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  • Why should I/we choose Richmond Center for Eating Disorders (RCED) for eating disorder treatment rather than a treatment facility?

    We believe that parents/patients should have a choice regarding eating disorder treatment.  Due to the seriousness of these illnesses we want individuals and their families/carers to be informed about treatment options as well as the outcomes of those treatments. The methods that are delivered at RCED have demonstrated empirical support. We believe that families/carers/individuals are not to be blamed for eating disorders, and instead are vital resources to the success of a treatment plan.

    Our Specialties

    Our expert Clinicians specialize in treating adolescents, athletes and young adults. Our Therapists are highly skilled and trained in utilizing evidenced based treatments; Family Based Treatment (FBT) and Cognitive Behavioral Therapy enhanced for Eating Disorders (CBT-E). Our Dietitians are trained in Certified Eating Disorder Nutrition and Sports Nutrition. And our Mentors have lived experiences either with their own children who are in successful recovery or their own path through recovery. They are also professionally trained in Mentorship in eating disorder recovery.

    We offer a highly effective 3-4 person care team to each family and individual. This team includes; Therapist (s), Dietitian, and Mentor who stay with the family for the duration of treatment and is committed to their success.   

    Can I see only the Therapist or Dietitian?

    We offer an all inclusive program of therapist, mentor and RD services. Our clients will be set up with all 3 providers after their assessments. We do not offer separate services for only one provider, such as a therapist or Dietitian. 

    What are your fees?

    Our practice accepts insurance for Therapy services. Our Family and Mentor services are Fee based. Please contact our practice for more specific costs for services. 

    Do you take insurance?

    Yes we take the following insurance plans for therapy services:

    Anthem BCBS

    Aetna

    Optum (United Healthcare, Oscar, Oxford)

    Our Dietitians are not in-network with insurance plans, they are considered out-of-network (OON). We can help you contact your insurance company to understand your OON reimbursement. We can also facilitate reimbursement for you. This is at no cost to you.

    What is a good faith estimate?

    You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost

    Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.

    • You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes  related costs like medical tests, prescription drugs, equipment, and hospital fees.

    • Make sure your health care provider gives you a Good Faith Estimate in writing at least one business day before your medical service or item. You can also ask your health care provider, and any other provider you choose for a Good Faith Estimate before you schedule an item or service.

    • If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.

    • Make sure to save a copy or picture of your Good Faith Estimate.

    For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call RCED @ (804) 767-0111

    Do you offer Teletherapy?

    We offer therapy and nutrition counseling via a secure and compliant telehealth software.

    What is your cancellation policy?

    We require 48 hours notice for all appointments and charge full session fee for each missed appointment.

    Where is your office located?

    The Fan District

    1312 B W Main St. Richmond, Va 23220

    Get Directions

    Where can I park?

    There is on street parking in front of our building.

    What is Anorexia (AN)?

    According to the National Eating Disorder Association (NEDA), AN has the following symptoms and impact:

    Anorexia nervosa is an eating disorder characterized by weight loss (or lack of appropriate weight gain in growing children); difficulties maintaining an appropriate body weight for height, age, and stature; and, in many individuals, distorted body image. People with anorexia generally restrict the number of calories and the types of food they eat. Some people with the disorder also exercise compulsively, purge via vomiting and laxatives, and/or binge eat.

    Anorexia can affect people of all ages, genders, sexual orientations, races, and ethnicities. Historians and psychologists have found evidence of people displaying symptoms of anorexia for hundreds or thousands of years.

    Although the disorder most frequently begins during adolescence, an increasing number of children and older adults are also being diagnosed with anorexia. You cannot tell if a person is struggling with anorexia by looking at them. A person does not need to be emaciated or underweight to be struggling. Studies have found that larger-bodied individuals can also have anorexia, although they may be less likely to be diagnosed due to cultural prejudice against fat and obesity.

