Other specified feeding or eating disorder

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Other specified feeding or eating disorder (OSFED)
Specialty Psychiatry

Other specified feeding or eating disorder (OSFED) is a DSM-5 category that, along with unspecified feeding or eating disorder (UFED), replaces the category formerly called eating disorder not otherwise specified (EDNOS) in the DSM-IV-TR. [1] It captures feeding disorders and eating disorders of clinical severity that do not meet diagnostic criteria for anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), avoidant/restrictive food intake disorder (ARFID), pica, or rumination disorder. [2] OSFED includes five examples:

Contents

Classification

The five OSFED examples that can be considered eating disorders include atypical AN, BN (of low frequency and/or limited duration), BED (of low frequency and/or limited duration), purging disorder, and NES. Of note, OSFED is not limited to these five examples, and can include individuals with heterogeneous eating disorder presentations (i.e., OSFED-other). Another term, Unspecified Feeding or Eating Disorder (UFED), is used to describe individuals for whom full diagnostic criteria are not met but the reason remains unspecified or the clinician does not have adequate information to make a more definitive diagnosis. [2]

Atypical anorexia nervosa
In atypical AN, individuals meet all of the criteria for AN, with the exception of the weight criterion: the individual's weight remains within or above the normal range, despite significant weight loss. [2]
Atypical bulimia nervosa
In this sub-threshold version of BN, individuals meet all criteria for BN, with the exception of the frequency criterion: binge eating and inappropriate compensatory behaviors occur, on average, less than once a week and/or for fewer than 3 months. [2]
Binge-eating disorder of low frequency and/or limited duration
In this sub-threshold version of BED, individuals must meet all criteria for BED, with the exception of the frequency criterion: binge eating occurs, on average, less than once a week and/or for fewer than 3 months. [2]
Purging disorder
In purging disorder, purging behavior aimed to influence weight or shape is present, but in the absence of binge eating. [2]
Night eating syndrome
In NES, individuals have recurrent episodes of eating at night, such as eating after awakening from sleep or excess calorie intake after the evening meal. This eating behavior is not culturally acceptable by group norms, such as the occasional late-night munchies after a gathering. [3] NES includes an awareness and recall of the eating, is not better explained by external influences such as changes in the individual's sleep-wake cycle, and causes significant distress and/or impairment of functioning. [2] Though not defined specifically in DSM-5, research criteria for this diagnosis proposed adding the following criteria (1) the consumption of at least 25% of daily caloric intake after the evening meal and/or (2) evening awakenings with ingestions at least twice per week. [4]

Treatment

Few studies guide the treatment of individuals with OSFED. However, cognitive behavioral therapy (CBT), which focuses on the interplay between thoughts, feelings, and behaviors, has been shown to be the leading evidence-based treatment for the eating disorders of BN and BED. [5] For OSFED, a particular cognitive behavioral treatment can be used called CBT-Enhanced (CBT-E), which was designed to treat all forms of eating disorders. This method focuses not only what is thought to be the central cognitive disturbance in eating disorders (i.e., over-evaluation of eating, shape, and weight), but also on modifying the mechanisms that sustain eating disorder psychopathology, such as perfectionism, core low self-esteem, mood intolerance, and interpersonal difficulties. [5] CBT-E showed effectiveness in two studies (total N = 219) and well maintained over 60-week follow-up periods. [6] CBT-E is not specific to individual types of eating disorders but is based on the concept that common mechanisms are involved in the persistence of atypical eating disorders, AN, and BN. [5]

Epidemiology

Few studies to date have examined OSFED prevalence. The largest community study is by Stice (2013), [7] who examined 496 adolescent females who completed annual diagnostic interviews over 8 years. Lifetime prevalence by age 20 for OSFED overall was 11.5%. 2.8% had atypical AN, 4.4% had subthreshold BN, 3.6% had subthreshold BED, and 3.4% had purging disorder. Peak age of onset for OSFED was 18–20 years. NES was not assessed in this study, but estimates from other studies suggest that it presents in 1% of the general population. [8]

