What is UFED?
UFED stands for unspecified feeding and eating disorder. This diagnosis applies when someone suffers severe distress or a crisis due to an eating disorder but does not meet full Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria for a specific eating disorder, such as anorexia nervosa (AN), bulimia nervosa (BN), or binge eating disorder (BED). (6)
Healthcare professionals sometimes diagnose someone with UFED when they do not want to specify why someone does not meet full DSM-5 criteria. This typically happens in a crisis setting, such as the emergency room, to expedite care when a full evaluation by a psychiatrist or psychologist is not possible. Making a correct diagnosis can take hours of interviewing, and in an emergency/suicidal situation, clinicians use UFED to expedite care. (5,7)
This category, along with OSFED (other specified feeding or eating disorders), accounts for the largest percentage of eating disorders–as high as 60% in some studies. And symptoms are just as serious and detrimental as anorexia, bulimia, binge eating disorder, and other eating disorders that have their own diagnosis and specific criteria. (5,7)
Types of UFED
Examples of eating disorders that would receive a diagnosis of UFED include: (7,8)
- Someone may meet most criteria for anorexia nervosa, such as having an intense fear of gaining weight and missing menstrual cycles, but may not have a low enough body weight according to current criteria. (5)
- Someone may meet most criteria for bulimia nervosa, but binging episodes occur sporadically, over many months or years. To be diagnosed with BN, someone must purge at least once weekly for at least three months, as opposed to more frequently, over weeks and months. To be diagnosed with BN, someone must purge at least once weekly for at least three months.
- Someone may attempt to lose weight by vomiting or using laxatives, enemas, or diuretics, which is consistent with purging disorder, but does not binge eat. Someone may experience these symptoms sporadically, during stressful situations, for example. They may go for years symptom free. If someone arrives in the ER due to severe dehydration as a result of excessive laxative use, they may receive a diagnosis of UFED.
- PICA is an eating disorder that is characterized by compulsively eating nonfood items, such as chalk, clay, cloth, coal, dirt, gum, hair, metal, paint, paper, pebbles, soap, string, or wool, but it also doesn’t have its own diagnosis.
Lab tests are usually ordered to check someone’s electrolytes, liver enzymes, thyroid function, vitamin levels, and blood sugar.
When Within Health is part of a treatment team, we do our best to coordinate with any crisis or hospital team to ensure a smooth transition of care.
Signs & symptoms of UFED
People often struggle with eating disorders for years before reaching out for help. They may not realize they have an eating disorder. They may be afraid or ashamed. This can result in a crisis situation, forcing someone to get help.
Signs and symptoms of UFED include but are not limited to: (1,5,7,8)
- Inability or refusal to, or overly self-conscious about eating in front of others
- Frequently disappearing after meals to purge
- Low confidence
- Low self esteem
- Poor body image
- Socially withdrawn
- Excessively introverted
- Overwhelming feelings of guilt, shame, and anxiety
- Wearing overly loose clothing or dress in heavy layers to hide their body
- Overly preoccupied with counting calories
- Strict dieting
- Signs of dramatic weight loss
- Denies feeling hungry
- Obsessive food rituals (for example, not allowing any food types to touch on their plate)
- Excessive exercise, to the point of injury and stress fractures
- Facial cheek swelling (edema from frequent vomiting)
- Discolored or stained teeth
- Calluses on the backs of hands and knuckles from self-induced vomiting
Effects of UFED
The long- and short-term consequences of undiagnosed and untreated UFED are as severe and life threatening as specified eating disorders. UFED stands as a temporary diagnosis until someone can be formally evaluated at length.
- Difficulty concentrating
- Drops in school and work performance
- Poor exercise and sports tolerance
- Mood swings
- Heart damage and digestive system disruption due to electrolyte abnormalities from purging
- Moderate to severe sleep disorders and sleep apnea from binging
- Esophageal cancer and tooth decay from chronic vomiting
- High blood pressure and heart disease
- Major depressive disorder and suicidal ideation (1,5,7,8)
Related complications and disorders
Many medical complications and mental health disorders can precede or result from eating disorders, such as: (7,8)
- Major depressive disorder
- Esophageal impaction, rupture, and cancer
- Oral and dental disease
- Cyclothymic disorder
- Acute stress disorder
- Post traumatic stress disorder
- Generalized anxiety disorder
- Panic disorder
- Suicidal ideation and attempt.
An ER physician typically assigns a diagnosis of UFED in the setting of an emergency, such as trauma or a life-threatening situation. A patient may be brought in due to a suicide attempt, fractures, severe self-harm, or syncope (passing out) due to extended periods of starvation.
When someone receives a diagnosis of UFED, usually their symptoms have persisted untreated for years. They may not realize they have an eating disorder, they may be in denial, or they may be ashamed to get help. These individuals tend to “slip through the cracks” of the healthcare system, unfortunately, and quietly endure until a crisis occurs.
Treatment of UFED
Typically, when someone comes to Within Health after a crisis episode with a diagnosis of UFED, we may advise them to continue with hospital (inpatient) care until they can safely return home.
Once someone has transitioned home, our providers monitor vitals using remote patient monitoring (RPM). We follow blood pressure, heart rate, and temperature using numberless monitors, to be sensitive to those with heightened anxiety around numbers. Clinical experience has taught us that focusing on numbers can cause unnecessary added stress.
We perform a comprehensive evaluation and develop a personalized treatment plan, so every individual receives the care they need. Our multidisciplinary approach entails a support team that includes a:
Therapies for UFED
Some of the most commonly recommended therapies for eating disorders, including UFED, are: (7,8)
- Cognitive behavioral therapy (CBT) or dialectical behavioral therapy (DBT): CBT and DBT are types of talk therapy in which therapists work with individuals to help them understand what may be causing their behaviors and teach them how to change their negative thought patterns and behaviors .
