Gender-Inclusive OSFED Treatment and Therapy

OSFED was formerly known as eating disorders not otherwise specified (EDNOS) in the DSM-IV (1994). The transition from EDNOS to OSFED occurred with the release of DSM-5 in 2013, which aimed to provide clearer diagnostic criteria and improve the classification of eating disorders. 

The DSM-5 includes the following examples for OSFED: 

• Atypical anorexia nervosa (AAN): Characterized by severe food restriction but with a normal body mass index (BMI) 
• Bulimia nervosa (BN) of low frequency or limited duration: Includes binge-eating and purging behaviors that occur less frequently or for shorter periods compared with typical BN criteria 
• Binge-eating disorder (BED) of low frequency or limited duration: Involves episodes of eating large amounts of food in a single sitting, occurring less frequently or for shorter durations than typical BED criteria 
• Purging disorder: Includes purging behaviors, such as vomiting, excessive exercise, and laxative abuse, without binge eating 
• Night eating syndrome: Involves excessive food intake after dinner or during the middle of the night  

Please note that this is not a comprehensive list. Eating disorders can take many forms, each with its own unique symptoms and challenges. 

Beyond OSFED, there are other emerging eating disorders, like orthorexia, that lack formal recognition in the DSM. Orthorexia is characterized by an obsession with “clean eating.” Despite its seemingly positive focus on health, orthorexia can be detrimental to a person’s well-being. For instance, people who struggle with orthorexia may eliminate entire food groups that they perceive as “bad” or unhealthy, leading to nutritional deficiencies and challenges in social settings involving food. 

In a society that often glorifies extreme behaviors in the pursuit of “health,” orthorexia remains misunderstood and underrecognized. The absence of formal diagnostic criteria contributes to this issue, making it difficult for people to receive the support they need. 

At Carolina House, we believe that anyone who is experiencing distress and impairment due to their eating behaviors deserves compassionate care and comprehensive treatment. Our team is dedicated to supporting individuals who have OSFED, orthorexia, and other eating disorders through personalized and evidence-based treatment. 

The signs and symptoms of OSFED can vary widely, affecting both the mind and body.  

People who are suffering from OSFED may: 

• Severely limit food intake  
• Constantly count calories or analyze the nutritional content of food 
• Avoid certain foods perceived as unhealthy (orthorexia) 
• Purge, use laxatives, or exercise excessively to “compensate” for eating 
• Withdraw from friends and family 
• Have a negative self-perception influenced by body image or eating behaviors 
• Feel anxious about eating with others or straying from food rituals 
• Suppress hunger by chewing excessive amounts of gum or drinking a lot of water 
• Experience sudden changes in mood, often related to food intake or body image 
• Feel guilty or ashamed after eating, particularly after a binge episode 
• Struggle to focus or concentrate 

Physical symptoms may include: 

• Digestive issues  
• Cold intolerance 
• Persistent fatigue 
• Dry skin, hair, and nails 
• Menstrual irregularities 
• Dizziness or fainting 
• Muscle soreness 
• Frequent bruises or slow-healing wounds 
• Disrupted sleep 
• Weight fluctuations 

If you or someone you know is showing any of these signs or experiencing these symptoms, we encourage you to reach out for support.  

Eating disorders typically have multiple causes and risk factors. Research published in the National Library of Medicine identified several key contributors to OSFED (referenced as EDNOS). These include: 

• Family history of eating disorders or other mental health conditions 
• Autoimmune and autoinflammatory diseases, such as diabetes, Crohn’s, and inflammatory bowel disease (IBD) 
• Childhood experiences, including disrupted households, bullying, and negative parental attitudes toward weight and eating habits 
• Personality traits like perfectionism, obsessiveness, and impulsivity 
• Co-occurring mental health conditions, particularly avoidant or borderline personality disorders 
• Financial hardship, potentially limiting access to nutritious food and increasing stress levels 
• Media and societal influences, including unrealistic beauty standards and weight stigma 
• Athletic pressures, particularly in sports that have strict food and weight requirements 

Understanding these complex factors is crucial for effective prevention, early intervention, and treatment planning for OSFED and related eating disorders. 