A few studies have compared the prevalence of EDNOS and OSFED and found that though the prevalence of atypical eating disorders decreased with the new classification system, the prevalence still remains high. For example, in a population of 215 young patients presenting for ED treatment, the diagnosis of EDNOS to OSFED decreased from 62.3% to 32.6%. [9] In another study of 240 females in the U.S. with a lifetime history of an eating disorder, the prevalence changed from 67.9% EDNOS to 53.3% OSFED. [10] Although the prevalence appears to reduce when using the categorizations of EDNOS vs. OSFED, a high proportion of cases still receive diagnoses of atypical eating disorders, which creates difficulties in communication, treatment planning, and basic research. [11]

History

In 1980, DSM-III was the first DSM to include a category for eating disorders that could not be classified in the categories of AN, BN, or pica. [12] This category was called Atypical Eating Disorder. Atypical Eating Disorder was described in one sentence in the DSM-III and received very little attention in the literature, as it was perceived to be uncommon compared to the other defined eating disorders. In DSM-III-R, published in 1987, the Atypical Eating Disorder category became known as Eating Disorder Not Otherwise Specified (EDNOS). [13] DSM-III-R included examples of individuals who would meet criteria for EDNOS, in part to acknowledge the increasingly recognized heterogeneity of individuals within the diagnostic category.

In 1994, DSM-IV was published and expanded EDNOS to include six clinical presentations. [1] These presentations included individuals who:

A disadvantage of DSM-IV's broad EDNOS category was that people with very different symptoms were still classified as having the same diagnosis, making it difficult to access care specific to the disorder and conduct research on the diversity of pathology within EDNOS. [14] Furthermore, EDNOS was perceived as less severe than AN or BN, despite findings that individuals diagnosed with EDNOS share similarities with full-threshold AN or BN in the degree of eating pathology, general psychopathology, and physical health. [15] This perception prevented people in need from seeking help or insurance companies from covering treatment costs. [15] DSM-5, published in 2013, sought to address these issues by adding new diagnoses and revising existing criteria.

Related Research Articles

An eating disorder is a mental disorder defined by abnormal eating behaviors that negatively affect a person's physical or mental health. Types of eating disorders include binge eating disorder, where the afflicted eats a large amount in a short period of time; anorexia nervosa, where the person afflicted has an intense fear of gaining weight and restrict food or overexercise to manage this fear; bulimia nervosa, where the afflicted individual eats a lot (binging) then tries to rid themselves of the food (purging); pica, where the afflicted eats non-food items; rumination syndrome, where the afflicted regurgitates undigested or minimally digested food; avoidant/restrictive food intake disorder (ARFID), where people have a reduced or selective food intake due to some psychological reasons ; and a group of other specified feeding or eating disorders. Anxiety disorders, depression and substance abuse are common among people with eating disorders. These disorders do not include obesity.

Bulimia nervosa Type of eating disorder

Bulimia nervosa, also known as simply bulimia, is an eating disorder characterized by binge eating followed by purging; and excessive concern with body shape and weight. The aim of this activity is to expel the body of calories eaten from the binging phase of the process. Binge eating refers to eating a large amount of food in a short amount of time. Purging refers to the attempts to get rid of the food consumed. This may be done by vomiting or taking laxatives. Other efforts to lose weight may include the use of diuretics, stimulants, water fasting, or excessive exercise. Most people with bulimia are at a normal weight. The forcing of vomiting may result in thickened skin on the knuckles, breakdown of the teeth and effects on metabolic rate and caloric intake which cause thyroid dysfunction. Bulimia is frequently associated with other mental disorders such as depression, anxiety, bipolar disorder and problems with drugs or alcohol. There is also a higher risk of suicide and self-harm. Clinical studies show a relationship between bulimia and vulnerable narcissism as caused by childhood 'parental invalidation' leading to a later need for social validation.

