Night eating patterns of individuals with eating disorders: Implications for conceptualizing the night eating syndrome

The prevalence, correlates, and symptom coherence of night eating syndrome (NES) in individuals seeking inpatient treatment for eating disorders were assessed. Inpatients (n = 68; M age = 29.8 years; % female = 94.1; % diagnosed with anorexia nervosa [AN] = 47.1; % diagnosed with bulimia nervosa [BN] = 47.1) were interviewed with the Night Eating Syndrome History and Inventory. Additionally, medical charts were reviewed and participants completed measures of eating behavior and quality of life. NES was diagnosed in 25% of patients; significantly more patients diagnosed with BN meet criteria for NES compared to those diagnosed with AN. In general, patients with NES did not differ from patients without NES on eating behaviors, attitudes, or quality of life; symptoms of NES frequently co-occurred. This study supports previous research finding that night eating behavior is common in individuals diagnosed with eating disorders.     

Development of criteria for a diagnosis: lessons from the night eating syndrome

Criteria for inclusion of diagnoses of Axis I disorders in the forthcoming Diagnostic and Statistical Manual (DSM-V) of the American Psychiatric Association are being considered. The 5 criteria that were proposed by Blashfield et al as necessary for inclusion in DSM-IV are reviewed and are met by the night eating syndrome (NES). Seventy-seven publications in refereed journals in the last decade indicate growing recognition of NES. Two core diagnostic criteria have been established: evening hyperphagia (consumption of at least 25% of daily food intake after the evening meal) and/or the presence of nocturnal awakenings with ingestions. These criteria have been validated in studies that used self-reports, structured interviews, and symptom scales. Night eating syndrome can be distinguished from binge eating disorder and sleep-related eating disorder. Four additional features attest to the usefulness of the diagnosis of NES: (1) its prevalence, (2) its association with obesity, (3) its extensive comorbidity, and (4) its biological aspects. In conclusion, research on NES supports the validity of the diagnosis and its inclusion in DSM-V.     

Prevalence of the night eating syndrome in a psychiatric population

OBJECTIVE: This study assessed the prevalence of night eating syndrome and its comorbid psychopathology in a psychiatric population. METHOD: The Night Eating Questionnaire was administered to 399 patients in two psychiatric outpatient clinics. Those scoring above 20 on the questionnaire (N=205) were assessed for night eating syndrome with a semistructured telephone interview. Chart reviews of all participants were performed to determine their psychiatric diagnoses and medications. RESULTS: Forty-nine participants (12.3%) met criteria for night eating syndrome. Greater rates of substance use disorders were found among patients diagnosed with night eating syndrome than among those without the syndrome. Obese patients were more likely than nonobese patients to manifest night eating syndrome. CONCLUSIONS: Night eating syndrome is prevalent among psychiatric clinic outpatients and is likely to co-occur with substance use disorders and obesity.     

Topiramate in the treatment of comorbid night eating syndrome and PTSD: a case study

Comorbid chronic sleepwalking with night eating syndrome and posttraumatic stress disorder were treated with topiramate for eight months in an obese 40-year-old woman. Central nervous system side effects of word-finding and memory difficulties were managed with dosage adjustments to a final dose of 100mg HS. Treatment led to resolution of posttraumatic stress disorder symptoms, night eating episodes, and sleepwalking episodes, with a weight loss of 70 pounds.     

A randomized, placebo-controlled trial of sertraline in the treatment of night eating syndrome

OBJECTIVE: The authors assessed the efficacy of sertraline in the treatment of night eating syndrome. METHOD: Thirty-four outpatients diagnosed with night eating syndrome were randomly assigned to receive either sertraline (N=17) or placebo (N=17) in an 8-week, double-blind, flexible-dose (50-200 mg/day) study. A mixed effects linear regression model was used to analyze change in the primary outcome measure, Clinical Global Impression (CGI) improvement rating. Secondary outcomes included changes in night eating symptoms, the number of nocturnal awakenings and ingestions, total daily caloric intake after the evening meal, CGI severity ratings, quality of life ratings, and weight. RESULTS: Sertraline was associated with significantly greater improvement than placebo. Twelve subjects in the sertraline group (71%) were classified as having responded (CGI improvement rating < or = 2, indicating much or very much improved) versus only three (18%) in the placebo group. There were also significant improvements in night eating symptoms, CGI severity ratings, quality of life ratings, frequency of nocturnal ingestions and awakenings, and caloric intake after the evening meal. Overweight and obese subjects in the sertraline group (N=14) lost a significant amount of weight by week 8 (mean=-2.9 kg, SD=3.8) compared with overweight and obese subjects receiving placebo (N=14) (mean=-0.3 kg, SD=2.7). CONCLUSIONS: In this 8-week trial, sertraline was effective in the treatment of night eating syndrome and was well tolerated.     

