This part will cover go more indepth into the information about the last two eating disorders on the list. Which includes Other specified feeding or eating disorder & Avoidant/Restrictive Food Intake Disorder
4.Other specified feeding or eating disorder (OSFED)
Anorexia, bulimia, and binge eating disorder are diagnosed using a list of expected behavioural, psychological, and physical symptoms.
Sometimes a person’s symptoms don’t exactly fit the expected symptoms for any of these eating disorders.
In that case, they might be diagnosed with an “other specified feeding or eating disorder” (OSFED).
This is very common. OSFED accounts for the highest percentage of eating disorders, and anyone of any age, gender, ethnicity or background can experience it.
It is every bit as serious as anorexia, bulimia, or binge eating disorder, and can develop from or into another diagnosis.
People suffering from OSFED need and deserve treatment just as much as anyone else with an eating disorder.
The symptoms and behaviours are distressing, and impact different aspects of someone's life.
As OSFED is an umbrella term, people diagnosed with it may experience very different symptoms. It can also be used to communicate why someone doesn't meet the criteria for another eating disorder.
Some specific examples of OSFED include:
Atypical anorexia – where someone has all the symptoms a doctor looks for to diagnose anorexia, except their weight remains within or above the “normal” range.
Bulimia nervosa (of low frequency and/or limited duration) – where someone has all of the symptoms of bulimia, except the binge/purge cycles don’t happen as often or over as long a period of time as doctors would use to diagnose bulimia.
Binge eating disorder (of low frequency and/or limited duration) – where someone has all of the symptoms of binge eating disorder, except the binges don’t happen as often or over as long a period of time as doctors would use to diagnose binge eating disorder.
Purging disorder – where someone purges, for example by being sick or using laxatives, to affect their weight or shape, but this isn’t as part of binge/purge cycles.
Night eating syndrome – where someone repeatedly eats at night, either after waking up from sleep, or by eating a lot of food after their evening meal.
Like any other eating disorder, OSFED is a very serious mental illness that is not only about the way the person treats food but about underlying thoughts and feelings. The eating disorder may be a way of coping with these thoughts, or a way of feeling in control.
People with OSFED may work to hide their illness and someone may have been ill for a long time before physical symptoms appear, if they do at all. Any of the symptoms associated with bulimia, anorexia, or binge eating disorder can be part of OSFED, and these would come with the same short-term and long-term risks as in the case of these eating disorders.
As with other eating disorders, it will probably be changes in the person’s behaviour and feelings that those around them notice first, before any physical signs appear.
Signs of OSFED to look out for might include:
Overly focused on and/or secretive behaviour around food
Self-consciousness when eating in front of others
Low confidence and self-esteem
Poor body image
Irritability and mood swings
Tiredness
Social withdrawal
Feelings of shame, guilt, and anxiety
Difficulty concentrating
It’s not always obvious that someone has an eating disorder – remember, they are mental illnesses. If you’re worried about yourself or someone you know, even if only some of the signs on this page are present, you should still seek help immediately, as this gives the best chance of recovery.
5. Avoidant/Restrictive Food Intake Disorder
What is Avoidant/Restrictive Food Intake Disorder?
Avoidant restrictive food intake disorder, more commonly known as ARFID, is a condition characterised by the person avoiding certain foods or types of food, having restricted intake in terms of overall amount eaten, or both.
Anyone of any age can have ARFID. It occurs in children, teenagers and adults. Although people with ARFID may lose weight or have low weight, this is not a criteria for ARFID. It can occur at any weight and varies in different people.
Someone might be avoiding and/or restricting their food for a number of different reasons. The most common are the following three reasons. You might see these referred to as subtypes of ARFID:
They might be very sensitive to the taste, texture, smell, or appearance of certain types of food, or only able to eat foods at a certain temperature. This can lead to sensory-based avoidance or restriction of intake.