Binge eating disorder (BED) is an eating disorder characterized by frequent and recurrent binge eating episodes with associated negative psychological and social problems, but without the compensatory behaviors common to bulimia nervosa, OSFED, or the binge-purge subtype of anorexia nervosa.

Binge eating is a pattern of disordered eating which consists of episodes of uncontrollable eating. It is a common symptom of eating disorders such as binge eating disorder and bulimia nervosa. During such binges, a person rapidly consumes an excessive quantity of food. A diagnosis of binge eating is associated with feelings of loss of control. Binge eating disorder is also linked with being overweight and obesity.

A pervasive developmental disorder not otherwise specified (PDD-NOS) is one of the four autistic disorders (AD) in the DSM-5 and also was one of the five disorders classified as a pervasive developmental disorder (PDD) in the DSM-IV According to the DSM-4, PDD-NOS is a diagnosis that is used for "severe or pervasive impairment in the development of reciprocal social interaction and/or verbal and nonverbal communication skills, or when stereotyped behavior, interests, and/or activities are present, but the criteria are not met for a specific PDD" or for several other disorders. PDD-NOS includes atypical autism, because the criteria for autistic disorder are not met, for instance because of late age of onset, atypical symptomatology, or subthreshold symptomatology, or all of these. Even though PDD-NOS is considered milder than typical autism, this is not always true. While some characteristics may be milder, others may be more severe.

Unspecified feeding or eating disorder (UFED) is a DSM-5 category of eating disorders that, along with other specified feeding or eating disorder (OSFED), replaced eating disorder not otherwise specified (EDNOS) in the DSM-IV-TR.

A food addiction or eating addiction is a behavioral addiction that is characterized by the compulsive consumption of palatable foods which markedly activate the reward system in humans and other animals despite adverse consequences.

Eating Attitudes Test

The Eating Attitudes Test, created by David Garner, is a widely used 26-item, standardized self-reported questionnaire of symptoms and concerns characteristic of eating disorders. The EAT is useful in assessing "eating disorder risk" in high school, college and other special risk samples such as athletes. EAT has been extremely effective in screening for anorexia nervosa in many populations.

Avoidant/restrictive food intake disorder (ARFID), previously known as feeding disorder, is a type of eating disorder in which people eat only within an extremely narrow repertoire of foods. It is a serious mental health condition that causes the individual to restrict food intake by volume and/or variety. This avoidance may be based on appearance, smell, taste, texture, brand, presentation, fear of adverse consequences, lack of interest in food, or a past negative experience with the food, to a point that may lead to nutritional deficiencies, failure to thrive, or other negative health outcomes. The fixation is not caused by a concern for body appearance or in an attempt to lose weight.

Purging disorder is an eating disorder characterized by the DSM-5 as self-induced vomiting, misuse of laxatives, diuretics, or enemas to forcefully evacuate matter from the body. Purging disorder differs from bulimia nervosa (BN) because individuals do not consume a large amount of food before they purge. In current diagnostic systems, purging disorder is a form of other specified feeding or eating disorder. Research indicates that purging disorder, while not rare, is not as commonly found as anorexia nervosa or bulimia nervosa. This syndrome is associated with clinically significant levels of distress, and that it appears to be distinct from bulimia nervosa on measures of hunger and ability to control food intake. Some of the signs of purging disorder are frequent trips to the bathroom directly after a meal, frequent use of laxatives, and obsession over one's appearance and weight. Other signs include swollen cheeks, popped blood vessels in the eyes, and clear teeth which are all signs of excessive vomiting.

National Eating Disorders Association

The National Eating Disorders Association (NEDA) is an American non-profit organization devoted to preventing eating disorders, providing treatment referrals, and increasing the education and understanding of eating disorders, weight, and body image. The National Eating Disorders Association organizes and sponsors National Eating Disorders Week. Also known as NEDAwareness Week, it takes place during the last week of February, and is "a collective effort of primarily volunteers, including eating disorder professionals, health care providers, students, educators, social workers, and individuals committed to raising awareness of the dangers surrounding eating disorders and the need for early intervention and treatment." NEDA is the defendant in the lawsuit Haugen & Armos vs The National Eating Disorder Association filed December 17, 2020 in US District Court for the Northern District of Texas.

