OSFED? Oz-Fed? Are you FED up with trying to decode eating disorder acronyms? It can surely get confusing, but here’s help.

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OSFED (Other Specified Feeding or Eating Disorder) debuted in 2013 in the American Psychological Association’s release of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), but the concept isn’t completely new. Prior to OSFED’s inception, anyone who failed to meet the narrowly defined diagnostic criteria for Anorexia Nervosa or Bulimia Nervosa received an EDNOS diagnosis – “Eating disorder Not Otherwise Specified.”

Over time, EDNOS became a diagnostic dumping ground, serving as a catch-all diagnosis for patients whose symptomology didn’t fall within the strict criteria for one eating disorder in particular. It erroneously earned a reputation as being somehow less severe than other eating disorders, leading many EDNOS patients to feel as though they had fallen short of having a “real” eating disorder.

OSFED can be fatal and is not a diagnosis to be taken lightly.  The associated risks – electrolyte imbalance, osteoporosis, cardiac abnormalities, dental erosion, etc. – are just as life-threatening as full-threshold anorexia, bulimia and binge eating disorder. Thus, the APA decided to do away with EDNOS all together and added several new and distinct eating disorder diagnoses, including OSFED.

OSFED is now the most common eating disorder, encompassing an estimated 70% of all diagnoses. It’s characterized by abnormal eating patterns, distorted body image and extreme consciousness of weight/shape.  Heightened anxiety around mealtimes and compulsive exercise are common symptoms.  OSFED consists of (but is not limited to) five primary presentations:

  1. Atypical anorexia occurs when all (restricting food, fear of gaining weight) but the weight criteria (less than 85% of what’s expected) are met for anorexia nervosa.
  2. Atypical bulimia nervosa occurs when all (binge eating, inappropriate compensatory behavior) but the frequency and/or duration (at least once a week for three months) criteria are met for bulimia nervosa.
  3. Purging disorder is characterized by frequent and recurring purging episodes in the absence of binge eating.
  4. Atypical binge eating disorder occurs when all (lack of control, eating while feeling full, eating when not hungry, feelings of guilt) but the frequency and/or duration criteria are met for BED (at least once a week for three months).
  5. Night eating syndrome is characterized by the consumption of a large percentage of one’s daily caloric intake occurring during the night.

As previously stated, OSFED is a dangerous disease, requiring similar precautions and care to other eating disorder diagnoses. Treatment should involve an interdisciplinary team of professionals, psychoeducation, psychotherapy, cognitive behavioral and dialectical behavioral skill coaching, nutritional counseling and psychopharmacology. Levels of care include the outpatient level, as well as inpatient and residential stays, depending on symptom intensity.

If you or someone you know is experiencing symptoms, we’re here to help.


Laura Roias is director at Walden’s Worcester clinic providing clinical, administrative and fiscal oversight and development for the clinic. Formerly, she was assistant director of Walden’s partial hospitalization and intensive outpatient programs where she obtained extensive experience conducting individual, group and family therapy. Ms. Roias employs a strengths-based perspective and uses a wide range of therapeutic modalities including Cognitive Behavioral Therapy, Dialectical Behavioral Therapy and Interpersonal Therapy. She received her master’s degree from the University of North Carolina.

*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.