The prevalence and clinical features of the night eating syndrome in psychiatric out-patient population

ObjectiveIn this study we aimed to investigate the prevalance and clinical correlations of night eating syndrome (NES) in a sample of psychiatric outpatients.MethodFour hundred thirthy three consecutive psychiatric out-patients older than 18 years were evaluated in the outpatient clinics using clinical interview according to the DSM-IV with regard to psychiatric diagnosis. Participants were also screened for presence of NES utilizing both clinical interview and self report based on Night Eating Questionnaire (NEQ) instruments. Sociodemographic and clinical features such as age, gender, education level, socioeconomic level and body mass index (BMI) were also recorded. The Body Shape Questionnaire (BSQ) and the Symptom Checklist-90 Revised (SCL-90R) were administered.ResultsBased on the proposed diagnostic criteria of the NES via utilizing clinical interview method, 97 (32 male, 65 female) of the sample met diagnostic criteria for NES. The point prevalence of NES was 22.4%. No statistically significant differences were found between the two groups in terms of age, gender, marital status, education and BMI. The patients with NES had higher NEQ, BSQ and SCL-90R subscale scores than patients without NES. Prevalance of depressive disorder, impulse control disorder, and nicotine dependency was higher among patients with NES. No differences were found with regard to the medication (antipsychotics, antidepressants and mood stabilizers).ConclusionNight eating syndrome is prevalent among psychiatric outpatients and associated with depression, impulse control disorder, and nicotine dependency. Body dissatisfaction and higher symptom severity are also other risk factors for the development of NES.     

Stress and night eating syndrome: a comparison study between a sample of psychiatric outpatients and healthy subjects

The Night Eating Syndrome (NES) is a disorder characterized by the clinical features of morning anorexia, evening hyperphagia, and insomnia with awakenings followed by nocturnal food ingestion. The core clinical feature appears to be a delay in the circadian timing of food intake. The diagnosis and early treatment of NES may represent an important means of prevention for obesity. Aims. The aim of the present study was to determine the vulnerability to develop NES between a clinical sample of patients with psychiatric disorders and a non clinical sample. We investigated a possible relation between stress and a dysfunctional eating behaviors as NES. Methods. The Night Eating Questionnaire (NEQ) has been administered to 147 psychiatric outpatients and to 531 subjects attending the University of L'Aquila. The NEQ is a questionnaire used to evaluate the prevalence of NES. The sample has been also evaluated through the Stress-related Vulnerability Scale (SVS) to measure both perceived stress and social support. Results. The 8.2% of patients scored above the diagnostic cut-off of the NEQ, compared to the 2.1% in the sample of healthy subjects. The majority of patients who had shown NEQ>25 had a diagnosis of major depressive disorder (MDD). The total scores on the NEQ were strongly associated with the SVS total score and especially with the "lack of social support" subscale. Conclusions. This study shows the increased vulnerability of NES in the sample of psychiatric patients compared to the sample of healthy subjects. The study further confirms the strong association between perceived stress, social support, altered eating behaviors and obesity.     

123I-ADAM SPECT imaging of serotonin transporter binding in patients with night eating syndrome: a preliminary report

Night eating syndrome (NES) represents a delay in the circadian pattern of food intake, manifested by evening hyperphagia and/or nocturnal awakenings accompanied by ingestions of food. A neurobiological marker of NES has been implicated with the recently discovered therapeutic response to the selective serotonin reuptake inhibitor (SSRI) sertraline. This pilot SPECT (single photon emission computed tomography) study compared the serotonin transporter (SERT) uptake ratios of night eaters with those of healthy controls. Six night eaters underwent SPECT imaging using the radiopharmaceutical (123)I-ADAM. Uptake, compared with that of the cerebellum, was obtained for the midbrain, basal ganglia, and temporal lobes; uptake ratios in night eaters were compared with those of six healthy controls. Night eaters had significantly greater SERT uptake ratios in the midbrain than healthy controls. These findings, in conjunction with the therapeutic response of NES to sertraline, indicate that the serotonin system is involved in the pathophysiology of NES.     

Successive self-management strategies towards coping with night eating

This case study describes the development of night eating in an adult male and attempts to treat it using a variety of self-regulatory strategies. Control required continuing use of self-administered response prevention, since night eating resumed when this was omitted.