Night eating syndrome

Last updated
Night eating syndrome
Specialty Psychiatry
Complications Obesity
Frequency1–2% (general population), approximately 10% of overweight individuals

Night eating syndrome (NES) is classified as an Other Specified Feeding or Eating Disorder (OSFED) under the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). [1] It involves recurrent episodes of night eating after awakening from sleep or after the evening meal. [2] [3] Awareness and recall of the eating is present, which is a key characteristic that differentiates the disorder from Sleep-Related Eating Disorder (SRED). [2] [3] Although there is some degree of comorbidity with binge eating disorder (BED), it differs from binge eating in that the amount of food consumed in the night is not necessarily objectively large nor is a loss of control over food intake required. [4] [5] The syndrome causes significant distress or functional impairment and cannot be better explained by external influences such as changes in the sleep-wake cycle, social norms, substance use, medication, or another mental or medical disorder. [4] [5]

Contents

History

NES was originally described by Albert Stunkard in 1955 [6] and is currently included in the other specified feeding or eating disorder (OSFED) category of the DSM-5. [1] Most of the updated literature relating to NES has been published in recent years due to its recent changes in the DSM-5.

Epidemiology

NES affects both men and women, [7] between 1 and 2% of the general population, [8] and approximately 10% of obese individuals. [9] Newer research suggests that the overall prevalence of NES ranges from 2.8% to 15.2% in clinical patients with eating disorders, obesity, and/or bariatric surgery. [2] [3] [4]

Previously, the age of onset was typically in early adulthood (spanning from late teenage years to late twenties) and was often long-lasting, [10] with children rarely reporting NES. [11] However, newer studies have suggested that age is not a risk factor for NES, yet this evidence is still lacking. [2]

Other social-demographic factors such as income, gender, education level, children, living with a romantic partner, and smoking levels do not have an effect on NES. [2] Furthermore, there have been contradictory conclusions on whether a higher BMI is a risk factor of NES, or if it is simply a consequence of night eating behavior. [2] [3] [4]

There has been no specific statistics regarding NES and mortality. [3]

Presentation

Comorbidities

NES has a substantial association with medical diagnoses such as obesity, sleep apnea, hypercholesterolemia, polycystic ovarian syndrome, and diabetes mellitus type II (T2DM), and psychiatric diagnoses such as binge eating disorder, anorexia nervosa, bulimia nervosa, generalized anxiety disorder, major depressive disorder, and substance use disorders. [2] [3] [4] [12]

In contrast to eating disorders like anorexia nervosa, NES does not necessarily depend on a person’s Body Mass Index (BMI). [2] [3] [4] It can occur in individuals with a weight considered normal for their age and height but is most commonly observed and studied in those with obesity. [13] [14] In fact, NES has been found to be a risk factor for an earlier onset of obesity. [2] NES is most commonly comorbid with excess weight; as many as 28% of individuals seeking gastric bypass surgery were found to have NES in one study. [2] [15] Night eating syndrome has also been associated with diabetic complications. [16]

Many people with NES also experience depressed mood, [2] [13] [17] [18] [19] [20] [21] [22] [23] [24] post-traumatic stress disorder, [2] and anxiety disorders. [2] [22] [23] [25] [26] People with NES have been shown to have higher scores for depression and low self-esteem. [2] NES may also have an association with personality traits, such as harm avoidance, self-directedness, and impulsivity. [2]

It has been demonstrated that nocturnal levels of the hormones melatonin and leptin are decreased. [13] Individuals tend to have poorer sleep quality and higher levels of insomnia. [2]

Often times, people with NES are unaware of their condition due to it often being overshadowed by other comorbidities. [2]

Diagnosis

Specific research diagnostic criteria have been proposed [2] [5] outside of the DSM-5 and include:

(A) Evening hyperphagia (consumption of 25% or more of the total daily calories after the evening meal) and/or nocturnal awakening and ingestion of food two or more times per week.

(B) Awareness of the night eating to differentiate it from the parasomnia sleep-related eating disorder (SRED).

(C) Three of five associated symptoms must also be present: lack of appetite in the morning, urges to eat at night, belief that one must eat in order to fall back to sleep at night, depressed mood, and/or difficulty sleeping.

(D) The eating pattern causes significant distress or interferes with daily functioning.

(E) The disordered pattern of eating has been maintained for at least 3 months.

