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What’s with all the acronyms? Lately, I have been hearing this question a lot from people whose lives have been touched by eating disorders. So I decided to ask my brilliant coauthor, clinical psychologist Jennifer J. Thomas to answer it for all of us. She is an assistant professor of psychology in the department of psychiatry at Harvard Medical School and Co-Director of the Eating Disorders Clinical and Research Program at Massachusetts General Hospital. And Dr. Thomas is just an overall amazing person, too. In the process of writing Almost Anorexic, not only did she demystify acronyms like DSM, (Diagnostic and Statistical Manual of Mental Disorders, a book clinicians use to diagnose psychiatric disorders), but she also became a new best friend. Yes, that’s BFF!

 

Goodbye EDNOS, Hello OSFED: Subthreshold and Atypical Eating Disorders in DSM-5 by Jennifer J. Thomas, Ph.D., @DrJennyThomas

DSM BooksI was thrilled to get my copy of DSM-5 in the mail this May. For one thing, it was bright purple—a cheerful improvement on DSM-IV’s dreary gray!

More importantly, DSM-5 improved on upon DSM-IV by providing more detail about eating disorders that do not meet criteria for anorexia nervosa, bulimia nervosa, or binge eating disorder. These presentations were previously classified as Eating Disorder Not Otherwise Specified (EDNOS) in DSM-IV, but the category was renamed OSFED (Other Specified Feeding or Eating Disorder) in DSM-5.

As a social media enthusiast, I have seen a lot of interesting Twitter responses to DSM-5 changes over the past few weeks, including tweets like “No more EDNOS? I guess I no longer have an eating disorder” or “OSFED? Ugh. I hate the ‘fed’ part.” So I’m writing this post as a way to de-mystify the recent changes to the category formerly known as EDNOS. Here is what really happened behind the scenes of DSM-5’s shiny (purple!) cover.

When DSM-IV was published in 1994, folks with atypical or subthreshold eating disorders were classified as EDNOS. DSM-IV provided a list of six examples that might fall into this category. For instance, meeting all criteria for anorexia but continuing to menstruate counted as EDNOS, and so did repeatedly chewing and spitting out food. Ditto for purging in the absence of binge eating, or bingeing in the absence of purging. The advantage of the EDNOS category was that people could receive an eating disorder diagnosis without meeting the relatively narrow criteria for anorexia or bulimia. The disadvantage was that people with very different symptoms got lumped into the same category, which made accessing specialized care and conducting research pretty challenging. Unfortunately, the pervasive myth that EDNOS was somehow less severe than anorexia or bulimia sometimes prevented people who fit into this category from seeking help, or insurance companies from covering costs.

Luckily, over the past 20 years, our understanding of subthreshold and atypical presentations has greatly improved. For example, my research has suggested that individuals who meet some but not all criteria for anorexia or bulimia typically have equivalent problems in the areas of eating disorder symptoms, medical consequences, and overall mental health. Jenni Schaefer and I thought this message was so important that it formed the basis for our book, Almost Anorexic!

Meanwhile, other clinical researchers identified new disorders that they suggested for inclusion in DSM-5. You have probably heard of binge eating disorder—first described by Mickey Stunkard at University of Pennsylvania—where individuals binge eat but do not purge.  With the advent of DSM-5, binge eating disorder was removed from the DSM-IV EDNOS category and added as an official eating disorder diagnosis.

Similarly, Pamela Keel at Florida State University identified a new syndrome called purging disorder, in which people purge but, unlike those with bulimia, do not binge. Meanwhile, Kelly Allison and her colleagues at University of Pennsylvania proposed a new category called night eating syndrome. People with night eating syndrome are distressed by a problem with their sleep-wake cycle that causes them to eat very little during the day and then either consume most of their calories in the evening or wake up in the middle of the night to eat.