The Eating Disorder Inventory (EDI) is a self-report questionnaire used to assess the presence of eating disorders, (a) anorexia nervosa both restricting and binge-eating/purging type; (b) bulimia nervosa; and (c) eating disorder not otherwise specified including binge eating disorder. The original questionnaire consisted of 64 questions, divided into eight subscales. It was created in 1984 by David M. Garner and others. There have been two subsequent revisions by Garner: the Eating Disorder Inventory-2 (EDI-2) and the Eating Disorder Inventory-3 (EDI-3).

The Eating Disorder Diagnostic Scale (EDDS) is a 22 item self-report questionnaire that assesses the presence of three eating disorders; anorexia nervosa, bulimia nervosa and binge eating disorder. It was adapted by Stice et al. in 2000 from the validated structured psychiatric interview: The Eating Disorder Examination (EDE) and the eating disorder module of the Structured Clinical Interview for DSM-IV (SCID)16.

Cyclothymia Mental disorder

Cyclothymia, also known as cyclothymic disorder, is a mental and behavioural disorder that involves numerous periods of symptoms of depression and periods of symptoms of elevated mood. These symptoms, however, are not sufficient to be a major depressive episode or a hypomanic episode. Symptoms must last for more than one year in children and two years in adults.

Anorexia nervosa Type of eating disorder

Anorexia nervosa, often referred to simply as anorexia, is an eating disorder characterized by low weight, food restriction, body image disturbance, fear of gaining weight, and an overpowering desire to be thin. Anorexia is a term of Greek origin: an- and orexis, translating literally to "a loss of appetite"; instead, the adjective nervosa indicates the functional and non-organic nature of the disorder. Anorexia nervosa was coined by Gull in 1873 but, despite literal translation, the symptom of hunger is frequently present and the pathological control of this instinct is a source of satisfaction for the patients.

The differential diagnoses of anorexia nervosa (AN) includes various types of medical and psychological conditions, which may be misdiagnosed as AN. In some cases, these conditions may be comorbid with AN because the misdiagnosis of AN is not uncommon. For example, a case of achalasia was misdiagnosed as AN and the patient spent two months confined to a psychiatric hospital. A reason for the differential diagnoses that surround AN arise mainly because, like other disorders, it is primarily, albeit defensively and adaptive for, the individual concerned. Anorexia Nervosa is a psychological disorder characterized by extremely reduced intake of food. People suffering from Aneroxia Nervosa have a low self-image and consider themselves overweight. Common behaviors and signs of someone suffering from AN:

Eating disorders and memory

Many memory impairments exist as a result from or cause of eating disorders. Eating disorders (EDs) are characterized by abnormal and disturbed eating patterns that affect the lives of the individuals who worry about their weight to the extreme. These abnormal eating patterns involve either inadequate or excessive food intake, affecting the individual's physical and mental health.

Cognitive behavioral therapy (CBT) is derived from both the cognitive and behavioral schools of psychology and focuses on the alteration of thoughts and actions with the goal of treating various disorders. The cognitive behavioral treatment of eating disorders emphasizes on the minimization of negative thoughts about body image and the act of eating, and attempts to alter negative and harmful behaviors that are involved in and perpetuate eating disorders. It also encourages the ability to tolerate negative thoughts and feelings as well as the ability to think about food and body perception in a multi-dimensional way. The emphasis is not only placed on altering cognition, but also on tangible practices like making goals and being rewarded for meeting those goals. CBT is a “time-limited and focused approach” which means that it is important for the patients of this type of therapy to have particular issues that they want to address when they begin treatment. CBT has also proven to be one of the most effective treatments for eating disorders.

