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What is Night Eating Disorder?

Updated: Oct 9, 2020

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Night eating syndrome is a combination of insomnia and binge eating disorder; an individual eats a regular diet during the day, but binges after the evening meal or during the night when they can't sleep. The disease can be accompanied by the feeling of needing to eat to get back to sleep.



Diagnosis Criteria

There must be a significant increase in food intake like one or both: 1) at least 25% of food intake is consumed after the evening meal or 2) at least two episodes of eating at night per week.


Ability to recall or observe behavior.


Must have three of the following:

1) Decreased desire to eat in the morning for four or more mornings per week,

2) Strong urge to eat between dinner and sleep onset and/or during the night,

3) Insomnia is present four or more nights per week,

4) A belief that one has to eat to fall back asleep, or

5) The depressed or worsened mood in the evening.


Association with significant distress and/or impairment in functioning.


Must be maintained for at least three months.


Behavior is not secondary to another condition such as substance abuse or dependence, medical disorder, medication, or another psychiatric disorder.



Allison, Kelly C et al. "Proposed diagnostic criteria for night eating syndrome." The International journal of eating disorders vol. 43,3 (2010): 241-7. doi:10.1002/eat.20693


Symptoms

Credit to Eating Recovery Center.

  1. "Morning anorexia" — skipping breakfast or not eating until noon or later on four or more mornings per week

  2. "Evening hyperphagia" — eating more than 25 percent of one's total daily calories (possibly in the form of continuous "grazing") between dinner and bedtime

  3. Having difficulty falling or staying asleep

  4. Experiencing mood or anxiety symptoms that get worse at night — leaving one feeling more agitated, irritable, or depressed in the evening

  5. Presence of a belief that one must eat to go to sleep initially or to return to sleep

Credit to WebMD.

Night eating syndrome is different from binge eating disorder. With BED, you're more likely to eat a lot at a single sitting. If you have NES, you likely eat smaller amounts throughout the night. NES is also different from a sleep-related eating disorder. With NES, you'll remember you've eaten the night before.


Causes

For the most part, the reason for night eating syndrome is unknown. Research has shown that there isn't one cause connected to every eating disorder case, but many interchangeable reasons. Not every case is the same. Causes are physiological, biological, and environmental.

Mental Health Disorders. Studies have found that night eating syndrome patients often have a history of other disorders such as substance abuse, depression, and anxiety. Many people also report negative emotions associated with their eating disorder, such as anxiety, boredom, anger, and sadness.

Run in Families. Families share not only genetics but also eating habits. Research hasn't found any genetic risks yet, though research has found that genes responsible for circadian rhythm and those genes can affect metabolism. Parents pass down their eating habits to their children, so if the parents have a pattern of disordered eating, they will more likely too.

Emotional Trauma. Stress can cause night eating syndrome, specifically, stressful life events like divorce, abuse, or death. It can be used as a coping mechanism for traumatic experiences. If a person feels they are losing control over their eating, they are more likely to develop an eating disorder.


Body Image. People with a negative body image are more likely to develop night eating syndrome. Negative body image includes having a fear of gaining weight, are overly focused on being thin, or unhappiness or frustration with their body. Negative body image can lead to frequent dieting and overeating and vice versa. Constant dieting is another risk factor for developing an eating disorder.

Weight/Eating Problems. Individuals with weight problems, higher body mass index, or other eating disorders are more likely to develop night eating syndrome. NES patients have a history of dieting and might be a response to dieting. Restriction of calorie intake during the day signals the brain to overcompensate at night.


College Students/High Achievers. College students and high achievers are at a higher risk of developing NES. Individuals who attend university might start eating at night and are unable to break the habit. High achievers might work through lunch then overcompensate at night.

Husse J, Hintze SC, Eichele G, Lehnert H, Oster H. Circadian clock genes Per1 and Per2 regulate the response of metabolism-associated transcripts to sleep disruption.PLoS One. 2012;7(12):e52983. doi:10.1371/journal.pone.0052983

Runfola, Cristin D et al. “Prevalence and clinical significance of night eating syndrome in university students.”The Journal of adolescent health : official publication of the Society for Adolescent Medicine vol. 55,1 (2014): 41-8. doi:10.1016/j.jadohealth.2013.11.012

Hormones. The circadian rhythm is affected by hormones. If there is a hormonal imbalance, it can lead to disturbances in the day-light cycle and, in turn, night eating syndrome. Disruptions in hormonal patterns can also lead to an inverted hunger signal so a person eats when they shouldn't and fasts when they shouldn't.