They may have had a distressing experience with food, such as choking or vomiting, or experiencing significant abdominal pain. This can cause the person to develop feelings of fear and anxiety around food or eating, and lead to them to avoiding certain foods or textures. Some people may experience more general worries about the consequences of eating that they find hard to put into words, and restrict their intake to what they regard as ‘safe’ foods. Significant levels of fear or worry can lead to avoidance based on concern about the consequences of eating.
In some cases, the person may not recognise that they are hungry in the way that others would, or they may generally have a poor appetite. For them, eating might seem a chore and not something that is enjoyed, resulting in them struggling to eat enough. Such people may have restricted intake because of low interest in eating.
It is very important to recognise that any one person can have one or more of these reasons behind their avoidance or restriction of food and eating at any one time. In other words, these examples are not mutually exclusive. And sometimes, there is no clear reason or event that has led to someone developing ARFID. This means that ARFID might look quite different in one person compared to another. Because of this, ARFID is sometimes described as an ‘umbrella’ term – it includes a range of different types of difficulty. Nevertheless, all people who develop ARFID share the central feature of the presence of avoidance or restriction of food intake in terms of overall amount, range of foods eaten, or both.
ARFID can be present on its own, or it can co-occur with other conditions; those most commonly co-occurring with ARFID are anxiety disorders, autism, ADHD and a range of medical conditions. The eating difficulties someone with ARFID has, can have been present for a very long time, in some cases almost as long as they can remember. In other people, it might have a more recent onset.
ARFID would not be diagnosed in someone who is fasting or chooses not to eat certain foods for religious or cultural reasons alone. Neither would it be diagnosed if there was a lack of available food or certain foods were being avoided because of allergies. A diagnosis of ARFID would also not be given if there is another clear reason for the eating difficulty, such as a medical condition that results in appetite loss or digestive difficulties.
Key aspects of ARFID are that it can have a negative impact on the person’s physical health and as well as on their psychological wellbeing. Children and young people with ARFID may fail to gain weight as expected and their growth may be affected, with a slowing in height increase. When a person does not have an adequate diet because they are only able to eat a narrow range of foods, they may not get essential nutrients needed for their health, development and ability to function on a day-to-day basis. In some people, serious weight loss or nutritional deficiencies may develop, which need treatment. In people whose food intake is very limited, nutritional supplements may be prescribed. In some cases a period of tube feeding may be recommended if physical risk is judged to be high.
Being limited in terms of what they can eat often causes people to experience significant difficulties at home, at school or college, at work and when with friends. Their mood and day-to-day functioning can be negatively affected. Many people with ARFID find it difficult to go out or to go on holiday, and their eating difficulties may make social occasions difficult to manage. They may find it difficult to make new friends or establish close relationships as social eating occasions are often part of this process.
Is ARFID different to anorexia and bulimia?
ARFID is different from anorexia nervosa, bulimia nervosa and related conditions; in ARFID, beliefs about weight and shape do not contribute to the avoidance or restriction of food intake. A diagnosis of ARFID would not be given at the same time as one of these other eating disorders, although it could precede or follow.
Signs of ARFID
Because ARFID includes a range of different types of difficulty that contribute to the avoidance or restriction of food intake, there is a wide range of possible signs and symptoms, not all of which would necessarily occur in one person.
Possible signs of ARFID include:
Eating a reasonable range of foods but overall having much less food than is needed to stay healthy.
Finding it difficult to recognise when hungry.
Feeling full after only a few mouthfuls and struggling to eat more.
Taking a long time over mealtimes/finding eating a ‘chore’.
Missing meals completely, especially when busy with something else.
Sensitivity to aspects of some foods, such as the texture, smell, or temperature.
Appearing to be a “picky eater”.
Always having the same meals.
Always eating something different to everyone else.
Only eating food of a similar colour (e.g. beige).
Attempting to avoid social events where food would be present.
Being very anxious at mealtimes, chewing food very carefully, taking small sips and bites, etc.
Weight loss (or in children, not gaining weight as expected).
Developing nutritional deficiencies, such as anaemia through not having enough iron in the diet.
Needing to take supplements to make sure nutritional and energy needs are met.
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