All About

Night Eating Syndrome

Night eating syndrome (NES) is a condition where a person eats more food at night than during the day. It is defined as an "Other Specified Feeding and Eating Disorder" (OSFED) by the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). (1)

Night eating syndrome doesn't always receive the same attention as other more well-known eating disorders, such as anorexia and bulimia. But the lack of notoriety does not minimize the struggles of approximately 1.5% of the general population, who identify as having night eating syndrome. (1)

Night Eating Syndrome

What is

Night Eating Syndrome

Night eating syndrome is a complex eating pattern that means a person eats more at night than during the day. NES is not the same as snacking, which is an expected relationship with food. 

Instead, the DSM-5 defines night eating syndrome as recurrent episodes of eating at night, and it's typically characterized by: (2)

  • Eating more than usual at night after a meal
  • Excessive food consumption after an evening meal
  • Awakening in the middle of sleep to eat
  • A lack of control or dissociation during the eating experience 
  • Eating until feeling uncomfortably full
  • Eating more rapidly than usual during the episode

Since it falls under OSFED in the DSM-5, it may also meet some (but not all) of the diagnostic criteria of other eating disorders like binge eating disorder.

Diagnosing

Night Eating Syndrome

The primary identifying characteristic of night eating syndrome is eating at least 25% of your daily food intake at night after the evening meal. (1)  For diagnostic purposes, it's said that a person is fully aware of their night eating and can recall it the next day, as it usually causes them significant distress. 

To diagnose NES, clinicians use the following methods:

  • Night Eating Questionnaire (NEQ)
  • Night Eating Diagnostic Scale (NEDS)
  • Night Eating Syndrome History and Inventory (NESHI)

Signs & Symptoms of

Night Eating Syndrome

The above-mention DSM-5 signs are sometimes accompanied by symptoms associated with other eating disorders, including:

  • Low self-esteem
  • Depression and/or anxiety
  • A strong need for approval
  • Being extremely self-critical
  • Stealing and/or hoarding food
  • Gastrointestinal symptoms
  • Denial about hunger

Effects of Night Eating Syndrome

Night eating syndrome is so much more than a midnight snack attack. NES can cause many problems for the individual if it's not taken seriously or not addressed by a healthcare professional.

Short-Term

The short-term effects of Night eating syndrome may include:

  • An inability to sleep
  • A loss of appetite
  • Moodiness
  • Fatigue
  • Eating more rapidly to feel more satisfied

Long-Term

When it comes to the long-term effects of night eating syndrome, patients may experience:

  • Periods of weight gain/loss
  • Weakened bones
  • Decreased muscle mass
  • Cardiovascular problems
  • Gastrointestinal problems
  • Excessively dry skin
  • Kidney problems 

Related Disorders

Night Eating Syndrome is not always a standalone disorder. Many experts believe it is closely related to other eating disorders, most notably binge eating disorder, bulimia nervosa, and eating disorders not otherwise specified.

Many individuals who have an eating disorder also struggle with co-occuring mental health or behavioral disorders. Between 42-75% of people with an eating disorder also manage a variety of psychiatric disorders, including: (4)

  • Mood disorders
  • Obsessive-compulsive disorders
  • Personality disorders

Treatment of

Night Eating Syndrome

The behaviors associated with night eating syndrome may be caused by various internal and external factors, such as other underlying eating disorders, stress, depression, anxiety, and body image issues. 

It's essential to address and deal with the underlying factors to help the individual cope with the symptoms associated with eating disorders, especially when the symptoms are severe and persistent.

Therapies for Night Eating Syndrome

Many therapies and techniques are helpful for those with NES. 

Like all eating disorders NES requires comprehensive biopsychosocial assessment and treatment, which is to say an assessment of the patient’s biological, psychological, and socio-environmental factors and how they relate to NES. A variety of therapies can be useful, including:

  • Psychotherapy
  • Cognitive behavioral disorder (CBT)
  • Dialectical behavior therapy (DBT)
  • Expressive therapies
  • Family therapy
  • Group therapy
  • Nutritional Therapy

One of the most effective treatments for the disorder is cognitive behavioral therapy, which includes a range of different interventions that are designed to help the individual develop healthier eating habits and learn new coping skills to deal with life's stressful situations. 

Other therapy options that have proven beneficial include:

  • Psychotherapy
  • Social Support Groups
  • Family-Based Therapy
  • Nutritional Therapy

Medications for Night Eating Syndrome

Generally, there are no medications specifically designed to treat night eating syndrome. However, some treatments can help address related issues, including antidepressants and selective serotonin reuptake inhibitors (SSRIs). (1)

When seeking out treatment for NES, keep in mind that some medication may be associated with exacerbating night eating syndrome, including sedative hypnotics which can cause individuals to engage in behaviors they would normally engage in awake (including eating).