(F) The pattern is not attributable to substance use, medical conditions, medication, or another psychiatric disorder.

Differential Diagnoses

BED and NES are often considered similar due to their prevalence in individuals with obesity and association with depressive symptoms. However, key distinctions are highlighted, particularly in eating patterns. While BED usually involves a loss of control over eating with large meal portions, NES is usually characterized by controlled, smaller snacks eaten at unusual times, such as late at night or after dinner. [2] Another key difference between the two disorders is that depressive symptoms fully mediated the link between BED and food insecurity, whereas for NES, depressive symptoms only partially mediated this relationship. [2]

NES is classified as an Other Specified Feeding or Eating Disorder (OSFED) under the DSM-5. MHWS - Eating Disorder.svg
NES is classified as an Other Specified Feeding or Eating Disorder (OSFED) under the DSM-5.

The relationship between NES and SRED is in need of further clarification. A significant debate in the literature concerns the classification of NES as an eating disorder, particularly due to its symptom overlap with SRED. Both NES and SRED involve nightly binge eating, weight gain, and sleep disturbances. Both conditions are more common in women and often coexist with mood disorders. Some researchers argue that the similarities between these disorders suggest they may, in fact, be the same condition viewed from different perspectives. The primary distinction noted is the level of consciousness during night eating episodes: NES patients are fully aware of their eating, whereas SRED patients may have partial or no awareness. There is debate as to whether these should be viewed as separate diseases, or part of a continuum. [2] [27]

Screening

Health professionals should issue screening when suspicion of an eating disorder (ED) is present. Validated screening tools include the Night Eating Questionnaire (NEQ), Night Eating Diagnostic Questionnaire (NEDQ), Eating Disorder Examination Questionnaire (EDE-Q), Night Eating Syndrome History and Inventory (NESHI), and Eating Among Teens Survey (EAT-II). [2] [3]

Treatment

A few treatment modalities are available for NES patients. These include bariatric surgery, bright light therapy (BLT), and progressive muscle relaxation (PMR). [2] Bariactric surgery has been found to reduce NES-related dysfunction in post-operative functioning. [2] Exposing NES participants to 10,000 lux light for 60 minutes each morning over 14 consecutive sessions was shown to reduce their NES symptoms, improve mood, and alleviate insomnia. [2] Research also showed a 30% decrease in food intake after dinner among participants who practiced PMR, along with a reduction in depressive and anxiety symptoms. [2]

Due to NES sharing similarities with mood disorders, SRED, and EDs, NES management may benefit from targeting disordered eating patterns, emotional regulation, and poor sleeping habits. [2] Furhtermore, research shows that a considerable proportion of adults with pre-existing T2DM having a clinical ED. Thus, the impact of newer appetite-suppressing diabetes treatments, along with the growing use of very low-calorie diets and bariatric surgery in T2DM management, further underscores the importance of screening for and diagnosing NES early. [4]

Consuming foods containing serotonin has been suggested to aid in the treatment of NES, [28] but other research indicates that diet by itself cannot appreciably raise serotonin levels in the brain. [29] A few foods (for example, bananas [29] ) contain serotonin, but they do not affect brain serotonin levels. [29] Various foods contain tryptophan, but the extent to which they affect brain serotonin levels must be further explored scientifically before conclusions can be drawn. [29]

Considering the complexity of NES, treatment should be tailored to each individual, integrating psychoeducation on diet, nutrition, and sleep with psychotherapy to achieve effective outcomes. [2] [3] [4]

See also

Related Research Articles

An eating disorder is a mental disorder defined by abnormal eating behaviors that adversely affect a person's physical or mental health. These behaviors include eating either too much or too little. Types of eating disorders include binge eating disorder, where the patient keeps eating large amounts in a short period of time typically while not being hungry; anorexia nervosa, where the person has an intense fear of gaining weight and restricts food or overexercises to manage this fear; bulimia nervosa, where individuals eat a large quantity (binging) then try to rid themselves of the food (purging); pica, where the patient eats non-food items; rumination syndrome, where the patient regurgitates undigested or minimally digested food; avoidant/restrictive food intake disorder (ARFID), where people have a reduced or selective food intake due to some psychological reasons; and a group of other specified feeding or eating disorders. Anxiety disorders, depression and substance abuse are common among people with eating disorders. These disorders do not include obesity. People often experience comorbidity between an eating disorder and OCD. It is estimated 20–60% of patients with an ED have a history of OCD.