    DIAGNOSTIC CRITERIA

    To be diagnosed with anorexia nervosa according to the DSM-5, the following criteria must be met:

    Restriction of energy intake relative to requirements leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health.

    Intense fear of gaining weight or becoming fat, even though underweight.

    Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.

    Even if all the DSM-5 criteria for anorexia are not met, a serious eating disorder can still be present. Atypical anorexia includes those individuals who meet the criteria for anorexia but who are not underweight despite significant weight loss. Research studies have not found a difference in the medical and psychological impacts of anorexia and atypical anorexia.

    WARNING SIGNS & SYMPTOMS OF ANOREXIA NERVOSA

    Emotional and behavioral

    Dramatic weight loss

    Dresses in layers to hide weight loss or stay warm

    Is preoccupied with weight, food, calories, fat grams, and dieting

    Refuses to eat certain foods, progressing to restrictions against whole categories of food (e.g., no carbohydrates, etc.)

    Makes frequent comments about feeling “fat” or overweight despite weight loss

    Complains of constipation, abdominal pain, cold intolerance, lethargy, and/or excess energy

    Denies feeling hungry

    Develops food rituals (e.g., eating foods in certain orders, excessive chewing, rearranging food on a plate)

    Cooks meals for others without eating

    Consistently makes excuses to avoid mealtimes or situations involving food

    Expresses a need to “burn off” calories taken in

    Maintains an excessive, rigid exercise regimen – despite weather, fatigue, illness, or injury

    Withdraws from usual friends and activities and becomes more isolated, withdrawn, and secretive

    Seems concerned about eating in public

    Has limited social spontaneity

    Resists or is unable to maintain a body weight appropriate for their age, height, and build

    Has intense fear of weight gain or being “fat,” even though underweight

    Has disturbed experience of body weight or shape, undue influence of weight or shape on self-evaluation, or denial of the seriousness of low body weight

    Postpuberty female loses menstrual period

    Feels ineffective

    Has strong need for control

    Shows inflexible thinking

    Has overly restrained initiative and emotional expression

    Physical

    Stomach cramps, other non-specific gastrointestinal complaints (constipation, acid reflux, etc.)

    Difficulties concentrating

    Abnormal laboratory findings (anemia, low thyroid and hormone levels, low potassium, low blood cell counts, slow heart rate)

    Dizziness

    Fainting/syncope

    Feeling cold all the time

    Sleep problems

    Menstrual irregularities—amenorrhea, irregular periods or only having a period while on hormonal contraceptives (this is not considered a “true” period)

    Cuts and calluses across the top of finger joints (a result of inducing vomiting)

    Dental problems, such as enamel erosion, cavities, and tooth sensitivity

    Dry skin

    Dry and brittle nails

    Swelling around area of salivary glands

    Fine hair on body (lanugo)

    Thinning of hair on head, dry and brittle hair

    Cavities, or discoloration of teeth, from vomiting

    Muscle weakness

    Yellow skin (in context of eating large amounts of carrots)

    Cold, mottled hands and feet or swelling of feet

    Poor wound healing

    Impaired immune functioning

    HEALTH CONSEQUENCES OF ANOREXIA NERVOSA

    In anorexia nervosa’s cycle of self-starvation, the body is denied the essential nutrients it needs to function normally. Thus, the body is forced to slow down all of its processes to conserve energy, resulting in serious medical consequences.

    The body is generally resilient at coping with the stress of eating disordered behaviors, and laboratory tests can generally appear perfect even as someone is at high risk of death. Electrolyte imbalances can kill without warning; so can cardiac arrest. Therefore, it’s incredibly important to understand the many ways that eating disorders affect the body.

    What is Avoidant Restrictive Food Intake Disorder (ARFID)?