Although purging disorder and night eating syndrome didn’t ultimately make the cut as official diagnoses, DSM-5 recognized the importance of subthreshold and atypical conditions by naming five specific OSFED subtypes:

  1. Atypical Anorexia Nervosa (i.e., anorexic features without low weight)
  2. Bulimia Nervosa (of low frequency and/or limited duration)
  3. Binge Eating Disorder (of low frequency and/or limited duration)
  4. Purging Disorder
  5. Night Eating Syndrome

DSM-5 also includes a category called Unspecified Feeding or Eating Disorder (UFED) that is reserved for folks who don’t fit into any of these five categories, or for whom there is not enough information to make a specific OSFED diagnosis. In our study of DSM-5 changes at the Klarman Eating Disorders Center, just 1 of 150 patients had UFED. This patient struggled with bingeing and purging but didn’t have the intense shape and weight concerns that are required for a bulimia diagnosis.

I appreciate that UFED is kind of a strange name. And, as highlighted by the tweets I shared above, OSFED is no better. But rest assured that the DSM-5 Eating Disorders Work Group did not select these acronyms in order to confuse us or in any way diminish the importance of these conditions. Instead, the new names were part of DSM-wide changes, meaning that OSFED and UFED are in good company with “Other Specified Depressive Disorder” and “Unspecified Anxiety Disorder,” among others.

To complicate matters even further (provided your head isn’t already spinning from all of these acronyms!), if you were following the DSM-5 process closely, you may have even heard OSFED referred to as FECNEC (Feeding or Eating Conditions Not Elsewhere Classified) or FEDNEC (where “conditions” became “disorders”). But both FEDNEC and FECNEC ultimately fell on the cutting room floor, so from now on we will stick with OSFED.

…at least until DSM-6.  TMI?

The bottom line? Whatever acronym best describes your eating disorder symptoms, full recovery is possible!

 

Thanks so much for your great post, Jenny. (If you meet Dr. Thomas, she will tell you to call her Jenny. Yes, our book is by Jenny and Jenni!) We would love to hear from you. Please post comments and questions here. We will do our best to respond.

This post has become so popular that we have created a downloadable version!
Just click here.

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  • Michael Elmer

    LOL! Wow! That IS quite a bit to take in! Hopefully insurance companies will take note of this and actually start paying for ED treatments… for both women and for men.

    • Jennifer J. Thomas, Ph.D.

      I hope so too, Michael! PS Great acronym usage.

  • M Levin

    Does this lump in people who have gastroparesis, have had total gastrectomies, tracheostomies etc with bulemics and anorexics? If so, this is not detailed enough.

    • Jennifer J. Thomas, Ph.D.

      It actually does NOT lump in these folks — good question! To have a feeding or eating disorder, your problem with food needs to cause difficulties above and beyond any physical problems that might be making it difficult to eat. Hope this helps!

  • Anad Lori Licker

    Hi Jenny,
    Great article. I’m sure many people can find use for it as a good cheat sheet for deciphering all of the changes in the new DSM.
    I do have a question for you. How do explain to people the difference between bulimia nervosa and the bulimia nervosa listed as one of the 5 subtypes of OSFED? I understabd ut but others might not. Having the same name is bound to cause confusion.
    thanks!
    Lori

    • Jennifer J. Thomas, Ph.D.

      Hi Lori — good question! A previous version of the draft criteria refers to “subthreshold BN” and “subthreshold BED,” but those terms were dropped in the final version. The diagnostic code will be the same for all OSFED subtypes (i.e., all subtypes will be part of OSFED), and in my own clinical practice I have used the term “subthreshold” to describe. Hope this clarifies!

      • Anad Lori Licker

        I know the term subthreshold can be a source of people feeling like their eating disorder is not severe or they’re not “sick enough.” For example, someone who has lost xx pounds by severely restricting but still is not underweight. He/she is having many of the same medical complications of someone underweight. He/she may have even had cardiac arrest. Do you know how that issue was addressed of the perception of not having a “real” eating disorder?

