Finding the “right” treatment for eating disorders can be such an arduous task that it often keeps people from finding any treatment. Other Specified Feeding or Eating Disorder, shortened to OSFED, appeared as a new eating disorder category in the fifth version of the Diagnostic and Statistical Manual (DSM-V) of Mental Disorders in 2013.
And the eating disorder community rejoiced! Because for far too long, people who struggled with debilitating eating disorders were denied treatment or denied the “right” treatment in an appropriate level of care, because they didn’t fit neatly into the anorexia nervosa or bulimia nervosa box.
What is OSFED?
OSFED has brought much-needed awareness, research and education to the eating disorder community, and healthcare as a whole, as we work to understand more about eating disorders and the many different ways they manifest.
All eating disorders can be deadly and often require treatment in higher levels of care in order to break their destructive cycle.
Atypical anorexia is a diagnosis used when all the criteria are met for anorexia nervosa except for being a significantly low weight. This diagnosis might be one of the most important in the fight against weight stigma, as it highlights the danger of malnutrition at any weight, size or shape.
Purging disorder is often confused with bulimia nervosa as most people associate purging with bulimia. Purging disorder is when the purging behavior that is intended to influence weight or shape occurs in the absence of a binge.
Bulimia Nervosa/Binge Eating Disorder (BED) of low frequency and/or limited duration
In order to meet full criteria for bulimia nervosa or BED, the behaviors must be present for a duration of three months and occur within a frequency of at least once a week. Prior to OSFED being recognized, someone who binged or binged/purged once every two weeks, as an example, would not be able to get the help they needed. Now people who struggle with these debilitating behaviors can receive a diagnosis and treatment before these behaviors increase in frequency and duration.
Night Eating Syndrome
Night eating syndrome is when a person consumes most of their intake for the day after their dinner meal. Waking and needing to eat before being able to go back to sleep often occurs, however, there is awareness of the eating episodes.
The final category is for people who have any other symptom or food ritual that doesn’t meet full criteria for anorexia, bulimia, binge eating or ARFID, and that indicates that one’s relationship with food is keeping them from engaging in social activities or from functioning fully at home, work, and/or school.
What treatments can be successful for OSFED?
Just like any other eating disorder or mental illness, early intervention is key. Of equal importance is the therapeutic alliance between patient and therapist. A positive, honest and trusting relationship with one’s provider is highly correlated with success in therapy.
Additionally, having a specialized multi-disciplinary treatment team consisting of a therapist, dietician, and medical team is ideal to work to address each facet of these illnesses. Sadly, there are still insurance companies that will not cover a registered dietician without a medical diagnosis such as diabetes.
Currently, the treatment for OSFED uses the same evidence-based practices used for anorexia, bulimia and/or binge eating with the specific modality being tailored to symptomatology. For example, atypical anorexia is treated as anorexia, and bulimia/BED of limited frequency and duration is treated as it would be if it met full criteria. The most commonly used modalities are:
Cognitive Behavioral Therapy
CBT, or Cognitive Behavioral Therapy, has been found to be one of the most effective treatment modalities for treating people with eating disorders and OSFED. It is a form of talk therapy that helps people understand how their thoughts, emotions and behaviors are related.
When considering how CBT is best used to treat eating disorders, it is important to think of starting with cBt – big “B”, little “c”. This is because the thoughts and emotions associated with the disordered eating patterns will take time to shift and often shift naturally as the disordered behaviors decrease, nutrition is restored, and clarity of cognitions improve with the dissipation of “all or nothing” thinking.
Dialectical Behavior Therapy
It is quite common for folks with eating disorders to come from invalidating environments or families of origin. This has lead them to have to “make things really big” in order to feel seen and heard. Although this behavior pattern may have served them at the time in their environments of origin, it often becomes very disserving long term and in other relationships, leading them to once again feel unseen and unheard.
DBT, or Dialectical Behavior Therapy, is another form of talk therapy, and it’s based on CBT, however it has been modified for those who feel and express emotions very strongly.
The four main behavioral strategies of DBT are:
Mindfulness – being present and accepting and naming your feelings without judgment
Interpersonal Effectiveness – learning specific skills that support improved interpersonal interactions by improving communication skills, learning how to disagree or say no in an effective manner, and communicating with others in a way that is more likely to get one’s needs met
Emotion Regulation – learning how to regulate ones emotions, especially in relation to situations that may be out of one’s control. This is an important skill to grasp as big emotions often lead to big vulnerability.
Distress Tolerance – learning how to tolerate and accept a stressful situation without making it worse.
Family-Based Treatment is the most evidenced-based treatment for adolescents with eating disorders and has also begun to be used and researched in treating young adults as well. FBT empowers the family to take back control over their household, especially meals.
Parents know how to feed their children – at least they did until the eating disorder came to live with them. Eating disorders affect the whole family system and certainly require the support of the family with firm limits in order to ensure a full recovery.
Walden’s approach to OSFED
Walden uses evidenced-based practices to treat all eating disorders including OSFED. We pride ourselves on providing truly individualized care to every patient. That means elective programming options to individualize the treatment experience, tailor meal and treatment plans to meet individual goals, assigning and reassigning clinicians based on matching backgrounds or skill set, and offering a multidiscipline treatment experience.
We know finding care can be tough. Walden is here for you. If you are concerned that you, or a loved one, may have an eating disorder, please reach out by completing the form on this page or email us at email@example.com.
Rebekah Bardwell Dowekyo, LPC, CEDS-S, is Assistant Vice President of Clinical Operations for Connecticut and Western Massachusetts Regions at Walden Behavioral Care. Bekah (she/her/hers) has over 20 years of eating disorder experience. Prior to joining Walden, Bekah was an Intensive Care Manager at the Connecticut Behavioral Health Partnership. She also founded and directed the Intuitive Eating Program (IOP) at Hollywood Pavilion Hospital in Florida and held various clinical positions at The Renfrew Center. Bekah earned her master’s degree in Mental Health Counseling from Florida Atlantic University, is a Licensed Professional Counselor in the State of Connecticut and is a Certified Eating Disorder Specialist.
*This blog post does not necessarily represent the views of Walden Behavioral Care and its management. The Walden Blog is meant to represent a broad variety of opinions relating to eating disorders and their treatment.