    According to the National Eating Disorder Association ARFID has the following signs and impact:

    Avoidant Restrictive Food Intake Disorder (ARFID) is a new diagnosis in the DSM-5, and was previously referred to as “Selective Eating Disorder.” ARFID is similar to anorexia in that both disorders involve limitations in the amount and/or types of food consumed, but unlike anorexia, ARFID does not involve any distress about body shape or size, or fears of fatness.

    Although many children go through phases of picky or selective eating, a person with ARFID does not consume enough calories to grow and develop properly and, in adults, to maintain basic body function. In children, this results in stalled weight gain and vertical growth; in adults, this results in weight loss. ARFID can also result in problems at school or work, due to difficulties eating with others and extended times needed to eat.

    DIAGNOSTIC CRITERIA

    According to the DSM-5, ARFID is diagnosed when:

    An eating or feeding disturbance (e.g., apparent lack of interest in eating or food; avoidance based on the sensory characteristics of food; concern about aversive consequences of eating) as manifested by persistent failure to meet appropriate nutritional and/or energy needs associated with one (or more) of the following:

    Significant weight loss (or failure to achieve expected weight gain or faltering growth in children).

    Significant nutritional deficiency.

    Dependence on enteral feeding or oral nutritional supplements.

    Marked interference with psychosocial functioning.

    The disturbance is not better explained by lack of available food or by an associated culturally sanctioned practice.

    The eating disturbance does not occur exclusively during the course of anorexia nervosa or bulimia nervosa, and there is no evidence of a disturbance in the way in which one’s body weight or shape is experienced.

    The eating disturbance is not attributable to a concurrent medical condition or not better explained by another mental disorder. When the eating disturbance occurs in the context of another condition or disorder, the severity of the eating disturbance exceeds that routinely associated with the condition or disorder and warrants additional clinical attention.

    RISK FACTORS

    As with all eating disorders, the risk factors for ARFID involve a range of biological, psychological, and sociocultural issues. These factors may interact differently in different people, which means two people with the same eating disorder can have very diverse perspectives, experiences, and symptoms. Researchers know much less about what puts someone at risk of developing ARFID, but here’s what they do know:

    People with autism spectrum conditions are much more likely to develop ARFID, as are those with ADHD and intellectual disabilities.

    Children who don’t outgrow normal picky eating, or in whom picky eating is severe, appear to be more likely to develop ARFID.

    Many children with ARFID also have a co-occurring anxiety disorder, and they are also at high risk for other psychiatric disorders.

    WARNING SIGNS & SYMPTOMS OF ARFID

    Behavioral and psychological

    Dramatic weight loss

    Dresses in layers to hide weight loss or stay warm

    Reports constipation, abdominal pain, cold intolerance, lethargy, and/or excess energy

    Reports consistent, vague gastrointestinal issues (“upset stomach”, feels full, etc.) around mealtimes that have no known cause

    Dramatic restriction in types or amount of food eaten

    Will only eat certain textures of food

    Fears of choking or vomiting

    Lack of appetite or interest in food

    Limited range of preferred foods that becomes narrower over time (i.e., picky eating that progressively worsens).

    No body image disturbance or fear of weight gain

    Physical

    Because both anorexia and ARFID involve an inability to meet nutritional needs, both disorders have similar physical signs and medical consequences.

    Stomach cramps, other non-specific gastrointestinal complaints (constipation, acid reflux, etc.)

    Menstrual irregularities—missing periods or only having a period while on hormonal contraceptives (this is not considered a “true” period)

    Difficulties concentrating

    Abnormal laboratory findings (anemia, low thyroid and hormone levels, low potassium, low blood cell counts, slow heart rate)

    Postpuberty female loses menstrual period

    Dizziness

    Fainting/syncope

    Feeling cold all the time

    Sleep problems

    Dry skin

    Dry and brittle nails

    Fine hair on body (lanugo)

    Thinning of hair on head, dry and brittle hair

    Muscle weakness

    Cold, mottled hands and feet or swelling of feet

    Poor wound healing

    Impaired immune functioning

    HEALTH CONSEQUENCES OF ARFID

    In ARFID, the body is denied the essential nutrients it needs to function normally. Thus, the body is forced to slow down all of its processes to conserve energy, resulting in serious medical consequences. The body is generally resilient at coping with the stress of eating disordered behaviors, and laboratory tests can generally appear perfect even as someone is at high risk of death. Electrolyte imbalances can kill without warning; so can cardiac arrest. Therefore, it’s incredibly important to understand the many ways that eating disorders affect the body.