        • Jenni Schaefer

          Hey Lori – Thanks for posting! You bring up a great point. In “Almost Anorexic,” we wrote about the experience of a patient who believed that her EDNOS diagnosis stood for “Eating Disorder Not OF SEVERITY.” Of course, that is not what EDNOS means at all. One of the main points of our book and this blog is that EDNOS and OSFED are, in fact, real eating disorders. We just need to keep getting this important message out there. I know that you are doing your part!

          • Anad Lori Licker

            yup. You know I’m sending people your way (ie the book). It is an under reported issue and a big soap box I’ve been climbing on. I’m glad to help out.<3

          • Jenni Schaefer

            Thanks so much, Lori!

  • Sarah Linney

    So, my reaction to this was what’s wrong with me then?! I tend to refer to myself as an anorexic because since I was 18 I’ve been underweight and I’ve probably been in the anorexic BMI category since I was 20. I’m 32 now and my BMI still sits at less than 17. But I didn’t diet for all this time (although it all started with a diet), a lot of the time I ate quite well – I just insist on maintaining this low weight and diet if I go so much as a pound over. For a lot of the last two years I’ve alternately starved and binged – eaten nothing but a few biscuits all day and then a truckload of chocolate at night – so I probably wasn’t undereating calorie-wise, but was certainly malnourished and very depressed. I’m now eating well, although I’ve not been able to face gaining weight yet. I do seem to be often on a diet to maintain this low weight though, and I wondered a) how you would classify me and b) if it is true that I will need fewer calories to maintain a low weight than I would to maintain a higher weight? Because I am really ready to gain a stone but I’m worried that once I get there I’ll always be on a diet to maintain it, just like I am now.

    • Jennifer J. Thomas, Ph.D.

      Hey there! While I can’t provide a diagnosis online (only your doctor can do this), what I can say is that most adults with eating disorders who have a BMI < 18.5 will be diagnosed with anorexia nervosa under DSM-5. This is because DSM-5 changes to the anorexia criteria allow for persistent behaviors that interfere with weight gain (e.g., eating very little throughout the day) to contribute to making a diagnosis even if the individual is not explicitly "dieting" or experiencing an intense fear of fatness. The weight criterion will also allow for clinical judgment in lieu of a strict cut-off like "85% of expected body weight." Also, it sounds like you are really motivated to feel better, which is so great to hear! I hope you are feeling supported and getting the help you need! You are absolutely correct that weight restoration is associated with an increase in resting metabolic rate. This is a very robust finding, and here's an example study: http://www.ncbi.nlm.nih.gov/pubmed/7942571

  • Trip

    I think its a good change. Having had the EDNOS diagnosis – when in the depth of it all I basically viewed it as a you are not good enough at losing weight. In a disorder that has a large component of perfectionism i think the not otherwise specified was a bad choice of words. At least they are starting to recognise that these people also need treatment. Unfortunately in New Zealand you only get treatment if you fit the two main classifications

    • Jennifer J. Thomas, Ph.D.

      Thanks for sharing your story, Trip! I know a lot of people will relate to the view that you had of your EDNOS diagnosis. I hope that the OSFED subtypes (with real names!) will promote access to evidence-based treatments in New Zealand and around the world.

    • Losing hope

      I know this is an old story, but I’m just reading it and, THIS, THIS, THIS, so much this. “You are not good enough at losing weight. You are not even good at your eating disorder.” Ugh. Ed is a jerk. 🙁

  • Jenni Schaefer

    Thanks for answering everyone’s questions, Jenny! Can you please answer one posted on my Facebook page: “Can you talk about how ARFID and “feeding disorder” fits in
    with the above new OSFED and UFED?”

    • Jennifer J. Thomas, Ph.D.

      Another great question! Avoidant/Restrictive Food Intake Disorder (new acronym “ARFID”) is a feeding disorder that was formerly named “Feeding Disorder of Infancy or Early Childhood” in DSM-IV. ARFID is not part of OSFED or UFED. Rather, it is an officially recognized feeding disorder with its own official category in DSM-5.