<span class="mw-page-title-main">Seasonal affective disorder</span> Medical condition

Seasonal affective disorder (SAD) is a mood disorder subset in which people who typically have normal mental health throughout most of the year exhibit depressive symptoms at the same time each year. It is commonly, but not always, associated with the reductions or increases in total daily sunlight hours that occur during the summer or winter.

<span class="mw-page-title-main">Bulimia nervosa</span> Type of eating disorder

Bulimia nervosa, also known simply as bulimia, is an eating disorder characterized by binge eating, followed by purging or fasting, as well as excessive concern with body shape and weight. This activity aims to expel the body of calories eaten from the binging phase of the process. Binge eating refers to eating a large amount of food in a short amount of time. Purging refers to the attempts to get rid of the food consumed. This may be done by vomiting or taking laxatives.

<span class="mw-page-title-main">Appetite</span> Desire to eat food

Appetite is the desire to eat food items, usually due to hunger. Appealing foods can stimulate appetite even when hunger is absent, although appetite can be greatly reduced by satiety. Appetite exists in all higher life-forms, and serves to regulate adequate energy intake to maintain metabolic needs. It is regulated by a close interplay between the digestive tract, adipose tissue and the brain. Appetite has a relationship with every individual's behavior. Appetitive behaviour also known as approach behaviour, and consummatory behaviour, are the only processes that involve energy intake, whereas all other behaviours affect the release of energy. When stressed, appetite levels may increase and result in an increase of food intake. Decreased desire to eat is termed anorexia, while polyphagia is increased eating. Dysregulation of appetite contributes to ARFID, anorexia nervosa, bulimia nervosa, cachexia, overeating, and binge eating disorder.

Binge eating disorder (BED) is an eating disorder characterized by frequent and recurrent binge eating episodes with associated negative psychological and social problems, but without the compensatory behaviors common to bulimia nervosa, OSFED, or the binge-purge subtype of anorexia nervosa.

Binge eating is a pattern of disordered eating which consists of episodes of uncontrollable eating. It is a common symptom of eating disorders such as binge eating disorder and bulimia nervosa. During such binges, a person rapidly consumes an excessive quantity of food. A diagnosis of binge eating is associated with feelings of loss of control. Binge eating disorder is also linked with being overweight and obesity.

<span class="mw-page-title-main">Fibromyalgia</span> Chronic pain of unknown cause

Fibromyalgia is a medical syndrome that causes chronic widespread pain, accompanied by fatigue, awakening unrefreshed, and cognitive symptoms. Other symptoms can include headaches, lower abdominal pain or cramps, and depression. People with fibromyalgia can also experience insomnia and general hypersensitivity. The cause of fibromyalgia is unknown, but is believed to involve a combination of genetic and environmental factors. Environmental factors may include psychological stress, trauma, and some infections. Since the pain appears to result from processes in the central nervous system, the condition is referred to as a "central sensitization syndrome". Although a protocol using an algometer (algesiometer) for determining central sensitization has been proposed as an objective diagnostic test, fibromyalgia continues to be primarily diagnosed by exclusion despite the high possibility of misdiagnosis.

<span class="mw-page-title-main">Serotonin–norepinephrine reuptake inhibitor</span> Class of antidepressant medication

Serotonin–norepinephrine reuptake inhibitors (SNRIs) are a class of antidepressant medications used to treat major depressive disorder (MDD), anxiety disorders, social phobia, chronic neuropathic pain, fibromyalgia syndrome (FMS), and menopausal symptoms. Off-label uses include treatments for attention-deficit hyperactivity disorder (ADHD), and obsessive–compulsive disorder (OCD). SNRIs are monoamine reuptake inhibitors; specifically, they inhibit the reuptake of serotonin and norepinephrine. These neurotransmitters are thought to play an important role in mood regulation. SNRIs can be contrasted with the selective serotonin reuptake inhibitors (SSRIs) and norepinephrine reuptake inhibitors (NRIs), which act upon single neurotransmitters.

A food addiction or eating addiction is any behavioral addiction characterized primarily by the compulsive consumption of palatable and hyperpalatable food items. Such foods often have high sugar, fat, and salt contents (HFSS), and markedly activate the reward system in humans and other animals. Those with eating addictions often overconsume such foods despite the adverse consequences associated with their overconsumption.