Research on OSFED is limited due to its recent classification in the DSM. Similarly, emerging eating disorders like orthorexia lack recognition, hindering research and awareness efforts.  

According to the National Eating Disorders Association (NEDA): 

• Prevalence: OSFED affects up to 6% of the population. 
• Severity: OSFED poses risks comparable to other eating disorders, with a study revealing that nearly 33% of eating disorder-related deaths were linked to OSFED.  

A review published in the National Library of Medicine (NLM) highlighted the following: 

• Mortality: OSFED carries mortality rates between 1.3 and 4.7 times higher than those of the general population. 
• Remission: A six-year study reported remission rates of 57% for restrictive-type OSFED and 64%-80% for binge-purge-type OSFED. 
• Diagnostic transitions: Approximately 22.5% of individuals initially diagnosed with bulimia nervosa were later diagnosed with another eating disorder, primarily OSFED. 
• Global impact: The Global Burden of Disease Study (2019) included BED and OSFED in its research, recognizing their prevalence and impact. At that time, these disorders affected 41.9 million people worldwide. 

Another source from the National Library of Medicine provided a comprehensive overview of orthorexia. Although its exact prevalence is unknown, studies indicate increasing rates, especially in Western societies in which “clean eating” has become a trend. 

Untreated OSFED can have a profound impact on a person’s health. Potential effects include: 

• Heart conditions 
• Gastrointestinal diseases 
• Infertility 
• Bone loss, increasing the risk for osteoporosis and injury 
• Damage to kidneys, liver, or pancreas 
• Development of other mental health conditions, such as anxiety, depression, and another eating disorder 
• Increased risk for self-harm or suicidal thoughts and behaviors 

Most tragically, if left untreated, OSFED can lead to death. However, with early intervention and professional help, individuals can heal from OSFED and reclaim their lives.  

As noted in the “Signs & Symptoms” and “Potential Effects” sections, an untreated eating disorder can significantly impact a person’s mental and physical well-being. Despite limited research about it, OSFED is just as severe as more recognized eating disorders and requires appropriate care.  

Benefits of receiving OSFED treatment at Carolina House can include: 

• Restoring physical health and nutritional balance 
• Developing a healthier relationship with food and body image 
• Learning effective coping mechanisms for managing stress and emotions 
• Building a supportive community with others on the path to healing 
• Receiving necessary resources and ongoing support for long-term success

At Carolina House, we provide comprehensive treatment for OSFED, including residential, inpatient, and outpatient care. We offer a variety of therapies, such as:  

• Group therapy 
• Individual therapy 
• Family therapy 
• Experiential therapies, including yoga, art, cooking, and gardening 

Depending on each client’s unique needs, they may also participate in these evidence-based practices: 

• Dialectical behavior therapy (DBT) 
• Cognitive behavioral therapy (CBT) 
• Motivational interviewing 
• Acceptance and commitment therapy (ACT) 

Each therapy method at Carolina House is carefully selected and integrated into personalized treatment plans to support clients on their journey toward healing from OSFED. 

Choosing Carolina House for OSFED treatment means entering a peaceful and nurturing environment, nestled within wooded landscapes, our campus offers serene settings where clients can connect with nature and themselves.  

Our commitment to providing exceptional care is shown through: 

• Personalized care plans designed to meet each client’s specific needs  
• Access to a dedicated team of professionals, including therapists, dietitians, and medical staff 
• Use of evidence-based therapies effective in treating eating disorders 
• Emphasis on promoting long-term healing and well-being through sustainable lifestyle changes 

At Carolina House in Durham, North Carolina, we recognize the courage it takes to seek treatment. If you are suffering in any capacity, we urge you to take that crucial first step and reach out for help. You deserve to heal and lead a fulfilling life, and we’re here to support you on your path to wellness.