      ARFID includes folks (often young people, but adults as well) who have nutritional deficiencies, poor growth, or low weight due to limited food intake. Rather than being due to shape/weight concerns, the limited intake in ARFID is linked to sensory aversion, lack of interest in food, or a feeding-related trauma. An example would be someone who only eats white foods (e.g., plain pasta), and therefore has a low weight and is missing the key nutrients from avoided foods (e.g., vegetables). Hope this helps!

      • Cara Winters

        I’m so glad this was changed!! I know a person who has an ED and is concerned about her weight, but is EXTREMELY picky about what she eats and how she eats it, more so than her weight even. I guess she would fit now under ARFID, whereas before she would have had to be EDNOS because there was nothing specific enough to match her actual condition.

        • Jennifer J. Thomas, Ph.D.

          Hi Cara, although I cannot provide a diagnosis online (only your friend’s doctor can do that), you raise an extremely interesting point about differential diagnosis. Someone who eats very little and cites picky eating preferences as the rationale would most likely fall under ARFID. But once the person starts endorsing shape/weight concerns (an exclusion criterion for the ARFID diagnosis) DSM-5 anorexia nervosa (w/ persistent behaviors interfering w/ weight gain) becomes a possible alternative. And to complicate matters further, some individuals feel more connected with one rationale (e.g., picky eating) at one point in the illness and another (e.g., shape/weight concerns) at another. Has that person crossed over from ARFID to AN? Does the person have the same illness as before, or has he/she developed a different one? Does it matter for treatment purposes? It’s a great question and an area in need of future research!

      • okay, I finally signed up for Disqus! ARFID onset is before age 6 I think. What is interesting to me is that the word “feeding and eating” is on OSFED. Feeding implies a feeder and feedee… Is there an age of onset? Fascinating that the diagnosis that seems more geared to infants and children, where the feeding relationship is a huge factor in eating has removed the word “feeding” from the definition. Maybe it’s semantics, but it seems more confusing to me, than clear!

        • Jennifer J. Thomas, Ph.D.

          Hi Katja, such great points! In recognition that ARFID can occur in both adults and children, DSM-5 has no longer has an “age of onset” requirement for the diagnosis. It’s interesting b/c, as you point out, previous versions of DSM did require that feeding disorders onset at an early age. If you look way back in the literature (i.e., the 1972 Feighner criteria) there used to be an age requirement for anorexia nervosa as well (i.e., it had to onset before age 25). I think the lack of age ranges in the new feeding and eating disorder diagnoses reflect the field’s increasing recognition that both problems can occur across the lifespan, and there there can be a great deal of overlap between the two. I see your point about the feeder/feedee piece being confusing, though!

  • Brooke

    I haven’t read the section yet, only posts and rumors but I heard from a professor that either the OSFED or the UFED are time-limited diagnoses (~6months) until an official one of anorexia, bulimia, or binge eating can be made. This is different from EDNOS which could remain indefinitely. Did you come across this or have any opinion about it? Thanks for all the work you do promoting awareness and recovery!

    • Jennifer J. Thomas, Ph.D.

      Hi Brooke, great question. OSFED is not a time-limited diagnosis; just like with EDNOS, someone may have a unique constellation of symptoms that only fits in OSFED and never migrates into AN, BN, or BED. UFED is tricker. The language in DSM-5 gives an example of conferring a UFED diagnosis in an emergency room situation where the clinician doesn’t yet have sufficient information to identify a diagnosis, so it could act as a place-holder. That being said, UFED could *also* be a longer-term diagnosis for a person who does not fit into any of the OSFED subtypes. This was the case for the one patient I mentioned in my blog post who had BN-like symptoms but w/o body image concerns, so she did not fit into the subthreshold BN category (which requires overvaluation of shape/weight). Hope this helps!!

  • Cara Winters

    Geeze… I didn’t realize the whole EDNOS spectrum was being totally renamed. OSFED… that is so freaking weird. Like, just -weird-. I don’t even care that it says ‘fed’… it’s weird, point blank.