Statistics

Studies show that 25% of individuals with serious mental illness met NES criteria and 5.9% for binge eating disorder.

Lundgren, Jennifer D et al. "The prevalence of night eating syndrome and binge eating disorder among overweight and obese individuals with serious mental illness." Psychiatry research vol. 175,3 (2010): 233-6. doi:10.1016/j.psychres.2008.10.027


A study discovered that 4.2% of university students have NES; after excluding individuals with binge eating disorder, it was 2.9%. Students with NES were significantly more likely to have histories of being underweight or anorexia nervosa.

Runfola, Cristin D et al. "Prevalence and clinical significance of night eating syndrome in university students." The Journal of adolescent health : official publication of the Society for Adolescent Medicine vol. 55,1 (2014): 41-8. doi:10.1016/j.jadohealth.2013.11.012


A study of the three hundred mental health patients, 15.7% had NES. Night eating syndrome was significantly more prevalent in individuals with major depression. The study found that depression, BMI, and smoking were characteristics of NES.

Küçükgöncü, Suat, and Emrem Beştepe. “Night Eating Syndrome in Major Depression and Anxiety Disorders.” Noro psikiyatri arsivi vol. 51,4 (2014): 368-375. doi:10.5152/npa.2014.7204


According to the National Institute of Health, about 1.5% of the population has night eating syndrome, and the disorder appears at the same rate in men and women.

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Health Consequences

Binge Eating Disorder Health Consequences


Overweight/Obese issues

  • High blood pressure

  • Diabetes

  • High cholesterol

  • Heart diseases

  • Cancer

  • Gallbladder disease



Treatment Options

Pharmacological Treatment. Multiple studies have tested selective serotonin reuptake inhibitors (SSRI), which are commonly used to treat depression and mood disorders. Research agrees that these drugs reduce symptoms of NES, but don't necessarily improve mood. More research must be conducted.

Cognitive Behavior Therapy. Cognitive Behavior Therapy (CBT) is a type of psychotherapy that attempts to modify dysfunctional thoughts, emotions, or behaviors. CBT adapted from binge eating disorder, and behavioral weight loss CBT methods have proven effective. Its primary goal is to correct eating during the night by eating more food earlier in the day and by reconfiguring the relationship between eating and sleep.

Progressive Muscle Relaxation. Progressive muscle relaxation (PMR) uses tension and release of various muscle groups to achieve muscular relaxation; it has been proven to improve other conditions like anxiety and stress. One study demonstrated that PMR reduced symptoms of NES, but also stress, anxiety, fatigue, anger, depression, and cortisol levels.

Phototherapy. Phototherapy is the administration of bright light to address the body's internal clock, skin disorder, or mood disorder. Two studies showed that phototherapy reduced depression and NES, but each study was only conducted on one person, so further research is required.

Behavior Therapy. Some studies have shown that behavior therapy is an effective treatment option for NES. One case study demonstrated that behavioral techniques like leaving notes or restricting access to food aided in recovery, but once behaviors were discontinued, symptoms returned. Other studies tried behavioral weight management; all therapy methods require more exploration.

Allison, Kelly C, and Ellen P Tarves. "Treatment of night eating syndrome." The Psychiatric clinics of North America vol. 34,4 (2011): 785-96. doi:10.1016/j.psc.2011.08.002

Berner, Laura A, and Kelly C Allison. "Behavioral management of night eating disorders." Psychology research and behavior management vol. 6 (2013): 1-8. doi:10.2147/PRBM.S31929


Book: Clinical Handbook of Complex and Atypical Eating Disorders

Author: Anderson, L.K.; Murray, S.B.; Kaye, W.H.

Publish Date: September 26, 2017

Price: $69 (Paperback)

Description: "Clinical Handbook of Complex and Atypical Eating Disorders brings together into one comprehensive resource what is known about an array of complicating factors for patients with ED, serving as an accessible introduction to each of the comorbidities and symptom presentations highlighted in the volume. The first section of the book focuses on the treatment of ED in the presence of various comorbidities, and the second section explores the treatment of ED with atypical symptom presentations. The third section focuses on how to adapt ED treatments for diverse populations typically neglected in controlled treatment trials: LGBT, pediatric, male, ethnically diverse, and older adult populations. Each chapter includes a review of clinical presentation, prevalence, treatment approaches, resources, c