    What is Bigorexia or The Adonis Complex

    Signs of Bigorexia

    • Overexerting themselves at the gym
    • Working out compulsively
    • Use of steroids
    • Excessively looking at their body in the mirror
    • Abuse of supplements and constantly drinking protein shakes
    • Irritability and angry outbursts
    • Depression and mania
    • Panicking if a gym session is missed

    Causes of Bigorexia

    Unfortunately, experts don’t have a clear understanding of what causes bigorexia or muscle dysmorphia just yet but like other compulsive disorders, research suggests that there are a number of factors which could contribute to it:

    • Genetics – those who have a relative suffering from the condition may be more likely to develop it
    • Brain differences – it’s thought that people with muscle dysmorphia may have insufficient levels of serotonin which is an important transmitter in the brain that affects mood and well-being
    • Environment – childhood environment, family issues, bullying, emotional trauma and cultural factors may increase a person’s risk of developing the condition

    According to Julie Alvira, MD: 

    Bigorexia––Adonis Complex

    A type of body dysmorphic disorder known as bigorexia, reverse anorexia or Adonis complex is becoming very popular among men gym goers. It is widely known that for many men muscularity equals masculinity. A man with bigorexia is not the typical person that seeks to maintain a healthy lifestyle. This is the male bodybuilder that becomes obsessed with his body because he is unhappy, one whom sometimes seeks injectable anabolic steroids, chest implants, and other type of cosmetic procedures to feed an emotional emptiness, which in some cases can be an underlying depression. Bigorexia can be misdiagnosed because there are a great number of men who just want to improve their physical appearance to attract partners. The problem here is when a vicious circle forms. According to Brown University, the more a person focuses on his body, the worse he tends to feel about how he looks. There are a number of factors that can lead to body dissatisfaction ranging from the comments of family and friends to deeper emotional issues such as different kinds of abuse, discrimination, and sensory experiences.

    Nowadays, exposures like social media does not help because of the increase popularity of body image acceptance and idealization of bodies leading to an increase comparison of a person’s body to others. A study at Stanford University showed that when a man feels uncomfortably obsessed with his body, sometimes it can result in sexual problems and risky behaviors.

    Dr. Murray, a clinical psychologist explains that unless a man acknowledges the problem and seeks help, treatment can’t be offered. In our society, it is very hard for this kind of man to seek help because of the “no pain, no gain” mentality and masculinity. If treatment occurs, it is done with the same techniques used to treat anorexia disorders. On the other hand, recent research by Phillips (2015) in the American Journal of Psychiatry presents that body dysmorphic disorder in general, is related to obsessive compulsive disorder (OCD) and benefits from psychosocial treatment and motivational interviewing techniques to engage and retain patients in treatment. Both disorders have many similarities but also differences that are still under research to find better approaches to the underlying symptoms and causes.

    What is Binge Eating Disorder (BED)

    According to the National Eating Disorder Association (NEDA), BED has the following signs and impact:

    Binge eating disorder (BED) is a severe, life-threatening, and treatable eating disorder characterized by recurrent episodes of eating large quantities of food (often very quickly and to the point of discomfort); a feeling of a loss of control during the binge; experiencing shame, distress or guilt afterwards; and not regularly using unhealthy compensatory measures (e.g., purging) to counter the binge eating. It is the most common eating disorder in the United States.