  • Cara Winters

    I do have a question, though. There is no specified BMI criteria for anorexia now, is there? And it also doesn’t specify needing to have stopped periods? Because I think I have anorexia (I fit the weight loss below normal, the mental symptoms, etc), but I still have regular periods. Is this now actually AN instead of what I was formerly, EDNOS?

    • Jenni Schaefer

      Hi Cara – Thanks for taking time to read the blog. You are correct that there is no specific BMI cutoff for anorexia in DSM-5. You are also right that amenorrhea—the loss of a menstrual cycle—has been removed as a requirement for anorexia. So, many people who were formerly diagnosed with EDNOS would now fit into the anorexia category. I am sorry to hear that you are struggling. If you need resources for support and treatment, please check out: https://jennischaefer.com/resources/#links I hope this helps!

  • afriskyr

    I have been struggling with eating for the last several months and I am afraid I might have an eating disorder. I have talked about this with my therapist only a couple of times and she said we will talk more about it in our next session which really makes me nervous. I did not think I could be anorexic since my weight is at the lower end of the normal range for my height. I was reading somewhere that rapid weight loss in a short time can be an indicator of anorexia. I don’t know if this is true and cannot remember where I read it. I have lost 20% of my body weight in 3 months which I did not think was too much but I seem to be drawing concern over this from family and friends and my therapist. I am not looking for a diagnosis as I know that cannot be given online but in the criteria of the DSM-V can someone be diagnosed with anorexia even if they are not underweight?

    • Jenni Schaefer

      I am very sorry to hear you are struggling but am happy to know that you are seeking help. You are right that only a clinician can give you an official diagnosis. What I have learned in working with Dr. Thomas is that many people fall into the OSFED category mentioned above called atypical anorexia. While a diagnosis of anorexia nervosa requires a low body weight, people with atypical anorexia might be a normal or above-average weight. An individual who loses a great deal of weight in a short amount of time but who is not underweight might receive a diagnosis of atypical anorexia. I hope this is helpful to you. Thanks for reading our blog. And keep seeking help. Full recovery really is possible!

      • afriskyr

        Thank you for the info and encouragement. My therapist had me take an ED test the other day during our session as well as several other tests related to body image. I am a little stressed during this time between appointments waiting to find out results yet I don’t really feel ready to be diagnosed with anything.
        Your book, Good bye Ed Hello Me, was inspiring and does give me motivation to talk about my eating problem with my therapist. I just got your other book too and will start it soon. I think I am reading them in reverse.

  • lily

    Hey, I wanted to thank you both for writing Almost Anorexic, I have been struggling with an eating disorder for five years. Before and during, and now after treatment I still deal with the idea that I am not sick enough because I am not underweight. I look at all the girls in program and alumni group who struggle with Anorexia and who are underweight and I think to myself that I do not deserve to be in group, I am not sick enough and it’s causing me to relapse but I am afraid to talk to my therapist and tell her how bad it really is because I just discharged from PHP/IOP five weeks ago. I am slipping into a relapse but I am feeling reluctant to say anything because I do not feel sick enough and I do not feel I deserve the help.

    • Jenni Schaefer

      Hi Lily – Thanks so much for reading our book. I am very sorry to hear that you are struggling a lot right now. I highly encourage you to be open and honest with your therapist and support team about how you are feeling. (I would have responded sooner, but I have been in New Zealand on my honeymoon!) I often felt the way you do– like I wasn’t “sick enough.” As you know from reading “Almost Anorexic,” many people feel that way. But you do deserve help. Serious eating disorders come in all shapes in sizes. You can get better. It takes being honest. I know you can do it.

  • Catherine T

    Great post!

    I feel that the DSM-5 has made significant progress regarding the accuracy of ED diagnoses, however I still believe that there is MUCH more progress to be made!
    The inclusion of specific BMIs, the vague use of the term “severity” and the lack of focus on EDs that encompass multiple ED diagnoses still need to be addressed.

