bulimia nervosa.
  • Approximately 24 million Americans have an eating disorder, and an estimated 50 percent have EDNOS (now OSFED); of the 12 million OSFED cases, approximately 624,000 are fatal.

The incorporation of EDNOS and then OSFED into the DSM was a triumph. As the eating disorder informational site Mirror Mirror explains, the DSM-V separated binge eating disorder from an OSFED diagnosis, and for the first time recognized night eating disorder and purging disorder. The greater differentiation between eating disorders in the DSM-V, as well as the naming of new disorders, is a sign of advancement in the field of eating disorder research and understanding.

The causes of an OSFED are multi-factored and draw on genes, the environment, and sociocultural factors. Persons with OSFED present with some common symptoms that include but are not limited to:

  • Intense fear of gaining weight
  • Extremely problematic eating habits
  • Body image distortion
  • Acute sensitivity to body shape and weight

Women, men, youth, and adults may all suffer from an OSFED. The distorted thinking that is characteristic of this disorder may make it difficult for a sufferer to self-diagnose. For this reason, it may be especially necessary for others to be aware of the physical and behavioral signs of an OSFED or other eating disorder. Parents, loved ones, and other concerned individuals are often instrumental in leading a person with an eating disorder to treatment. The first step is getting the needed information on these disorders.

Physical and psychological signs may overlap with traditional categories, such as anorexia or bulimia. The goal of helping a person with an eating disorder is not to correctly diagnosis the exact illness; an eating disorder specialist will do that. A realistic and helpful goal would be to realize that there is a problem and then to consult a treatment professional. A representative sample of the physical and psychological signs of an OSFED is as follows:

·       Weight gain, loss, or fluctuations ·       In females, menstruation interruption
·       Lowered immunity ·       Damaged teeth, bad breath
·       Swelling around jaw ·       Dehydration and dizziness
·       Preoccupation with eating habits ·       Depression, irritability, and anxiety

Signs of OSFED may be invisible (such as purging and night eating), but the disorder may be apparent in different ways. The obviousness of extreme weight loss aside, persons with OSFED may compulsively talk about food, eating, self-perception, and others’ bodies. When an OSFED person broadcasts her perception of eating, she may also, whether consciously or unconsciously, be trying to control the relationship others’ have to her food intake.

Eating is a largely social behavior that can be harrowing for a person with an eating disorder. A person with an OSFED may act out this illness in the following ways:

·       Compulsive dieting ·       Excluding food groups
·       Preoccupation with food elimination ·       Rigid eating practices
·       Being antisocial at mealtimes ·       Have acute interest in food preparation
·       Increasing isolation ·       Eating at unusual times

An OSFED can cause short-term and long-term physical damage, such as:

·       Kidney failure ·       Stomach rupture or inflammation
·       Damage to esophagus ·       Increased risk of heart disease
·       Slow or irregular heartbeat ·       Osteoporosis
·       Increased risk of infertility ·       Chronic diarrhea or constipation

It is no surprise that OSFED-related behaviors can present serious health complications. Unfortunately, persons with an OSFED may not be stopped by the symptoms alone. The disordered thinking underlying OSFED can be understood to perversely focus the sufferer on food not as an agent necessary to survival but as an enemy to be overcome. For this reason, an OSFED sufferer may take the signs of this disorder and feel positively reinforced, feeling as if she is attaining this goal. Unlike in the drug addiction context, abstinence is not an option – everyone has to eat.

There is presently a growing concern that eating disorders may be hiding behind the healthy eating movement. Greatist, a forum for healthy eaters, discusses this phenomenon. The trend for “raw,” “vegan,” and “gluten-free” diets is essentially based on excluding certain foods from one’s diet. Sound familiar? It should, because excluding food groups is one of the signs of an eating disorder. How can one tell the difference between a healthy eater and a person hiding an eating disorder?

There are important differences between a healthy eater and a person with an eating disorder. The latter will see and judge himself through the prism of his weight or body appeal, deriving his sense of self-worth predominantly from this source. In this way, individuals suffering from an eating disorder will tend to discount many of the qualities that make up who they are and focus on one only feature – how they look (and often, how disappointed they are with how they look). To conceal this thinking or to give it a positive overlay, an individual may present herself as a healthy food enthusiast. In these cases, it will be important to be aware of the signs and symptoms of an eating disorder.

Gender and eating disorders

A study published in the International Journal of Eating Disorders explored whether there is a difference between the genders in terms of concerns about body image, binge eating, and unhealthy compensatory behaviors, such as vomiting. The study randomly asked males and females between the ages of 18 and 35, all members of a health maintenance organization (HMO), to participate in a survey online or by mail, and 3,714 women and 1,808 men responded to the survey questionnaire. The survey made several key findings, including:

  • Women are more likely than men to suffer from anorexia nervosa and bulimia nervosa.
  • Women were considerably more likely than men to check or avoid their bodies, binge eat, fast, and vomit.
  • More women than men reported that they could not control what or how much they ate, yet more men than women reported overeating.
  • Women were more likely than men to be dissatisfied with their weight.
  • Of all abnormal eating behaviors discussed in the questionnaire, men were most prone to binge eat and engage in excessive exercise to control weight.