    BED is one of the newest eating disorders formally recognized in the DSM-5. Before the most recent revision in 2013, BED was listed as a subtype of EDNOS (now referred to as OSFED). The change is important because some insurance companies will not cover eating disorder treatment without a DSM diagnosis.

    DIAGNOSTIC CRITERIA

    Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:

    Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most people would eat in a similar period of time under similar circumstances.

    A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).

    The binge eating episodes are associated with three (or more) of the following:

    Eating much more rapidly than normal.

    Eating until feeling uncomfortably full.

    Eating large amounts of food when not feeling physically hungry.

    Eating alone because of feeling embarrassed by how much one is eating.

    Feeling disgusted with oneself, depressed, or very guilty afterward.

    Marked distress regarding binge eating is present.

    The binge eating occurs, on average, at least once a week for 3 months.

    The binge eating is not associated with the recurrent use of inappropriate compensatory behaviors (e.g., purging) as in bulimia nervosa and does not occur exclusively during the course of bulimia nervosa or anorexia nervosa.

    WARNING SIGNS & SYMPTOMS OF BINGE EATING DISORDER

    Emotional and behavioral

    Evidence of binge eating, including disappearance of large amounts of food in short periods of time or lots of empty wrappers and containers indicating consumption of large amounts of food.

    Appears uncomfortable eating around others

    Any new practice with food or fad diets, including cutting out entire food groups (no sugar, no carbs, no dairy, vegetarianism/veganism)

    Fear of eating in public or with others

    Steals or hoards food in strange places

    Creates lifestyle schedules or rituals to make time for binge sessions

    Withdraws from usual friends and activities

    Frequently diets

    Shows extreme concern with body weight and shape

    Frequent checking in the mirror for perceived flaws in appearance

    Has secret recurring episodes of binge eating (eating in a discrete period of time an amount of food that is much larger than most individuals would eat under similar circumstances); feels lack of control over ability to stop eating

    Disruption in normal eating behaviors, including eating throughout the day with no planned mealtimes; skipping meals or taking small portions of food at regular meals; engaging in sporadic fasting or repetitive dieting

    Developing food rituals (e.g., eating only a particular food or food group [e.g., condiments], excessive chewing, and not allowing foods to touch).

    Eating alone out of embarrassment at the quantity of food being eaten

    Feelings of disgust, depression, or guilt after overeating

    Fluctuations in weight

    Feelings of low self-esteem

    Physical

    Noticeable fluctuations in weight, both up and down

    Stomach cramps, other non-specific gastrointestinal complaints (constipation, acid reflux, etc.)

    Difficulties concentrating

    HEALTH CONSEQUENCES OF BINGE EATING DISORDER

    The health risks of BED are most commonly those associated with clinical obesity, weight stigma, and weight cycling (aka, yo-yo dieting). Most people who are labeled clinically obese do not have binge eating disorder. However, of individuals with BED, up to two-thirds are labelled clinically obese; people who struggle with binge eating disorder tend to be of normal or higher-than-average weight, though BED can be diagnosed at any weight.

    What is Bulimia Nervosa (BN)

    According to the National Eating Disorder Association (NEDA) BN has the following signs and impact:

    Bulimia nervosa is a serious, potentially life-threatening eating disorder characterized by a cycle of bingeing and compensatory behaviors such as self-induced vomiting designed to undo or compensate for the effects of binge eating.

    DIAGNOSTIC CRITERIA

    According to the DSM-5, the official diagnostic criteria for bulimia nervosa are:

    Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:

    Eating, in a discrete period of time (e.g. within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances.

    A sense of lack of control over eating during the episode (e.g. a feeling that one cannot stop eating or control what or how much one is eating).

    Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting, misuse of laxatives, diuretics, or other medications, fasting, or excessive exercise.

    The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for three months.

    Self-evaluation is unduly influenced by body shape and weight.

    The disturbance does not occur exclusively during episodes of anorexia nervosa.