    Check out our blog on this issue at http://sizedupedawareness.tumblr.com

  • Elsa

    I just found out about the name change and honestly I’m very upset. I’ve had ednos for almost 7 years now and this is just complete rubbish. The new acronyms are just embarrassing and a huge trigger. It’s bad enough to not fall under either anorexia or bulimia. Maybe I’m just overreacting, but when the disorder (or at least the label it’s given) that’s been basically my whole life changes I think I have a right to be upset. I mean imagine if they changed the name of bipolar disorder or borderline personality disorder?

    • Jenni Schaefer

      Hi Elsa – Thanks for your comment. Countless people feel exactly as you do. Whatever the name, people who suffer deserve help. As you know, diagnostic categories are often not an adequate mark of the severity of a disorder. Some with EDNOS/OSFED, for example, actually suffer more than people who have been diagnosed with other things. You might want to check out this excerpt from our book, which mentions this: https://jennischaefer.com/wp-content/uploads/2013/06/Introduction-Almost-Anorexic.pdf Thanks again for sharing. I am sure that many people feel comfort in reading your words and knowing that they are not alone.

    • Morgan

      they did change the name for BPD, now it’s “emotionally unstable disorder” and I’m pissed lol

  • Maura

    Thank you for sharing this. I am doing some research I suppose to justify the fact that I am ok and not in trouble which might sound crazy but well then again I never claimed to be sane 🙂 I was always obese until I started dealing with the childhood abuse I suffered. Then I became anorexic for about 5 years. I have been in recovery for almost 13 years but recently have had some massive life changes and being so engrossed in work I didn’t realize I was falling back into old patterns. Now I am back full tilt struggling but don’t fit the anorexia label weight by far. Which by the way rabbit trail, back when I struggled with anorexia in the late 90s what was considered underweight is now normal weight? That makes no sense to me and only makes the voice in my head stronger. Right now my doctor is the only one aware of my struggle but I have only been seeing her for a couple years and so really even though she cares a great deal it doesn’t look that serious. Everyone else is praising me for my weight loss saying I look great ( while ANA silences my voice screaming I am slowly killing myself help!) so I guess I am ok then. Anyway thank you for sharing and helping to explain the new DSM manual in regards to EDs. Blessings!!

    • Jenni Schaefer

      Thanks for sharing your story with us, Maura. I am so sorry that you are struggling. But I am glad to hear that you are seeing a doctor. You might consider adding more support to the mix. I would never have recovered without the help of a therapist, dietitian, and support group as well as my awesome doctor. Further, you might want to go to http://www.almostanorexic.com and take the Free and Confidential Screening. Also, the video on that page includes other people’s stories, which may be helpful to you. If you haven’t checked into http://www.mentorconnect-ed.org/ yet, you might want to visit the site and sign up for a free mentor. I know that many others can relate to your experience. To get better, connecting with others can be crucial. Our eating disorders can’t win if we connect with lots of support. Stay strong! Full recovery is totally possible.

      • Maura

        Thanks Jenni I will check those out!

    • Anad Lori Licker

      If it’s ok to jump in, I can add an additional perspective.

      Generally people who are “ok” with _____, don’t usually wonder if there’s something wrong with them let alone do research. You wanting to find an answer about whether or not you are ok is not crazy at all either. I understand.

      I think the need to see where we fit in terms of diagnosis is understandable too. I did it myself and so have so many, many others. Unfortunately too many people die because they don’t feel sick enough to get help. It’s not uncommon to think “I’m not that bad because I weigh x pounds and am not underweight.”

      Hopefully you can listen more to the voice that recognizes that you’re “falling back into old patterns” and “am back full tilt struggling.” You deserve to get help now. You don’t need to be underweight first.

      As to others praising your weight loss maybe you can tell some that you know they’re probably meaning to offer praise but it doesn’t help/you have a history of an eating disorder/or fill in the blank.

      I hope this helps.
      From one who’s been there,
      Lori

      • Maura

        Thanks for the encouragement Lori I appreciate it! It’s hard in moments to find truth when your meter is off so it is always good to hear someone else speak it!

        • Anad Lori Licker

          If we aren’t already connected you can send me a friend request on Facebook. That invitation is open to anyone interested in eating disorder recovery.

