Editor's note: This article was sponsored by THIRA Health.
Today’s most common eating disorder is one you’ve probably never heard of. Rates of eating disorders have more than doubled over the past decade, according to a 2019 analysis of published research. The majority of these cases are referred to as other specified feeding or eating disorder, or OSFED, says psychiatrist Mehri Moore, M.D., medical director and founder of THIRA Health, a mental health treatment center for women and girls in Bellevue, Washington.
What is OSFED?
Debuted in 2013 as a catchall term for eating disorders that don't fit the narrow criteria for anorexia, bulimia, binge-eating disorder or avoidant-restrictive food intake disorder, OSFED was previously known as eating disorder not otherwise specified, or EDNOS. Like other eating disorders, OSFED is characterized by a preoccupation with food, fears about weight gain and abnormal eating patterns that restrict someone’s ability to participate in life.
Because the public doesn’t know much about OSFED, people sometimes mistakenly assume that it’s less severe or damaging than other eating disorders. This isn’t true, since the condition shares the same health risks as other eating disorders, including malnutrition, poor bone health, heart and circulation problems, and dental erosion, and can be fatal in a small percentage of cases.
For someone with OSFED, an eating problem hampers their ability to engage in life or meet developmental milestones, but their abnormal eating doesn’t align with the established symptoms or timetable for another eating disorder, says Moore. “They may not have lost enough body weight or may be bingeing and purging just once a week. But the behavior still impacts their development and their daily routine and impairs their functioning.”
What to look for
Caregivers should know that eating problems can’t always be neatly defined, and most eating disorders fall outside the well-established definitions they might associate with anorexia or bulimia, says Moore. A person experiencing OSFED may not be excessively thin, appear to be dieting or rush to the bathroom to throw up after meals. Or they may hide these behaviors from their parents.
Signs of OSFED may be hard to spot in a culture where body dissatisfaction is the norm and cries of “I’m so fat!” are common. Symptoms may be subtle or show up gradually, says Moore. Things such as a gradual withdrawal from swimming, clothes shopping or any activity that shows their body; a fixation with body size and weight; avoiding family meals and asking to eat in another room instead of at the dinner table; and consuming less food around others are worrisome, she notes.
Successfully treating an eating disorder involves treating the underlying condition, often anxiety, depression or mood dysregulation.
“Parents may notice that food and body weight are a constant point of discussion for their child; they may be preoccupied with the word ‘fat,’” says Moore. Behaviors such as gradually withdrawing from activities such as swimming, clothes shopping or any other that shows their body; fixating on body size and weight; avoiding family meals and asking to eat in another room instead of at the dinner table; and consuming less food around others are worrisome signs, she notes.
Eating disorders, including OSFED, can be cured, says Moore. “I use the word ‘cured’ because I have seen it happen.” Nearly three decades ago, Moore pioneered a comprehensive eating disorder treatment center in Seattle called The Moore Center.
Successfully treating an eating disorder involves treating the underlying condition, often anxiety, depression or mood dysregulation, she says. “Eating disorders are a leading symptom of anxiety and depression.”
Using a form of structured talk therapy called dialectical behavior therapy, or DBT, THIRA’s new eating disorder treatment programs address eating disorders along with underlying mental health conditions. “We’re using the model of DBT, family-based treatment and meal monitoring to address the whole person, instead of just the diagnosis. It’s truly a holistic approach,” says Moore.
Because OSFED and other eating disorders involve varied symptoms, treatment plans are individualized, says Moore. Recovery takes longer if patients need to restore weight or address severe nutritional deficits.
While severely ill patients may benefit from hospitalization and around-the-clock monitoring, others don’t need that level of support. Partial hospitalization programs like THIRA’s (one of three programs Thira offers) allow patients to continue living at home while receiving daily support, medical monitoring and counseling on-site. “At the end of the day, they can go home, sleep in their own beds and have the support of their families,” says Shea McCammant, professional relations coordinator at THIRA Health.
The treatment model helps families change negative patterns and also come to acceptance of other patterns and attributes, says Moore. “We see healthy body image as radical acceptance of who you are and what your body looks like, and being able to accept and use your body the way that it is designed to perform for you.”
The goal is a family culture that supports wellness, says Moore. “We’re building a wholehearted acceptance of your physical self that prevails in the family.”