Eating disorders are frequently in the news, and people are occasionally inundated by images of skeletal or morbidly obese individuals whose emotional distress keeps them from becoming healthy and fit. Although the public is told to beware of stress-eating, bingeing and purging, or substituting food for love, few of these sensationalistic articles delve deep enough into these extremely complex situations to help readers truly understand where they come from or how they affect people’s lives.
On the other hand, we seldom hear anything about feeding disorders. Parenting magazines will occasionally discuss the problems involved when an infant refuses to breastfeed, or when a child with sensory issues balks at eating food of a certain color, texture, or taste, but the nature of feeding disorders for adolescents and adults, and the implications they carry for a family, are seldom explored.
In a gray area somewhere between the two diagnoses of a feeding disorder and an eating disorder falls a condition called other specified feeding or eating disorder (OSFED). This is the general diagnosis for eating, feeding, digestion, and nutrition symptoms that do not completely fit the symptom list of any single disorder. While this may seem like an unhelpful diagnosis, it allows doctors to go forward knowing that an eating disorder exists, even if they have not been able to narrow it down more specifically.
What Are Eating and Feeding Disorders?
According to the National Institute of Mental Health (NIMH), eating disorders are about far more than just eating too much or too little. They are psychiatric and medical disorders with symptoms that are behavioral. The symptoms of eating disorders can include:
- Skipping meals, pretending to eat, or making excuses for not eating
- Expressing distaste, shame, or repulsion at the thought of eating or the necessity of eating
- Exercising to excess (one of the less well-known symptoms of an eating disorder)
- Leaving during meals to go to the bathroom
- Dental problems from the loss of tooth enamel that occurs with frequent vomiting
- Abuse of laxatives, diet pills, diuretics, stimulants, or antidepressant medications
Eating disorders often lead to, or are comorbid with, other mental health and medical disorders, including depression, anxiety, cutting, and substance abuse.
Feeding disorders are slightly different from eating disorders. Feeding disorders refer to the inability of people, often but not always children, to eat foods of certain textures, smells, or tastes. This can lead to a lack of nutrition, which can severely impact development, and place sufferers at risk of delayed development, behavior problems, and the isolation that comes from not being able to share meals or events with friends. Someone with a feeding disorder may display the following symptoms:
- Refusal to try new foods in any circumstances
- Refusal or inability to eat foods from entire food groups
- Gagging or choking when eating or having other trouble swallowing
- Sensory issues in other areas
- Weight loss or malnutrition
The Kennedy Kreiger Institute points out that it is usually impossible to identify a single cause of a person’s feeding disorder. These disorders are sometimes, but not always, connected to physical ailments such as gastritis, food allergies, or short gut syndrome, but a physiological cause is not always easy to discern. Theories have been offered suggesting that feeding disorders are psychosomatic, emotional, or behavioral, meaning that they are the result of positive reinforcement over a period of time.
Unspecified Feeding or Eating Disorder
The National Eating Disorders Association (NEDA) explains that other specified feeding or eating disorder (OSFED) is the diagnosis that is made when an eating condition does not meet the criteria for any of the other eating or feeding disorders, but it is still a problem and disrupting the person’s life. OSFED is in fact the most common eating or feeding disorder
There are five primary subtypes of OSFED, each with symptoms of other disorders. They are listed by the National Association of Anorexia Nervosa and Associated Disorders (ANAD) as:
- Atypical anorexia nervosa
- Bulimia nervosa
- Binge eating disorder
- Purging disorder
- Night eating syndrome
Some of the symptoms of these five subtypes so closely resemble traditional diagnoses that they keep the eating disorder from being easily classified. These are explored by the Cleveland Clinic, and they can include one or more of the following:
- If the patient is female, OSFED includes all the symptoms of anorexia except for amenorrhea (lack of menstrual cycles).
- An individual with OSFED displays all the symptoms of anorexia except the person’s weight is in the normal range.
- The person with OSFED meets all the criteria for bulimia except that the binge/purge pattern occurs less than twice a week.
- The weight of the person with OSFED is in the normal range, but the person induces vomiting after eating small amounts of food, even a bite or two.
- The person with OSFED chews and spits out large amounts of food but never swallows it.
Someone with OSFED, as well as other eating disorders, is at higher risk for comorbid disorders, including anxiety disorders, obsessive-compulsive disorder, substance-related disorders, and addiction. Some researchers from the National Institute of Health have suggested that eating disorders could themselves be considered addictions, because they have a common pattern of basic psychological disturbance. Whether or not that is accurate in most cases, it is often true that eating disorders are strongly associated with substance addictions.
According to ANAD, OSFED is the most frequently diagnosed eating disorder, more than the “pure” forms of any specific eating disorder. That complexity of symptoms, combined with the presence of complicating disorders such as anxiety and addiction, makes treatment a challenge. Nevertheless, there is hope for recovery and health.
It’s important to find medical and psychiatric professionals who understand the significance of OSFED and other eating disorders. The best place to start is with a personal physician who can recommend counselors, treatment centers, or psychiatrists with the experience needed to help with the struggles of eating disorders and other conditions that may go with them.
Other professionals who may be involved in treatment include psychologists, dieticians, family therapists, and social workers. Treatment should be both physical and psychological, and it should get to the root causes of the disorder. Therapy may include individual, family, or group therapy with people who share the same struggles. It may also be necessary to consult with substance abuse counselors, since substance abuse so often co-occurs eating disorders. Medication may be another option, especially if a comorbid condition like depression or anxiety is present. Medication should only be used in conjunction with therapy.
A high-quality treatment center will take into account that a person suffering from OSFED may have an addiction, or a person with an addiction may be struggling with OSFED or another eating disorder. Therapy will offer ways to substitute harmful behaviors with healthy ones, to sustain recovery in the long run. With proper care, complete recovery is possible.