What to expect from an OSFED Residential Treatment Center
Learn more about our program from our Director of Eating Disorder Programming, Dr. Anita Johnston, PhD, CEDS.
OSFED was previously known as Eating Disorder Not Otherwise Specified (EDNOS) in previous editions of the Diagnostic and Statistical Manual, but the name has since been updated to OSFED. Other Specified Feeding or Eating Disorder (OSFED) may not be as well-known as anorexia, bulimia, or binge eating disorder, but it is just as serious as other disorders and can require residential treatment, just like any other eating disorder.
One may be encouraged to seek out an OSFED residential treatment center if they are experiencing significant physical, medical, mental, or emotional impacts brought on by their eating disorder. These symptoms could include: malnutrition; heightened stress, anxiety, or depression; inability to participate in school or work; or impaired relationships. OSFED residential treatment centers are able to provide a safe space, equipped to address all of the medical and psychological impacts of OSFED.
At ‘Ai Pono’s Maui location, we provide the residential level of care. Residential treatment is technically an inpatient treatment setting in that patients come stay with us for anywhere from 45-60 days on average to fully immerse themselves in treatment. We provide 24/7 nursing support, consultations with physicians and psychiatrists, group and individual therapy, meal support, recreation, and more. We are not, however, an inpatient hospital setting that provides the highest level of medical treatment for eating disorders.
As mentioned above, individuals with OSFED may struggle to accept that they are “sick enough” for treatment at all, much less residential treatment. Delay in getting care for long periods of time may actually result in more significant physical, mental, and emotional impacts as the result of minimized or untreated eating disorder symptoms. Many of these symptoms may not be visible, so receiving OSFED treatment in a residential setting allows for those symptoms to be properly identified and treated by a team of eating disorder informed medical and mental health professionals.
Because of the increasing number of individuals with OSFED diagnosis, it can also be extremely helpful to be able to connect with other peers in a treatment setting who are experiencing the same symptoms, thoughts, insecurities, and questions as someone with OSED may have.
Someone may receive a diagnosis of OSFED if they meet some, but not all, of the specific diagnostic criteria for another eating disorder. Types of OSFED include:
Atypical anorexia- All of the criteria for anorexia may be met, but the person’s weight is within or above the “normal” range.
Bulimia nervosa- All of the criteria is met for bulimia nervosa, but the behaviors are less frequent or have been happening for a shorter amount of time.
Binge eating disorder- The individual participates in binging behavior, but these behaviors are less frequent or have been happening for a shorter amount of time.
Purging disorder- There is purging (either vomiting or exercising), but no binging.
Night eating syndrome- Excessive consumption of food late at night.
One of the most common types of OSFED is atypical anorexia. With atypical anorexia, an individual may meet all other criteria for anorexia nervosa, except their weight is within or above “normal” range according to their height. We know that eating disorders come in many forms and not all symptoms of eating disorders are visible, therefore it is entirely possible for someone to have anorexia without needing to look a certain way. In the past, these individuals may have not been properly diagnosed or may not even have sought care because they did not meet all the criteria of anorexia nervosa. The introduction of an OSFED diagnosis means that more individuals can receive the treatment they need and deserve.
Health consequences of OSFED can also be difficult to recognize and identify, because they could include a number of different conditions and effects. For example, someone who is diagnosed with OSFED may be intermittently vomiting, restricting, and binging, therefore they will experience a range of complex symptoms dependent on what behaviors they may be engaging in at any given time. Individuals struggling with and OSFED diagnosis may see their weight, mood, energy levels, and other symptoms vary greatly over a period of time. This can make it difficult for care providers or loved ones to recognize and understand what is going on or how to help.
Furthermore, those with a diagnosis of OSFED often perceive that their eating disorder is not as serious as others or that they are not “sick enough” to pursue treatment. For example, if someone restricts every day, only purges 1-2 times a week, and is not significantly underweight, they may tell themselves that their eating disorder is “not that bad.” They may also assign more value or “weight” to certain symptoms i.e. they consider the purging behavior to be more serious than restriction and because they aren’t engaging in purging that much they may not recognize the severity of their issue or seek treatment or support for it.
When treating OSFED in a residential environment, individuals with this diagnosis may report that they have a difficult time relating to their peers because their eating disorder is “different,” or, they “do not look like they have an eating disorder.” As an example, individuals with atypical anorexia frequently struggle with body image issues and often compare themselves to others both in and outside of the treatment space. This is why any OSFED residential treatment center program should promote body inclusivity and positivity as well as provide general education and affirmation that eating disorders and bodies come in all forms and they all are deserving of treatment.