          • Maura

            Thanks Lori I appreciate the invite. This has been a long road for me and I am afraid this time around recovery is not in the cards for me. Good luck though! And may all the blessings you give to others return 10 fold back!

  • E.

    lol:) these acronyms make me smile..I thought “well, I have sort of compulsive eating similar to” emotional eating” which sometimes, more rarely, leads to bingeing episodes, eat “normal” quantities of food in other periods..all of this goes with a constant desire to look “small” and consequent restrictive behavior..I still don’t fit anywhere I guess!”

    • Thanks for reading our blog post. I spoke with Dr. Thomas regarding your thoughts. It is possible that you fit into “other OSFED” or “UFED,” but it’s hard to tell online. Regardless of where you fit in, one thing is certain: you deserve help. And full recovery is possible. Hang in there!

      • E.

        Thank you so much Jenny and thank you Dr Thomas!!thank you for answering! I appreciate a lot
        the job you are doing to help those with eating disorders, i think it’s
        very important bacause there are too many people who “don’t feel sick
        enough”. I’m so much better now, and after “letting control go” in my
        life and after feeling worthy of help I’m eating well.
        Sometimes
        it’s hard to undercover all the meanings behind food but I hope people
        stop to feel they don’t deserve help and get treatment. I now can
        concentrate on other thing and be there for the people I love, not
        thinking just about food. And it’s so worthy!!

        • E.

          Jenny ,I wanted to ask you another question if you have time and feel like answering (but I don’t want to bother in any way!).
          I noticed that many people refer to their eating disorder as a “ED” or
          other names..I also do that because( even though I now think that my
          issues had less or nothing to do with weight, calories and food) I perceive the eating disorder as a part of me, or someone “real”
          and almost “living”. My therapist always invited me to express myself,
          and to “give voice” to my emotions and all the issues I wasn’t dealing
          with. That helped me in a way because it gave me the chance to solve
          them by not “blaming food” for them, but it also feels so natural
          thinking of it as a part of me and in a way “ED is will always be ED”.
          Do you ever felt this could keep you from fully recover?I mean: how can we fully recover if this is a part of ourselves?

  • Great article! This can all get so confusing for the families of those with eating disorders, especially to parents trying to figure out, “My daughter/son has WHAT? What do all these letters mean?” Love the article – will share with our followers!

    • Thanks for reading and sharing! And keep up your important work!

  • K.P

    This is an old post but I just came across it. I never considered myself to have an eating disorder, I just didn’t care for or like food.I didn’t want to have to eat.So my eating patterns did not worry me. Until in the middle of my long depression – about the time you posted this – things became more severely noticeable. But I knew I did not fit any eating disorder diagnosis and I always looked healthy, heavy in fact to myself. It occurred to me that it might be an unrecognized problem and that others may have similar problems like me. I am glad to see it is recognized.

  • Kate

    I honestly really appreciate the inclusion of Atypical Anorexia Nervosa, although I still have problems with it. I have received the diagnoses of Bulimia Nervosa and EDNOS. The EDNOS diagnosis because despite intense and prolonged periods of restriction and fasting not coupled with a binge, I maintained what was considered, at face value, a “healthy weight.”

    My hope for the DSM-6 is that the new anorexia definition unlinks the behaviors from their (possible!) effects. Depending on one’s genetics and body chemistry, the same behaviors can result in drastically different impacts on one’s weight, size, and/or appearance. By requiring that restriction lead to a “significantly low body weight,” and that all other symptoms are tied to this low body weight, the DSM sends multiple erroneous and harmful messages.

    First, it limits the diagnosis to a smaller pool of possible people. If my natural weight set point is higher than another’s, but we eat and/or restrict exactly the same amount, this other person meets the diagnostic criteria, while I do not. Am I not equally as ill as him or her? Would I not benefit from the option of similar treatment? One thing we know to be true is that eating disorders, including anorexia nervosa, do not discriminate: they affect people of every gender, sexual orientation, social class, race, height, and yes, size.

