EDNOS and OSFED are often used interchangeably, and for good reason: OSFED is the diagnosis that replaced EDNOS when the Diagnostic and Statistical Manual of Mental Disorders was updated in 2013.
EDNOS last appeared in the DSM-IV, and OSFED appears in the DSM-5. But the change was more than a new acronym. The criteria shifted too, which changed who falls into this category and how clinicians describe what a person is experiencing.
Still, what matters most is not which acronym appears on a chart. It is understanding what these diagnoses are, how they come to be, and how to treat them. Behind every diagnosis is an individual who is suffering, in need of support and compassion. Left untreated, this illness can be life-altering and, in the most awful of circumstances, life-ending.
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What Is EDNOS?
EDNOS stands for Eating Disorder Not Otherwise Specified. It was the diagnosis used in the DSM-IV for people with clinically significant eating disorder symptoms who did not meet the full criteria for anorexia nervosa or bulimia nervosa. Because those criteria were narrow, EDNOS became the most commonly diagnosed eating disorder, and many people with serious symptoms were placed in what was often treated as a catch-all category.
What Is OSFED?
OSFED stands for Other Specified Feeding or Eating Disorder. It is the DSM-5 diagnosis for people whose symptoms cause significant distress or impairment but do not meet the full criteria for anorexia nervosa, bulimia nervosa, binge eating disorder, ARFID, or another specific feeding or eating disorder. With OSFED, the clinician names the specific presentation, such as atypical anorexia or purging disorder. For a closer look at how it shows up day to day, see our post on the signs and symptoms of OSFED.
Learn more about OSFED Treatment in Toronto
What Is the Difference Between EDNOS and OSFED?
OSFED is the updated name for EDNOS, but the two are not identical. When the DSM-5 replaced the DSM-IV in 2013, EDNOS was retired and split into two new categories: OSFED and UFED. At the same time, the criteria for other eating disorders were broadened, so some people who would once have been diagnosed with EDNOS now receive a more specific diagnosis.
The key changes in the DSM-5 were:
- EDNOS was split in two. OSFED is used when the clinician specifies the presentation. UFED (Unspecified Feeding or Eating Disorder) is used when they do not.
- Binge eating disorder became its own diagnosis. In the DSM-IV, it was listed only as an example of EDNOS.
- Anorexia no longer requires loss of periods. People with regular menstrual cycles who meet every other criterion can now be diagnosed with anorexia nervosa.
- The bulimia threshold was lowered. Binge eating and compensatory behaviours now need to happen once a week over three months, down from twice a week.
- ARFID was added. Avoidant/restrictive food intake disorder became a formal diagnosis, alongside pica and rumination disorder in the same chapter.
EDNOS vs OSFED at a Glance
|
EDNOS |
OSFED |
|
|
Manual |
DSM-IV (1994) |
DSM-5 (2013) and DSM-5-TR (2022) |
|
Full name |
Eating Disorder Not Otherwise Specified |
Other Specified Feeding or Eating Disorder |
|
Binge eating disorder |
Listed as an example of EDNOS |
A separate diagnosis |
|
Named presentations |
Six clinical examples |
Five named presentations, plus other |
|
Unspecified cases |
Included under EDNOS |
Diagnosed as UFED |
|
Seriousness |
As serious as anorexia or bulimia |
As serious as anorexia or bulimia |
The Six EDNOS Examples in the DSM-IV
- All criteria for anorexia are met, but the person’s menstrual cycles are regular.
- All criteria for anorexia are met, but despite significant weight loss, the person’s weight is in a clinically normal range.
- All criteria for bulimia are met, but binge eating and compensatory behaviours happen less than twice a week or for less than three months.
- Regular purging after eating small amounts of food, at a clinically normal body weight.
- Repeatedly chewing and spitting out, but not swallowing, large amounts of food.
- Recurrent binge eating without the regular compensatory behaviours of bulimia (now diagnosed as binge eating disorder).
The Five OSFED Presentations in the DSM-5
- Atypical anorexia nervosa: all criteria for anorexia are met, but despite significant weight loss, the person’s weight is within or above a clinically normal range.
- Bulimia nervosa of low frequency or limited duration: binge eating and compensatory behaviours happen less than once a week or for less than three months.
- Binge eating disorder of low frequency or limited duration: binge eating happens less than once a week or for less than three months.
- Purging disorder: recurrent purging to influence weight or shape, without binge eating.
- Night eating syndrome: recurrent episodes of eating after waking from sleep, or eating a large amount of food after the evening meal.