The following statistics are from the National Eating Disorder Association website:
Children hospitalized for OSFED had just as many medical complications as children hospitalized for anorexia nervosa
Adults with ‘atypical’ or ‘subclinical’ anorexia and/or bulimia scored just as high on measures of eating disorder thoughts and behaviors as those with DSM-diagnosed anorexia nervosa and bulimia nervosa
People with OSFED were just as likely to die as a result of their eating disorder as people with diagnosed anorexia or bulimia
The health consequences of OSFED depend in part on which eating disordered behaviors are being used. It is important to recognize that OSFED is as serious as other eating disorders and should not be trivialized or underestimated. All patients entering our residential treatment for OSFED are required to complete a comprehensive medical and psychological assessment prior to admission. These assessments provide us with a detailed account of past and current issues and allow us to build an appropriate and responsive treatment plan that is individualized to the patient’s needs and personal goals. The medical clearance provides our medical team with a baseline for comparison and ensures that any medical symptoms of OSFED such as malnutrition, abnormal labs, GI upset, insomnia, and others can be addressed in the residential treating setting.
Throughout the course of one’s stay with us, the medical symptoms of OSFED are able to be monitored by our medical staff. This includes daily vital measurements, weekly or bi-weekly labs, and consultations with a psychiatrist and medical staff. Within a safe and controlled setting, patients are able to re-engage in consistent eating patterns that allow for nutritional stabilization and improved physical and mental health. Because OSFED can also lead to nutritional deficiencies, nursing and medical staff at an OSFED residential treatment center are qualified to assess and provide appropriate prescriptions and recommendations regarding medications, supplements, and vitamins to restore the patient's mind and body to optimal functioning.
At our Maui location, we provide the Residential level of care. Residential is a term that refers to an inpatient treatment setting, but not one that provides the highest level of medical treatment that would be available in a hospital setting. Individuals in our program stay with us for anywhere from 45-60 days on average to fully immerse themselves in a treatment and recovery process. We provide 24/7 nursing support, consultations with physicians and psychiatrists, group and individual therapy, meal support, recreation, and more. Although many may make their way to us from across the country, we believe that all who seek treatment at ‘Ai Pono have been sent this way for a reason and do our best to welcome them as members of our recovery ohana (family).
At ‘Ai Pono Hawaii, we have all the benefits of an OSFED residential treatment center including 24/7 medical support, safety and containment, a multidisciplinary team, 4x individual sessions per week, intensive group therapy, and meal support, but we also maintain a connection with our unique setting. Located a short walk from the closest ocean shore and adjacent to Iao Valley National Park, patients are able to convene with nature on a daily basis. We often utilize our large lawn individual and group sessions. Reestablishing and maintaining a connection to the environment is one of the pillars of our program as we feel it allows patients to become more “pono” or in balance with themselves, others, and the spaces that they occupy.
Many individuals struggling with OSFED also struggle with Body Dysmorphic Disorder or other body image concerns. In order to support these individuals, therapeutic work must focus on reconnecting and healing one’s relationship with their body. It is also important to learn about and discuss the impacts of culture, family background, etc. on the shaping of one’s self image and how to distinguish one’s healthy or true values from those that have been forced upon us via external sources.
Patients with OSFED are often involved in patterns of dietary chaos and confusion prior to entering treatment. They may “flip flop” in behaviors and eating patterns from one day to the next. Therefore, one of the simplest and more important aspects of residential treatment is the structuring and normalization of eating. OSFED residential treatment centers allow patients to settle into a healthy routine of food and eating, one that is centered around consistent nourishment and responsive to genuine hunger and fullness cues.
Group therapy remains one of the most effective therapeutic approaches when it comes to treating eating disorders, including OSFED. Eating disorders can leave individuals feeling incredibly fearful, confused, and isolated. Group therapy provides a safe venue for patients to establish empathy and connection with peers who have had similar thoughts, feelings, and experiences. This empathy builds trust among patients so that they can experiment with becoming more vulnerable in the therapeutic environment in order to address the root of their eating disorder.
Dialectical Behavioral Therapy Skills Groups focusing on assertive communication and emotional literacy
Narrative Therapy/Storytelling
Full Moon Letting Go/Intention Setting Gatherings
Visits to Nature and Cultural Sites
Nature Therapy
Hawaiian Cultural Groups
Ecstatic Dance
These varied groups provide patients with a genuinely holistic treatment experience and different avenues through which to identify and work through the meaning behind their disordered eating patterns in order to find true healing.
Although the diagnosis of OSFED is becoming more common, it can often be difficult to receive a proper diagnosis. One of our first pre-admissions steps is to complete a free level of care assessment in order to learn more about your specific symptoms and how we might be able to support you in your search for support and healing. We also support you in completing a medical clearance, so that we can evaluate your eating disorder and its symptoms wholly, from a behavioral and medical perspective. Reach out to us today if you have been diagnosed with OSFED or identify with the symptoms.
