Eating Disorders

Other Specified Feeding or Eating Disorders (OSFED)

This category applies to situations in which there are symptoms of disordered eating and/or feeding behaviors however they do not fully meet criteria for an eating disorder diagnosis of anorexia, bulimia or binge-eating disorder. While these eating disorders do not have defined symptoms, they all share the commonality of causing significant emotional and physical distress that can greatly disrupt an individual’s daily life and health status. Similar to all types of eating disorders, anyone struggling with emotional or physical disturbances involving food, eating and body weight deserves attention. If an individual suspects OSFED he or she should seek guidance from a qualified eating disorder professional for help.

Examples of the “other specified” designation include the following:

  • Atypical anorexia nervosa: All the criteria for anorexia nervosa are met, however, despite significant weight loss the individual’s weight is within or above the normal range.
  • Bulimia nervosa (of low frequency and/or limited duration): All the criteria for the bulimia nervosa are met, except that the binge eating and inappropriate compensatory behaviors occur, on average, less than once a week and/or for less than 3 months.
  • Purging disorder: Recurrent purging behavior to influence weight or shape (e.g., self-induced vomiting; misuse of laxatives, diuretics, or other medications; excessive exercise) in the absence of binge eating.
  • Binge-eating disorder (of low frequency and/or limited duration): All of the criteria for binge-eating disorder are met, except that the binge eating occurs, on average, less than once a week and/or less than 3 months.
  • Night Eating Syndrome: Recurrent episodes of night eating, manifested by eating after awakening from sleep or by excessive food consumption after the evening meal. There is awareness and recall of the eating. The night eating causes significant distress and/or impairment in functioning.

Additional types of disordered eating and feeding disorders

  • Orthorexia Nervosa: Being obsessed with a “healthy and or clean” diet to the point where it interferes with one’s life. Orthorexia is a serious condition which can harm an individual’s health and impact quality of life.
  • “Bigorexia” or Muscle Dysmorphia: The opposite of anorexia where the individual has a fear of never being “big enough.”
  • Repeatedly chewing and spitting out, but not swallowing large amounts of food.
  • Pica: A compulsive craving for eating, chewing or licking non-food items or foods containing no nutrition (e.g., chalk, plaster, paint chips, baking soda, starch, glue, rust, ice, coffee grounds, and cigarette ashes). Cravings for non-food items may be related to vitamin or mineral deficiencies.
  • Sleep Eating Disorder (SED-NOS): When an individual has recurrent episodes of sleep walking during which time they binge on usually large quantities of food. It is a combined sleep-eating problem.


What is Body Dysmorphic Disorder (BDD)?

BN is defined as having recurrent cycles of binge eating followed by some form of compensatory behavior, such as vomiting, with the intent to undo or compens

Examples of the “other specified” designation include the following:

Body Dysmorphic Disorder is a preoccupation or obsession with a flaw or a perceived flaw in visual appearance. Individuals with BDD experience such intense concern with visual appearance that this impacts relationship, work, social interactions and everyday life. Some example of this would be obsessing to the point of severe depression over physical attributes such as freckles, a large nose, blotchy skin, wrinkles, acne, scarring, and body weight. Individuals with BDD often have low self-esteem and strong fear of rejection.

BDD diagnosed by these specific criteria:

  1. Preoccupation with one or more perceived defects or flaws in physical appearance that are not observable, or appear only slight, to others.
  2. At some point during the disorder, the individual has performed repetitive behaviors (e.g., mirror checking, excessive grooming, skin picking, reassurance seeking) or mental acts (e.g., comparing his or her appearance with that of others) in response to the appearance concerns.
  3. The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
  4. The appearance preoccupation is not better explained by concerns with body fat or weight in an individual whose symptoms meet diagnostic criteria for an eating disorder.

(Adapted from the DSM-5)


What is Emotional Eating?

Emotional eating is eating for reasons other than physical hunger (e.g., sadness, anger, loneliness, boredom, stress, anxiety...). While almost everyone eats for emotional reasons once in a while, emotional eating often occurs with greater frequency, intensity and compulsivity amongst individuals with eating disorders, especially with eating disorders involving binge behaviors (binge eating disorder and bulimia nervosa).

So why does one emotionally eat? Emotional eating is an attempt to soothe, lessen or control an uncomfortable feeling with food and often leads to overeating. An example could be attempting to soothe oneself with a bowl of ice cream when feeling sad. The reality, however, is food cannot satisfy a feeling although one might temporarily be comforted during the eating episode. Once the emotional eating has occurred the feelings return, often intensified by the addition of guilt or shame around overeating behaviors. This leads to a vicious cycle of using food to cope with negative emotions followed by increased distress and guilt after the eating behavior.

It is important to work with both a Registered Dietitian Nutritionist and Therapist when overcoming emotional eating. The RDN can help the individual learn how to identify and respond to hunger and fullness cues and recognize potential triggers or patterns that may lead to emotional eating episodes. The therapist, can address the emotions behind the emotional eating and explore some root causes. Emotional eating can cause significant mental and physical distress and is important to address with both a nutritional and psychological approach.


What is Food Addiction?

Food addiction involves the loss of control over the ability to stop eating certain foods. It involves the chemical dependencies on specific foods or food in general and often involves highly palatable foods such as those high in sugar, salt and fat. After eating certain foods, people develop physical craving for the foods which can lead to progressively greater intakes over time. The individual may feel unable to stop eating certain foods, feeling “addicted” to the foods, which can negatively impact ones’ emotional and physical well-being.(


Eating behaviors

Unfortunately, our dietary habits are integrally related and interwoven with our emotional health. Many of the substances we consume and behaviors we participate in are used as painkillers, often on a sub-conscious level. These are ways of avoiding honestly facing our feelings, both about ourselves and our lives, and are often utilized as ways to feel good temporarily while avoiding personal growth.

The use of substances or behaviors as coping skills is what commonly challenges people when trying to change their dietary habits because the barriers to healthy eating are often, ‘not about the food.’ The barriers are frequently related to thought patterns and emotional health; therefore, when there are challenges in modifying food intake to what is supportive to health and healing, it is not generally due to a lack of desire or knowledge. The process of healing looks different from person to person. It has its own starting point and the path takes its own unique course.