What is OSFED?
Other Specified Food and Eating Disorder (OSFED); a conglomerate of behaviors and disordered addictions that demonstrate a disordered relationship with food and body. OSFED is considered a “catch-all” or broad category within Eating Disorders, as it is the presence of several ED behaviors. Many individuals with an ED show signs of several behaviors across all schemas within ED diagnosis; such as, bingeing, purging, restricting and showing severe signs of anxiety in relation to food, and her body.
What is ARFID?
Avoidant-Restrictive Food Intake Disorder (ARFID) is more common in children and adolescents and is most often associated with anxiety and obsessive compulsive disorder (OCD).
Feeding and Eating disturbances are displayed by persistent failure to meet appropriate nutritional and/or energy needs. Signs and symptoms may include significant weight loss, or failure to achieve expected weight gain, significant nutritional deficiency, dysfunction in social situations, dependence on supplements or internal feeding.
ARFID symptoms and signs include avoidant, aversive, restrictive or mix type when it comes to food intake.
Diagnostic Criteria for ARFID
(National Eating Disorder Association (NEDA), 2017)
- An eating or feeding disturbance (e.g., apparent lack of interest in eating or food; avoidance based on the sensory characteristics of food; concern about aversive consequences of eating) as manifested by persistent failure to meet appropriate nutritional and/or energy needs associated with one (or more) of the following:
- Significant weight loss (or failure to achieve expected weight gain or faltering growth in children).
- Significant nutritional deficiency.
- Dependence on enteral feeding or oral nutritional supplements.
- Marked interference with psychosocial functioning.
- The disturbance is not better explained by lack of available food or by an associated culturally sanctioned practice.
- The eating disturbance does not occur exclusively during the course of anorexia nervosa or bulimia nervosa, and there is no evidence of a disturbance in the way in which one’s body weight or shape is experienced.
- The eating disturbance is not attributable to a concurrent medical condition or not better explained by another mental disorder. When the eating disturbance occurs in the context of another condition or disorder, the severity of the eating disturbance exceeds that routinely associated with the condition or disorder and warrants additional clinical attention (NEDA, 2017).
Warning Signs & Symptoms of ARFID
Behavioral and psychological
- Dramatic weight loss
- Dresses in layers to hide weight loss or stay warm
- Reports constipation, abdominal pain, cold intolerance, lethargy, and/or excess energy
- Reports consistent, vague gastrointestinal issues (“upset stomach”, feels full, etc.) around mealtimes that have no known cause
- Dramatic restriction in types or amount of food eaten
- Will only eat certain textures of food
- Fears of choking or vomiting
- Lack of appetite or interest in food
- Limited range of preferred foods that becomes narrower over time (i.e., picky eating that progressively worsens).
- No body image disturbance or fear of weight gain (NEDA, 2017).
Because both anorexia and ARFID involve an inability to meet nutritional needs, both disorders have similar physical signs and medical consequences.
- Stomach cramps, other non-specific gastrointestinal complaints (constipation, acid reflux, etc.)
- Menstrual irregularities—missing periods or only having a period while on hormonal contraceptives (this is not considered a “true” period)
- Difficulties concentrating
- Abnormal laboratory findings (anemia, low thyroid and hormone levels, low potassium, low blood cell counts, slow heart rate)
- Post-puberty female loses menstrual period
- Feeling cold all the time
- Sleep problems
- Dry skin
- Dry and brittle nails
- Fine hair on body (lanugo)
- Thinning of hair on head, dry and brittle hair
- Muscle weakness
- Cold, mottled hands and feet or swelling of feet
- Poor wound healing
- Impaired immune functioning (NEDA, 2017).
Health Consequences of ARFID
In ARFID, the body is denied the essential nutrients it needs to function normally. Thus, the body is forced to slow down all of its processes to conserve energy, resulting in serious medical consequences. The body is generally resilient at coping with the stress of eating disordered behaviors, and laboratory tests can generally appear perfect even as someone is at high risk of death. Electrolyte imbalances can kill without warning; so can cardiac arrest. Therefore, it’s incredibly important to understand the many ways that eating disorders affect the body (NEDA, 2017).
National Eating Disorder Association. (2017). General Statistics. Retrieved from https://www.nationaleatingdisorders.org/general-statistics