Eating disorders typically peak at specific periods in development, notably sensitive and transitional periods such as puberty. Feeding and eating disorders in childhood are often the result of a complex interplay of organic and non-organic factors. Medical conditions, developmental problems and temperament are all strongly correlated with feeding disorders, but important contextual features of the environment and parental behavior have also been found to influence the development of childhood eating disorders. Given the complexity of early childhood eating problems, consideration of both biological and behavioral factors is warranted for diagnosis and treatment.

Body image disturbance (BID) is a common symptom in patients with eating disorders.

References

  1. 1 2 American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.
  2. 1 2 3 4 5 6 7 8 American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
  3. ↑ Nolen-Hoeksema, S. (2013). (Ab)normal Psychology (6th edition). New York: McGraw Hill. p. 347. ISBN   9780078035388.
  4. ↑ Allison K.C., Lundgren J.D., O'Reardon J.P., Martino N.S., Sarwer D.B., Wadden T.A., Stunkard A.J. (2008). "The Night Eating Questionnaire (NEQ): Psychometric properties of a measure of severity of the night eating syndrome". Eating Behaviors, 9(1), 62-72.
  5. 1 2 3 Fairburn C.G., Cooper Z., Shafran R. (2003). "Cognitive behaviour therapy for eating disorders: a 'transdiagnostic' theory and treatment". Behaviour Research and Therapy, 41(5), 509-28.
  6. ↑ Fairburn C.G. & Wilson G.T. (2013). "The Dissemination and Implementation of Psychological Treatments: Problems and Solutions". International Journal of Eating Disorders, 46(5), 516-21.
  7. ↑ Stice E., Marti C.N., Rohde P. (2013). "Prevalence, incidence, impairment, and course of the proposed DSM-5 eating disorder diagnoses in an 8-year prospective community study of young women". Journal of Abnormal Psychology , 122(2), 445-57.
  8. ↑ Milano W, De Rosa M, Milano L, Capasso A (2012). "Night eating syndrome: an overview". Journal of Pharmacy and Pharmacology , 64(1), 2-10.
  9. ↑ Ornstein RM, Rosen DS, Mammel KA, Callahan ST, Forman S, Jay MS, Fisher M, Rome E, Walsh BT (2013). "Distribution of eating disorders in children and adolescents using the proposed DSM-5 criteria for feeding and eating disorders". Journal of Adolescent Health , 53(2), 303-5.
  10. ↑ Keel P.K., Brown T.A., Holm-Denoma J., Bodell L.P. (2011). "Comparison of DSM-IV versus proposed DSM-5 diagnostic criteria for eating disorders: reduction of eating disorder not otherwise specified and validity". International Journal of Eating Disorders, 44(6), 553-60.
  11. ↑ Thomas, J. J., Vartanian, L. R., & Brownell, K. D. (2009). "The relationship between eating disorder not otherwise specified (EDNOS) and officially recognized eating disorders: Meta-analysis and implications for DSM". Psychological Bulletin , 135, 407-33.
  12. ↑ American Psychiatric Association (1980). Diagnostic and statistical manual of mental disorders (3rd ed.) (DSM-III). Washington, DC: Author.
  13. ↑ American Psychiatric Association (1987). Diagnostic and statistical manual of mental disorders (3rd ed., rev.) (DSM-III-R). Washington, DC: Author.
  14. ↑ Eddy K.T., Le Grange D., Crosby R.D., Hoste R.R., Doyle A.C., Smyth A., Herzog D.B. (2010). "Diagnostic classification of eating disorders in children and adolescents: how does DSM-IV-TR compare to empirically-derived categories?". Journal of the American Academy of Child and Adolescent Psychiatry . 49(3), 277-87.
  15. 1 2 Thomas, Jennifer J. (2013, August 21). Goodbye EDNOS, Hello OSFED [Blog post]. Retrieved from http://www.jennischaefer.com/blog/eating-and-body-image/goodbye-ednos-hello-osfed-subthreshold-and-atypical-eating-disorders-in-dsm-5/
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