Nocturnal sleep-related eating disorder (NSRED) is a combination of a parasomnia and an eating disorder. It is a non-rapid eye movement sleep (NREM) parasomnia. It is described as being in a specific category within somnambulism or a state of sleepwalking that includes behaviors connected to a person's conscious wishes or wants. Thus many times NSRED is a person's fulfilling of their conscious wants that they suppress; however, this disorder is difficult to distinguish from other similar types of disorders.

The Binge Eating Scale is a sixteen item questionnaire used to assess the presence of binge eating behavior indicative of an eating disorder. It was devised by J. Gormally et al. in 1982 specifically for use with obese individuals. The questions are based upon both behavioral characteristics and the emotional, cognitive response, guilt or shame.

<span class="mw-page-title-main">Selective serotonin reuptake inhibitor</span> Class of antidepressant medication

Selective serotonin reuptake inhibitors (SSRIs) are a class of drugs that are typically used as antidepressants in the treatment of major depressive disorder, anxiety disorders, and other psychological conditions.

<span class="mw-page-title-main">Anorexia nervosa</span> Type of eating disorder

Anorexia nervosa (AN), often referred to simply as anorexia, is an eating disorder characterized by food restriction, body image disturbance, fear of gaining weight, and an overpowering desire to be thin.

The differential diagnoses of anorexia nervosa (AN) includes various types of medical and psychological conditions, which may be misdiagnosed as AN. In some cases, these conditions may be comorbid with AN because the misdiagnosis of AN is not uncommon. For example, a case of achalasia was misdiagnosed as AN and the patient spent two months confined to a psychiatric hospital. A reason for the differential diagnoses that surround AN arise mainly because, like other disorders, it is primarily, albeit defensively and adaptive for, the individual concerned. Anorexia Nervosa is a psychological disorder characterized by extremely reduced intake of food. People with anorexia nervosa tend to have a low self-image and an inaccurate perception of their body.

Cognitive behavioral therapy (CBT) is derived from both the cognitive and behavioral schools of psychology and focuses on the alteration of thoughts and actions with the goal of treating various disorders. The cognitive behavioral treatment of eating disorders emphasizes on the minimization of negative thoughts about body image and the act of eating, and attempts to alter negative and harmful behaviors that are involved in and perpetuate eating disorders. It also encourages the ability to tolerate negative thoughts and feelings as well as the ability to think about food and body perception in a multi-dimensional way. The emphasis is not only placed on altering cognition, but also on tangible practices like making goals and being rewarded for meeting those goals. CBT is a "time-limited and focused approach" which means that it is important for the patients of this type of therapy to have particular issues that they want to address when they begin treatment. CBT has also proven to be one of the most effective treatments for eating disorders.

Other specified feeding or eating disorder (OSFED) is a subclinical DSM-5 category that, along with unspecified feeding or eating disorder (UFED), replaces the category formerly called eating disorder not otherwise specified (EDNOS) in the DSM-IV-TR. It captures feeding disorders and eating disorders of clinical severity that do not meet diagnostic criteria for anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), avoidant/restrictive food intake disorder (ARFID), pica, or rumination disorder. OSFED includes five examples:

<span class="mw-page-title-main">Albert Stunkard</span> American psychiatrist

Albert J. ("Mickey") Stunkard was an American psychiatrist. He is known for his first descriptions of binge eating disorder and night eating syndrome in the 1950s.

Body image disturbance (BID) is a common symptom in patients with eating disorders and is characterized by an altered perception of one's own body.

Atypical anorexia nervosa is an eating disorder in which individuals meet all the qualifications for anorexia nervosa, including a body image disturbance and a history of restrictive eating and weight loss, except that they are not currently underweight. Atypical anorexia qualifies as a mental health disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), under the category Other Specified Feeding and Eating Disorders (OSFED). The characteristics of people with atypical anorexia generally do not differ significantly from anorexia nervosa patients except for their current weight.

The Night Eating Questionnaire (NEQ) is one of the most widely used measures for the assessment of night eating syndrome. The original NEQ was revised several times and its current version was published by Allison and colleagues in 2008. The NEQ has 14 items and responses are recorded on a five-point scale from 0 to 4 with each item having different response labels. Additional items for assessing perceived distress and functional impairment can be used but these are not included in the total score.

References

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