    WARNING SIGNS & SYMPTOMS OF BULIMIA NERVOSA

    Emotional and behavioral

    In general, behaviors and attitudes indicate that weight loss, dieting, and control of food are becoming primary concerns

    Evidence of binge eating, including disappearance of large amounts of food in short periods of time or lots of empty wrappers and containers indicating consumption of large amounts of food

    Evidence of purging behaviors, including frequent trips to the bathroom after meals, signs and/or smells of vomiting, presence of wrappers or packages of laxatives or diuretics

    Appears uncomfortable eating around others

    Develops food rituals (e.g. eats only a particular food or food group [e.g. condiments], excessive chewing, doesn’t allow foods to touch)

    Skips meals or takes small portions of food at regular meals

    Disappears after eating, often to the bathroom

    Any new practice with food or fad diets, including cutting out entire food groups (no sugar, no carbs, no dairy, vegetarianism/veganism)

    Fear of eating in public or with others

    Steals or hoards food in strange places

    Drinks excessive amounts of water or non-caloric beverages

    Uses excessive amounts of mouthwash, mints, and gum

    Hides body with baggy clothes

    Maintains excessive, rigid exercise regimen – despite weather, fatigue, illness, or injury—due to the need to “burn off ” calories

    Shows unusual swelling of the cheeks or jaw area

    Has calluses on the back of the hands and knuckles from self- induced vomiting

    Teeth are discolored, stained

    Creates lifestyle schedules or rituals to make time for binge-and-purge sessions

    Withdraws from usual friends and activities

    Looks bloated from fluid retention

    Frequently diets

    Shows extreme concern with body weight and shape

    Frequent checking in the mirror for perceived flaws in appearance

    Has secret recurring episodes of binge eating (eating in a discrete period of time an amount of food that is much larger than most individuals would eat under similar circumstances); feels lack of control over ability to stop eating

    Purges after a binge (e.g. self-induced vomiting, abuse of laxatives, diet pills and/or diuretics, excessive exercise, fasting)

    Extreme mood swings

    Physical

    Noticeable fluctuations in weight, both up and down

    Body weight is typically within the normal weight range; may be overweight

    Stomach cramps, other non-specific gastrointestinal complaints (constipation, acid reflux, etc.)

    Difficulties concentrating

    Abnormal laboratory findings (anemia, low thyroid and hormone levels, low potassium, low blood cell counts, slow heart rate)

    Dizziness

    Fainting/syncope

    Feeling cold all the time

    Sleep problems

    Cuts and calluses across the top of finger joints (a result of inducing vomiting)

    Dental problems, such as enamel erosion, cavities, and tooth sensitivity

    Dry skin

    Dry and brittle nails

    Swelling around area of salivary glands

    Fine hair on body

    Thinning of hair on head, dry and brittle hair (lanugo)

    Cavities, or discoloration of teeth, from vomiting

    Muscle weakness

    Yellow skin (in context of eating large amounts of carrots)

    Cold, mottled hands and feet or swelling of feet

    Menstrual irregularities — missing periods or only having a period while on hormonal contraceptives (this is not considered a “true” period)

    Poor wound healing

    Impaired immune functioning

    Many people with bulimia nervosa also struggle with co-occurring conditions, such as:

    Self-injury (cutting and other forms of self-harm without suicidal intention)

    Substance abuse

    Impulsivity (risky sexual behaviors, shoplifting, etc.)

    Diabulimia (intentional misuse of insulin for type 1 diabetes)

    Learn more about co-occurring conditions >

    HEALTH CONSEQUENCES OF BULIMIA NERVOSA

    The recurrent binge-and-purge cycles of bulimia can affect the entire digestive system and can lead to electrolyte and chemical imbalances in the body that affect the heart and other major organ functions.