These five are examples, not a complete list. A clinician can use OSFED for any presentation that causes real distress and does not fit another category, such as repeated chewing and spitting.
OSFED vs UFED: What Is the Difference?
UFED stands for Unspecified Feeding or Eating Disorder. Like OSFED, it describes eating disorder symptoms that cause significant distress but do not meet the full criteria for a specific diagnosis. The difference is whether the clinician names the presentation. OSFED is used when they do (for example, “OSFED, purging disorder”). UFED is used when they choose not to, or do not yet have enough information, which is common in emergency settings or early assessments. UFED is not a milder diagnosis. It simply carries less detail.
Is EDNOS Still a Diagnosis?
No. EDNOS was retired along with the DSM-IV. Clinicians in Canada now use OSFED or UFED, and both categories carry over into the current DSM-5-TR. You may still see EDNOS in older medical records and research, or on your own file if you were diagnosed before 2013. If that describes you, the label on your chart does not change the care you deserve.
Is EDNOS Serious?
Yes. The words “other” and “not otherwise specified” have led many people to assume these diagnoses are milder, and that is not the case. People with EDNOS experience eating disorder symptoms and medical consequences that are just as severe as those seen in anorexia and bulimia. One large study found that mortality rates for EDNOS were comparable to, and in fact higher than, those for anorexia and bulimia (Crow et al., American Journal of Psychiatry, 2009). EDNOS and OSFED also commonly occur alongside depression, anxiety, and other mental health conditions, and they carry an increased risk of suicidal thoughts.
What Is the Treatment for EDNOS and OSFED?
The treatment for EDNOS is no different from the treatment for OSFED. Both follow a similar structure to the treatment of all other eating disorders. Although the structure remains constant, specific treatment, timing, and the professionals involved will differ vastly depending on the individual in need. Getting to the root of an eating disorder is facilitated through therapy, the most arduous, albeit important step in treatment and eventual recovery. If you are curious about where these illnesses begin, our post on what causes eating disorders is a good place to start.
Eating disorders are mental health diagnoses, so working with a psychiatrist, psychologist, therapist, or social worker is a critical component of treatment. Nutrition support from a registered dietitian and medical monitoring are usually part of care as well. Between sessions, these strategies for how to cope with OSFED can help.
OSFED Treatment in Toronto and Across Canada
At EatWell Health Centre, you do not need a formal diagnosis to access care. Our therapists and registered dietitians offer OSFED treatment in person in Toronto and virtually across Canada, with no waitlist and no referral needed. If you are waiting for a hospital programme, our hospital waitlist support can help bridge the gap.
Frequently Asked Questions
Is EDNOS the same as OSFED?
Mostly. OSFED replaced EDNOS in the DSM-5 in 2013, but the criteria changed too. Some people who met the criteria for EDNOS would now be diagnosed with binge eating disorder, anorexia nervosa, or bulimia nervosa instead.
What classifies as an OSFED?
The DSM-5 lists five named presentations of OSFED: atypical anorexia nervosa, bulimia nervosa of low frequency or limited duration, binge eating disorder of low frequency or limited duration, purging disorder, and night eating syndrome. Any other presentation that causes significant distress but does not meet the criteria for a specific eating disorder can also be diagnosed as OSFED.
What is an example of EDNOS?
A common example of EDNOS was someone who met every criterion for anorexia except loss of menstrual periods. Another was recurrent binge eating without purging, which is now its own diagnosis: binge eating disorder.
What is the difference between OSFED and UFED?
Both describe eating disorders that do not meet the full criteria for a specific diagnosis. With OSFED, the clinician names the presentation. With UFED, they do not, often because there is not yet enough information.
Is EDNOS serious?
Yes. EDNOS carries medical and psychological risks comparable to anorexia and bulimia, including an elevated mortality rate. It deserves the same level of care as any other eating disorder.
Do I need an OSFED diagnosis to get treatment at EatWell?
No. If food, eating, or your body is affecting your quality of life, that is enough. You can reach out to our team directly and we will help you figure out next steps.
Eating Disorder Support in Toronto
Whether you were diagnosed with EDNOS years ago, recently came across the term OSFED, or have never had a diagnosis at all, your struggles with food deserve real care. Our eating disorder treatment team treats OSFED with the same seriousness as any other eating disorder, working through the thoughts, behaviours, and relationship with food that keep it going.
EatWell Health Centre offers eating disorder treatment with no waitlist and no referral needed. Virtual care is available across Canada, and in-person care is available in Toronto.
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