- Medication: Our psychiatrists participate in shared decision making to determine if someone’s co-occurring conditions warrant medication, or if therapy alone suffices.
- Nutrition Rehabilitation: An integral part of healing includes restoring a positive relationship with food, without the pressures or rules of dieting. This involves learning how to recognize, respect, and follow hunger and satiety cues and identify and heal trauma stemming from diet culture.
- Mood or food diary: Some may find this overwhelming or anxiety inducing, while others find this helpful with the assistance of a registered dietitian/nutritionist. Keeping a diary can identify patterns, unconscious behaviors, and triggers.
- Alternative medicine: Eating disorders often stem from traumatic events that happened during childhood, such as physical, sexual, or emotional abuse, death of a caregiver or close family member, divorce, poverty, or natural disaster. Depending on the type of trauma suffered, alternative treatments such as massage, music, art, body trust/awareness, yoga, biofeedback, and acupuncture therapy can be extremely beneficial. (4)
Levels of care for UFED
There are typically three levels of care:
- Partial hospitalization program (PHP)
- Intensive outpatient program (IOP)
- Outpatient program (OP)
History of UFED
Other specified feeding or eating disorders (OSFED) and Unspecified Feeding or Eating Disorders (UFED) replaced the former term “eating disorder not otherwise specified” (EDNOS) in the DSM-4. Some providers still use EDNOS and frequently confuse OSFED and UFED. Previously, nearly 70% of persons with eating disorders received an EDNOS diagnosis. Healthcare professionals mistakenly believed their cases were not as severe as those with formal ED diagnoses. This resulted in those persons not getting the care they needed. (3) But now providers are more informed, and individuals are getting the care they need.
How to help someone with UFED
If you suspect you or a friend or family member may have an UFED, please seek professional care as soon as possible.
Here are some tips to keep in mind when talking to someone who you think may have an eating disorder:
- Stay open and accepting
- Listen without judgment
- Set healthy boundaries
- Try not to enable ED behaviors
- Avoid making comments about their weight or eating habits
- Approach setbacks with patience
- Share your concern and encourage them to get help
- Offer to support them in any way you can
Call our clinical care team today to start treatment for an eating disorder. Our admissions team can discuss first steps with you, and introduce you to our virtual care program for UFED.
Disclaimer about "overeating": Within Health hesitatingly uses the word "overeating" because it is the term currently associated with this condition in society, however, we believe it inherently overlooks the various psychological aspects of this condition which are often interconnected with internalized diet culture, and a restrictive mindset about food. For the remainder of this piece, we will therefore be putting "overeating" in quotations to recognize that the diagnosis itself pathologizes behavior that is potentially hardwired and adaptive to a restrictive mindset.
Disclaimer about weight loss drugs: Within does not endorse the use of any weight loss drug or behavior and seeks to provide education on the insidious nature of diet culture. We understand the complex nature of disordered eating and eating disorders and strongly encourage anyone engaging in these behaviors to reach out for help as soon as possible. No statement should be taken as healthcare advice. All healthcare decisions should be made with your individual healthcare provider.
- OSFED. Beat. (n.d.). Retrieved December 21, 2021, from https://www.beateatingdisorders.org.uk/get-information-and-support/about-eating-disorders/types/osfed
- Cork S. C. (2018). The role of the vagus nerve in appetite control: Implications for the pathogenesis of obesity. Journal of neuroendocrinology, 30(11), e12643. https://doi.org/10.1111/jne.12643
- Fairburn, C. G., & Bohn, K. (2005). Eating disorder NOS (EDNOS): an example of the troublesome "not otherwise specified" (NOS) category in DSM-IV. Behaviour research and therapy, 43(6), 691–701. https://doi.org/10.1016/j.brat.2004.06.011
- Holland, K. (2022, February 9). Alternative treatments for eating disorders. Healthline. Retrieved March 24, 2022, from https://www.healthline.com/health/eating-disorders-alternative-treatment
- Other specified feeding or eating disorder. National Eating Disorders Association. (2018, July 30). Retrieved March 24, 2022, from https://www.nationaleatingdisorders.org/learn/by-eating-disorder/osfed
- Unspecified feeding or eating disorder. National Eating Disorders Association. (2018, February 22). Retrieved March 24, 2022, from https://www.nationaleatingdisorders.org/unspecified-feeding-or-eating-disorder
- Yager, MD, J. (n.d.). Eating disorders: Overview of epidemiology, clinical features, and diagnosis. UpToDate. Retrieved December 21, 2021, from uptodate.com
- Yager, MD, J. (n.d.). Eating disorders: Overview of prevention and treatment. UpToDate. Retrieved March 24, 2022, from uptodate.com
What is the difference between OSFED and UFED?
OSFED is given as a diagnosis when someone does not meet all the specific DSM-5 criteria for an eating disorder. UFED is a diagnosis typically given to a patient in the ER when a provider does not have enough time for a full evaluation to specify why a patient may not meet all DSM-5 criteria.
Is an UFED worse than an OSFED?
No, UFEDs have similar symptom severity and can be just as life threatening if left untreated. For many years, UFED diagnoses went largely ignored, which delayed care. (1,3,5,6)
How can you heal from an UFED?
Eating disorders are very serious illnesses with life threatening consequences. It can be hard to ask for help. But with the right treatment from experienced healthcare professionals and support of loved ones, recovery is possible.