OSFED: When your child has a non-typical eating disorder

The media portrays eating disorders in a pretty narrow view. While most people have heard of anorexia and bulimia, those two clinical diagnoses are actually much less common than Other Specified Feeding and Eating Disorders (OSFED). Anorexia Nervosa is diagnosed in 1 in 200 adults, but at least 5% of adults, and up to 10% of teen girls have eating disorder symptoms that can be identified as OSFED.

One way to understand this is to observe that eating disorders occur along a spectrum. Most people in our society move up and down the spectrum to dieting and overeating occasionally. But if your child has become stuck at either end of the spectrum, there is plenty of room for concern that an eating disorder is taking hold.

Eating Behavior Spectrum 2

Purging behavior can occur at either end of the spectrum. Many people who are towards the Anorexia side of the spectrum also binge and purge and many people who are on the Binge Eating side of the spectrum may never purge to compensate for their binges. People who are diagnosed with Bulimia Nervosa may exhibit traits on both sides of the spectrum and can fall into any bodyweight category.

The most common situation that parents encounter when they have a child who has an OSFED eating disorder is that many insurance companies only provide coverage for clinical diagnoses of Anorexia or Bulimia. This leaves the parents stuck with a situation of either paying for care out of pocket or leaving the eating disorder to fester until the diagnostic criteria is met.

The diagnostic criteria for Anorexia Nervosa requires clinically low body weight, and yet many people who clearly suffer from an eating disorder are not clinically underweight.

The diagnostic criteria for Bulimia Nervosa requires both binge eating and purging, and yet many people who purge do not binge eat.

The greatest challenge for parents who have a child with an OSFED eating disorder is that often they must pursue treatment for their child even when medical professionals will not clinically diagnose the problem. While insurance companies will cover surgical mastectomies in people who have the BRCA gene, they often will not cover OSFED eating disorders.

Here are some of the signs of OSFED that you should look for in your child:

  • Intense fear of weight gain
  • Feelings of shame and guilt based on body size or weight
  • Obsessive dieting and restricting food
  • Cutting out entire food groups
  • Binge eating large quantities of food in a short amount of time
  • Purging, which may include vomiting, laxative use, or over-exercising to compensate for food intake
  • Feelings of shame and guilt based on eating behavior
  • Fear of certain foods

If you have a child who is diagnosed with OSFED, here are some things you should know:

  • OSFED is just as dangerous as Anorexia and Bulimia, and requires treatment, even if your physician says it is “subclinical”
  • Many people who have OSFED believe they are “not sick enough,” which leaves their disorder under-treated, setting them up for a lifetime eating disorder
  • People who have OSFED may be at a normal weight, but they are suffering nutritional deficiencies due to their eating disorder behavior
  • People who have OSFED may weight cycle. Since our culture values thinness, this means that people who have OSFED will be rewarded when they lose weight in an unhealthy manner, and they will feel like a failure when they gain weight. This cycle can continue indefinitely if the eating disorder is not treated.

If you have a child with OSFED, then you may need to work hard to find the right course of treatment that fits your child’s unique situation and accommodates your financial situation. The most important thing is to recognize that OSFED is serious and dangerous, and should be treated as soon as possible to minimize long-term damage to your child.

Ginny Jones is on a mission to empower parents to raise kids who are free from eating disorders and body hate.

She’s the editor of More-Love.org and a Parent Coach who helps parents handle their kids’ food and body issues.

Comments 7

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  3. Thank you for writing this post. I think that OSFED (which I believe was previously called EDNOS – are they the same thing?) needs more recognition and people need to be aware that it even exists. I struggled to find help for many years because when I finally did reach out, I would have been considered to have OSFED. My parents were also incredibly not concerned. If people are just given the information and the knowledge, it would be tremendously helpful for parents to be more aware of when their children need help – rather than brushing it off as a “normal” diet.

    1. Hi Melissa, You’re right – OSFED was previously called EDNOS. I’m so sorry to hear that you struggled to find the care you deserved, and hope you have found peace and recovery.

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