Understanding

Night Eating Syndrome

Individuals with night eating syndrome may be undereating during the day and may feel shame around eating, and experience a sense of dissociation when eating at night alone. This may provide a sense of security and comfort for the individual, which will reinforce the behavior. 

The exact reasons why people who have NES ingest more food after a meal are unclear, but researchers say that it may be related to an inability to fall asleep at night or a change in the way a person's body functions metabolically at night.

It's believed that those with NES suffer from disruption to their circadian rhythm or a circadian rhythm sleep disorder, which involves difficulty falling asleep, waking up during the sleep cycle, and/or having difficulties or the inability to fall back asleep. (5)

Living with Night Eating Syndrome

The symptoms of night eating syndrome can be exhausting to endure. The person with NES may be uncomfortable because they feel bloated throughout the night, making it difficult to sleep or breathe. 

In many cases, the person with NES may already be under tremendous stress and anxiety, which only worsens their situation. A lack of proper sleep habits due to NES can lead to insomnia, anxiety and stress throughout the day, making them feel mentally and physically exhausted. 

The most important thing to do when it comes to dealing with eating disorders is to seek treatment. Many treatment programs and therapies can be helpful for those that are suffering from night eating syndrome, and it's crucial to find the ones which are best suited for you. 

There are also many ways to help with the symptoms of NES on a day-to-day basis. 

Patients can do things like:

  • Keep a food journal
  • Strive to eat flexibly and meet nutritional needs in a mindful way throughout the day
  • Determine a plan to eat healthier at night
  • Learn to differentiate between real hunger and cravings
  • Explore relationships with food and body
  • Uncover underlying rigid beliefs and/or internalized shame related to the need to eat
  • Take time to relax or meditate
  • Get adequate sleep

History of Night Eating Syndrome

Discussion of night eating syndrome dates back to 1955 when psychiatrist Albert Stunkard, a leading specialist in eating disorders, first described it as a behavioral issue amongst those with a higher weight than average. (6) 

It wasn't until 2013 that it was given its clinical entry into the DSM-5 as one of many Other Specified Feeding and Eating Disorders.

How to Help Someone with

Night Eating Syndrome

Not everyone can cope with night eating syndrome on their own, nor should they have to hide their condition. As the disorder can cause serious health problems, it's important to get support from friends and family and to seek professional help. 

Here are a few ways to help your loved ones with NES:

  • Supporting them during the day
  • Helping them with their coping skills
  • Begin to notice when your loved one may be fatigued and would benefit from your support 
  • Taking care of them when they're too tired to do things on their own
  • Providing emotional support during the times when the person feels most vulnerable

Within Health works with you, wherever you are, to provide compassionate treatment for eating disorders like night eating syndrome. Call our admissions team to start your healing process and rebuild a healthy relationship with food.

Frequently asked questions

What is Night Eating Syndrome?

Night eating syndrome (NES) is a condition that affects your ability to control your eating habits at night.

What are the most common characteristics of someone with NES?

People who suffer from NES often experience periods of excessive eating during the night. The person may then wake up feeling hungrier than normal in the morning. The stomach may also feel bloated. 

A person with NES is often extremely tolerant of hunger and may often go without eating for long periods of time. In addition to hunger, the individual with NES may also feel extremely thirsty. Feelings of faintness may also be experienced.

How is NES treated?

There is no one sure-fire cure for NES, and it is a recurring disorder that may require ongoing medical and psychological interventions. Psychotherapy and psychiatric care may be helpful in addressing any underlying psychiatric conditions that the night eating is compensating for, while psyhchotherapy can begin to address underlying beliefs and/or patterns with related to food, weight and eating patterns. Nutritional therapies will help the person unlock beliefs around food and patterns that can lead a person to be vulnerable to NES. Medical treatment may include a combination of lifestyle modifications, medication, and some form of therapy.

Resources

  1. Muhlheim, L. (2020, July 1). Other Specified Feeding and Eating Disorder (OSFED): What You Need to Know. Verywell Mind. https://www.verywellmind.com/osfed-the-other-eating-disorder-1138307
  2. National Eating Disorders Association. (2018, July 30). Other Specified Feeding or Eating Disorder. https://www.nationaleatingdisorders.org/learn/by-eating-disorder/osfed
  3. National Eating Disorders Association. (2018a, February 22). Binge Eating Disorder. https://www.nationaleatingdisorders.org/learn/by-eating-disorder/bed
  4. National Eating Disorders Association. (2021, July 14). Statistics & Research on Eating Disorders. https://www.nationaleatingdisorders.org/statistics-research-eating-disorders
  5. Circadian Rhythm Sleep Disorders: Types, Symptoms and Management. (n.d.). Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/12115-circadian-rhythm-disorders
  6. Cleator, J. (2012, September 10). Night eating syndrome: implications for severe obesity. Nutrition & Diabetes. https://www.nature.com/articles/nutd201216?error=cookies_not_supported&code=b69c0bd7-1c9d-4fc4-b48e-98a5ffd11a87
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