    This is why I believe it to be absolutely essential that we focus on the behaviors that constitute eating disorder symptoms. There is a pervasive myth that the only worrisome and unhealthy aspect of having an eating disorder is that a low weight often accompanies the disorder. However, we know that ED behaviors like restriction and purging are in and of themselves harmful.

  • Becky taylor

    Hiya I’m not sure if I have a problem with food so I thourght I would look online. I used to be an elite athlete in a sport where weight played a significant part so I was always dieting weeks before competitions and always keeping an eye on my weight, during the last few months of competing and training I began to binge and purge but not too frequently and i didn’t always purge sometimes I would exercise to burn the calories I had consumed but I didn’t think anything of it. But now that it have left the team I keep going through phases of restricting and counting calories for weeks then I binge and feel guilty so I purge or exercise. But I’m at a healthy weight although I’d like to be lighter, I don’t feel it’s at the stage of being an eating disorder because it’s not that bad and i still go to college and get on with normal everyday life it’s just something that I do so it feels normal does that make any sense.
    Please reply if you have the time
    Thank you

  • Rebecca Edgecumbe

    This is a great post! I think there have been many improvements from the DSM-4. Could anyone tell me what the difference between anorexia binge/purge subtype and bulimia? As I know the bulimia subtype non-purge has been removed from the DSM-5. I’m assuming the answer is low-weight for the anorexia subtype? Also under the new OSFED what’s the difference between purging disorder between anorexia binge/purge subtype? Would those with purging disorder still restrict their diet? It’s all very confusing to get my head around!

    • Ashleyy

      Based on a ED conference I went to, my understanding is that when diagnosing an eating disorder, there is a “process” to be followed. Does the person meet criteria for AN? If yes, stop there. Only if no, consider if meets criteria for BN.

      Therefore, even if you are binging/purging a ton, if your weight and loss of menstruaring meets AN criteria, you will be diagnosed with AN (b/p subtype) . This was a few years ago, mind you, so who know if things have changed.

      This helped me understand my own diagnoses. I identified fully as bulimic due to frequency of my bingeing and purging episodes, and when i was diagnosed with AN I felt as sense of shame that I was not “living up to” my diagnosis. I thought that I was a failure as an anorexic as I didn’t have “the willpower” not to b/p.

  • Shirley Liu

    Thank you for the very informative post! I only found out about this eating disorder a couple of months ago, and the statistics are frightening. I think the worst part is that there is very little public knowledge on OSFED, and eating disorders on a broader scale. Many of us don’t even realise that our “eating habits” could suggest something potentially life-threatening.

    I started a campaign to garner OSFED awareness in Australia, and your book was featured on a recent post:
    https://otheruglystepsister.wordpress.com/

    • Thanks for all that you are doing to raise awareness in Australia. I hope to visit soon! We really appreciate your support of our book, Almost Anorexic. Means a lot.

  • Claire Hofer

    Wow. I’m glad to see a post that so clearly defines the new DSM and subtypes of OSFED/EDNOS (…I know the former is now correct, but some have a hard time with the change). I have been struggling with an eating disorder for over twelve years and fluctuated between anorexia, bulimia, and the gnarly fluctuation of the two. I have never quite filled all of the exact “checkmarks” for either though, so I get either/or depending on who/where the treatment is provided. In fact I feel my ED is invalidated because I don’t have a “legitimate” diagnosis. I hope this can make the greater population aware that there is an immensely broader spectrum of eating disorders/disordered eating in general. For myself and many others I’m sure, I think having less stigma and more understanding will make the recovery for the struggling a bit easier.

  • Christi

    How can I cite this as a source? I am writing a paper/article about removing the weight requirement as diagnostic criterion for Anorexia Nervosa, allowing it and atypical AN to be blended. I wanted to quote you about the myth behind EDNOS/OSFED (that its not as bad). Sadly, I can’t find a publisher. Any info would help since I’m first citing in MLA and then APA for the different places I’d like to submit. Thank you!