The study made particular note of the practice of checking or avoiding one’s body image. According to the researchers, this symptom is understudied. The survey revealed that approximately one in every five women, and one in every 10 men stated that they checked their body size “very often” during the prior three months. According to the researchers, the body checking or avoiding practice may become a diagnostic criterion for binge eating disorder in the future. As studies continue to illuminate eating disorder behaviors, more effective diagnostic and treatment efforts can be designed to rehabilitate sufferers.

Treatment for OSFED

InterventionAccording to a scholarly discussion published on Medscape, results from community studies show that most individuals with eating disorders do not seek treatment. The reason may be a failure to self-detect the illness, shame, or other psychological barriers surrounding getting help. Although eating disorders may be undertreated, research is clearly progressing in this field.

For instance, review studies have shown that binge eating disorder in adults has been responsive to both cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT), and the results have been long-lasting in some cases. Further, research is developing with a focus on the brain activity involved in eating disorders (neurobiology). Such research, including techniques such as brain imaging, has been able to identify brain circuits involved in disordered eating behavior. Efforts are being made to use the findings from brain-based research studies to develop treatment methods such as deep brain stimulation. Binge eating disorder treatment is heading in the direction of using medications that would block opiate, dopamine, and cannabinoid receptors involved with this disorder.

Research in the area of eating disorders, in addition to the expansion of this illness within the DSM-V, demonstrates that treatment of eating disorders is progressing. At present, eating disorders are treated in one of three program types: inpatient, outpatient, or hospitalization (as necessary). Psychotherapy is a core feature of these programs, once a patient’s health has stabilized.

The American Psychological Association provides an “FYI” publication on the role of psychotherapy in the treatment of eating disorders. The Association strongly advises that eating disorders be treated with psychotherapy as part of a multidisciplinary approach, including meetings with physicians and a nutritionist. For some patients, depending on the severity and length of the disorder, treatment may be long-term. To help avoid a relapse, it may also be necessary to involve family members, including spouses or partners, in the care program. Group therapy can provide mutual support and understanding and serve as an additional pillar of treatment.

In individual psychotherapy, a therapist will work with a recovering person to address the psychological factors underlying the disordered thinking and behavior. Treatment approaches often involve the following:

  • Teaching the patient to replace destructive ideas and actions with positive ones
  • Identify if a certain event triggered the eating disorder and revisit it as a learning tool
  • Work to improve the patient’s interpersonal relationships with family, friends, and other significant persons
  • Focus on shifting thinking from a preoccupation with weight to a desire for optimal health

It should be noted that certain conditions, such as bulimia, may be treated with medication. Using a prescription, however, does not mean psychotherapy is not necessary. Rather, medication should be taken in combination with psychotherapy. The effects of the medication and any feelings toward it can be a point of helpful discussion in therapy. One of the greatest benefits of rehab is not only that the eating disorder will be addressed, but that treatment can also provide the recovering person with a blueprint for healthy living. Many graduates of eating disorder rehabs credit these programs not only with helping to get well but also with helping to live a better life overall.

The American Psychological Association provides an “FYI” publication on the role of psychotherapy in the treatment of eating disorders. The Association strongly advises that eating disorders be treated with psychotherapy as part of a multidisciplinary approach, including meetings with physicians and a nutritionist. For some patients, depending on the severity and length of the disorder, treatment may be long-term. To help avoid a relapse, it may also be necessary to involve family members, including spouses or partners, in the care program. Group therapy can provide mutual support and understanding and serve as an additional pillar of treatment.

In individual psychotherapy, a therapist will work with a recovering person to address the psychological factors underlying the disordered thinking and behavior. Treatment approaches often involve the following:

  • Teaching the patient to replace destructive ideas and actions with positive ones
  • Identify if a certain event triggered the eating disorder and revisit it as a learning tool
  • Work to improve the patient’s interpersonal relationships with family, friends, and other significant persons
  • Focus on shifting thinking from a preoccupation with weight to a desire for optimal health

It should be noted that certain conditions, such as bulimia, may be treated with medication. Using a prescription, however, does not mean psychotherapy is not necessary. Rather, medication should be taken in combination with psychotherapy. The effects of the medication and any feelings toward it can be a point of helpful discussion in therapy. One of the greatest benefits of rehab is not only that the eating disorder will be addressed, but that treatment can also provide the recovering person with a blueprint for healthy living. Many graduates of eating disorder rehabs credit these programs not only with helping to get well but also with helping to live a better life overall.

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At The Recovery Village, our expert team of eating disorder specialists is available 24/7 to support our clients throughout the recovery process. We are equipped to handle a wide range of eating disorders, at all levels of severity. Our scientifically based rehab services include medication management with a psychiatric provider, nutrition therapy, and recreational therapy, such as yoga.

Symptoms of OSFED
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Symptoms of OSFED was last modified: November 1st, 2016 by The Recovery Village