Other eating problems

OSFED is used when someone has many of the signs of an eating disorder, but their experience doesn’t match one exact diagnosis. The clinician names how it is different, for example “atypical anorexia.”

OSFED can affect adults, teens and children of any gender. It is the most commonly diagnosed eating disorder.

UFED describes eating or feeding problems that cause real distress or harm but don’t meet the full criteria for a specific eating disorder. It is often used when there isn’t enough information yet, such as in an emergency department.

The Butterfly Foundation calls UFED a serious, potentially life-threatening illness, and says the label does not make it less serious.

Pica and rumination syndrome are covered later in this guide. ARFID, where people avoid or restrict food for reasons not about body image, has its own guide.

A person with atypical anorexia has the fears and restriction of anorexia, but their body may look “average” or larger. Because of this, they are often missed, or even praised, while they are seriously unwell.

The physical health effects can be similar to those of anorexia.

Purging disorder involves repeated purging to influence weight or shape, without the binge episodes seen in bulimia.

Purging can seriously harm the stomach, food pipe, heart rhythm and the balance of salts in the body.

Some people have the experiences of bulimia or binge eating disorder, but the episodes happen less often or haven’t gone on as long. This is still OSFED, and still serious.

Night eating syndrome is listed as a form of OSFED. The next section explains it in more detail.

People often describe

• Feeling tired and unrested in the morning
• Not feeling hungry for breakfast
• Trouble getting through the day at work or school
• Feelings of shame, worry or embarrassment
• Waking up several times a night

The cause isn’t fully known. Studies suggest changes to the body clock (circadian rhythm) can bring on hunger and alertness at night. Genes, stress and not eating enough during the day may also play a part.

NES is more common in people who live with depression, anxiety, substance use or another eating disorder.

Approaches a care team may suggest

• A sleep diary, and sometimes an overnight sleep study
• Cognitive behavioral therapy (CBT)
• Light therapy to help reset the body clock
• Progressive muscle relaxation before bed
• Regular, nourishing meals during the day

Treatment often works well, though it can take time and a mix of approaches.

Rumination happens often in babies and commonly in people with developmental disabilities. It can also start in children and adults without other conditions, often during a stressful period.

It is rare overall. But some studies suggest up to 1 in 10 people with another eating disorder, or with fibromyalgia, may have it.

With rumination, the food usually doesn’t taste sour, because it hasn’t mixed with stomach acid yet. Doctors may run tests first to rule out other stomach and gut conditions.

You don’t have to wait months before seeing someone. Early care helps.

The main treatment is behavioral therapy, which helps people notice the body’s signals and respond differently. Providers often teach diaphragmatic (belly) breathing. Biofeedback, CBT and relaxation can also help.

Behavioral therapy works well for most people, including children.

Pica is often linked with low levels of nutrients like iron or zinc. Some adults crave a certain texture in their mouth. It is also more common in people with autism or intellectual disabilities, and in people under stress.

Pica can lead to lead poisoning, infections, blockages in the stomach or gut, and damaged teeth.

Safety ideas at home

• Ask a doctor about a lead test if old paint or soil may be involved
• Keep risky items out of reach where you can
• Tell a clinician about stomach pain, bloating, nausea or tiredness

Doctors first look for missing nutrients or problems like lead poisoning. Behavioral support, involving the family and home, rewards eating regular food and helps reduce eating non-food items.

Often pica lasts several months and then goes away on its own. It can last longer, especially alongside developmental conditions.

Experts say the line is whether a person can be flexible, and whether the drive to eat “healthily” causes distress. Wanting to eat well is not a problem in itself.

Anorexia often focuses on how much a person eats. The pattern called orthorexia focuses on the quality of food.

It might look like

• Distress when “approved” foods aren’t available
• Food rules that get stricter over time
• Hours spent on “healthy lifestyle” content
• Skipping meals out or events because of the food
• Checking labels over and over

Cutting out whole food groups can lead to missing nutrients and medical problems like bone loss. Strict rules can also lead to a cycle of restriction, overeating and guilt, plus lost time and isolation.

People with perfectionism, anxiety, OCD, or a history of disordered eating may be at higher risk.

Few studies have tested treatments yet. Experts suggest CBT, including exposure and response prevention (a method used for OCD), slowly reintroducing feared foods, and mindfulness.

Common examples

• Cutting out whole food groups
• Dieting
• Eating in a rigid or irregular way
• Feeling guilt or shame after eating
• Labelling foods as “good” or “bad”
• Skipping meals

Many of these are so normal in everyday life that they are easy to miss.

Disordered eating can lead to tiredness, poor sleep, digestive problems, low mood, anxiety and pulling away from others. It can also develop into an eating disorder.

Dieting is one of the most common risk factors for an eating disorder. Teens who diet are much more likely to develop one.

Disordered eating is often treated as normal, or even praised. That can make it hard to notice when it is causing harm.

Early support is one of the best ways to prevent an eating disorder. Change is possible, even after many years of disordered eating.

Things you could say

• “I care about you, and I’ve noticed you seem stressed around meals.”
• “You don’t have to have it all figured out. I’m here.”
• “Would you like help finding someone to talk to?”

OSFED and UFED can be as serious as other eating disorders. Saying “at least it’s not anorexia” can make someone feel their struggle doesn’t count.

ANAD runs free weekly online groups led by trained volunteers in recovery, including groups for caregivers and siblings. It also offers free recovery mentors.

Groups are open to anyone, whatever their diagnosis or stage of recovery.

It’s okay to feel worried, frustrated or tired. Talking with friends, a therapist or a caregiver group can help you keep going.