    The body is generally resilient at coping with the stress of eating disordered behaviors, and laboratory tests can generally appear perfect even as someone is at high risk of death. Electrolyte imbalances can kill without warning; so can cardiac arrest. Therefore, it’s incredibly important to understand the many ways that eating disorders affect the body.

    What is Other Specified Feeding or Eating Disorder (OSFED)

    According to the National Association of Eating Disorders (NEDA) 

    Other specified feeding and eating disorder (OSFED), formerly known as eating disorder not otherwise specified (EDNOS) in previous versions of the DSM, is less well known than higher-profile diagnoses like anorexia nervosa, bulimia nervosa, and binge eating disorder. Despite its lack of public attention, as a catch-all category that includes a wide range of symptoms, OSFED is actually the most common eating disorder diagnosis, representing an estimated 32% to 53% of all people with eating disorders.1 It was developed to encompass people who did not meet the full diagnostic criteria for anorexia nervosa or bulimia nervosa but still had a significant eating disorder.

    Symptoms

    Like other eating disorders, symptoms include behavioral, emotional, and physical aspects.

    Behavioral symptoms of OSFED often include a preoccupation with weight, food, calories, fat grams, dieting, and exercise,2 including:

    • Refusing to eat certain foods (restriction against categories of food like no carbs, no sugar, no dairy)
    • Frequent comments about feeling “fat” or overweight
    • Denial about feeling hungry
    • Fear of eating around others
    • Binge eating
    • Purging behaviors (frequent trips to the bathroom after meals, signs and/or smells of vomiting, wrappers or packages of laxatives or diuretics)
    • Food rituals (such as excessive chewing or not allowing foods to touch)
    • Skipping meals or eating small portions at regular meals
    • Stealing or hoarding food
    • Drinking excessive amounts of water (or non-caloric beverages)
    • Using excessive amounts of mouthwash, mints, and gum 
    • Hiding body with baggy clothes 
    • Exercising excessively (despite weather, fatigue, illness, or injury) 

    The emotional symptoms of OSFED can include:

    • Low self-esteem
    • Depression
    • Strong need for approval
    • Anxiety
    • Little motivation to engage in relationships or activities
    • Easily irritated
    • Extremely self-critical

    The physical symptoms of OSFED include:

    • Noticeable fluctuations in weight
    • Gastrointestinal symptoms (such as stomach cramps, constipation, and acid reflux)
    • Menstrual irregularities and amenorrhea (missing periods)
    • Difficulty concentrating
    • Anemia
    • Low thyroid and hormone levels
    • Low potassium
    • Low blood cell counts
    • Slow heart rate
    • Dizziness
    • Fainting/syncope
    • Feeling cold all the time
    • Sleep troubles
    • Cuts and calluses across the top of finger joints (a result of inducing vomiting)
    • Dental problems (such as discolored teeth, enamel erosion, cavities, and tooth sensitivity)
    • Dry skin
    • Dry and brittle nails
    • Swelling around area of salivary glands
    • Fine hair on body
    • Thinning of hair or dry and brittle hair
    • Muscle weakness
    • Yellow skin (from eating large quantities of carrots)
    • Cold, mottled hands and feet
    • Swelling of feet
    • Poor wound healing
    • Impaired immune system

    Causes

    OSFED is a complex illness and, while we don’t know the exact cause, genetics and environmental factors both appear to play a role. When it comes to eating disorders, it’s often said that “genes load the gun, but environment pulls the trigger.”

    In other words, in those who are genetically vulnerable, certain situations and events contribute to or trigger the development of an eating disorder.

    Environmental factors include:

    Diagnosis

    One problem with psychiatric diagnoses, in general, is that many patients do not fit neatly into the typical diagnostic categories. It’s not always clear-cut. Sometimes people meet most but not all of the criteria for a diagnosis.

    In the case of eating disorders, a person who does not qualify for a specific eating disorder diagnosis would be classified as OSFED. The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) includes five examples of patients who would be classified as OSFED:

    Frequently Asked Questions