Wednesday 26/06/2024
PHOTO: Megan te Boekhorst
TEXT: María Sabaté and Lina Camacho
Night eating syndrome (NES) is currently classified as an Other Specified Feeding or Eating Disorder (OSFED) under the Diagnostic Statistical Manual (DSM-5). This syndrome is characterized by a series of recurrent episodes of nighttime food intake, manifested by the ingestion of food after sleep onset or excessive food intake after dinner. There is awareness of the eating, and it can cause significant distress and/or problems in functioning.
What is NES or Night Eating Syndrome?
Researchers efforts to improve the criteria for diagnosing NES, led to a fruitful change in the way symptoms of NES are now described in the DSM-5 (American Psychiatric Association, 2013). Allison et al. (2010) proposed criteria includes (to be evaluated by a professional):
(A) Evening hyperphagia, defined as the consumption of 25% or more of total daily caloric intake after the evening meal, and/or two nocturnal ingestions on average per week;
(B) Awareness of one’s eating behaviors and ingestions;
(C) Three of the following: (i) morning anorexia, (ii) the desire to eat between dinner and sleep, (iii) sleep onset insomnia, (iv) the belief that one needs to eat in order to fall asleep, (v) depressed or lowering of mood in the evening and night time;
(D) Distress or impaired functioning;
(E) A period of 3 months or more under these conditions; and
(F) These conditions are not secondary to any medical condition.
Difference between NES and late night binges
Binge Eating Disorder (BED) and NES are thought to be very similar disorders due to their higher rate of occurrence in patients with obesity and their strong links with depressive symptoms (Allison et al., 2007). However, a key differentiating factor between NES and BED patients is the portion size of the food intake. While patients with BED experience “loss of control” (LoC) when eating and consume unusually large meals, NES patients tend to retain their control (to some extent) and “snack” at atypical times, i.e., at night or after the evening meal (Latzer and Tzischinsky’s 2012a; Stunkard and Allison, 2003).
What is behind the behavior and what function does the symptom serve?
When we talk about an Eating Disorder, the behavior is usually the tip of the iceberg. The eating behavior might be a coping mechanism/self-regulation strategy or a way for the sufferer to feel in control; usually behind the behavior we find traumatic experiences.
The relationship between childhood trauma and Eating Disorders (ED), especially sexual abuse and anorexia nervosa, bulimia nervosa and binge eating disorder, has been widely demonstrated. But only a few studies have examined the history of traumatic life events and childhood maltreatment in patients with NES. This year Latzer, Y. et al., 2024, decided to collaborate and fill the gap in research by interviewing sufferers from this syndrome, as inquiring about real testimonies allows for an investigation of participants’ experiences, perceptions, and meanings in their own words
Relationship of NES with traumatic events
There are two central themes that stand out in people with NES:
1. Nighttime eating is an experience that represents a dark part of the individuals’ behavior, this “dark” moment includes loss of control, overeating, feelings of disgust and shame related to eating, memories of physical, sexual, and emotional abuse, as well as of physical and emotional neglect. In addition, although many people with NES do not connect these complicated feelings from their past traumas to their nighttime eating, the way they describe these experiences is the same way they describe the nighttime eating experience, as a “loss of control, helplessness, pain, and disgust with oneself”.
People with NES had often lived past traumatic events of physical and sexual abuse that they experienced as an invasion of their body accompanied by pain, confusion, and a feeling that their body did not belong to them, but was an object to satisfy the needs of the other.
2. People with NES find a comforting and safe place during night food intake; sufferers see food as relaxing and calming, as a tool to fill the void, as a way to gain control in life and dissociate from reality. This behavior, therefore, is an attempt to self soothe by numbing and disconnecting from painful memories and emotions. Several of those interviewed in the study reported that the behavior (to some extent) helped them function in their daily lives.
Nighttime eating and vicious cycles
The “dark” and comforting aspects of nighttime eating intertwine and end up becoming a vicious cycle very difficult for patients with NES to get out from. Like other Eating Disorders, NES acts as a tool to manage negative emotions when the person lacks other abilities to regulate the pain. The behavior temporarily fills the inner emptiness and alleviates loneliness, however very quickly it also generates guilt and self-punishment. Nighttime binge eating provides momentary relief and comfort, but the pain easily reappears, therefore perpetuating the vicious cycle.
Often, people with NES describe nighttime eating as a “monster” that causes harm in their lives by reliving traumatic memories, but also as a “guardian angel” that offers them safety and comfort.
Despite great suffering, physical and emotional trauma, many take pride in their ability to function in their daily lives, support their families and cope with challenges. Paradoxically, although they are aware that they cannot control their nighttime eating habit, this behavior helps them keep their daytime lives under control, allowing them to maintain a reasonable level of functioning. These results then suggest that these people end up compartmentalizing their suffering in such a way that it is relegated to their nocturnal behavior and during the day they may act as if nothing had happened.
Facing our most painful memories might feel terrifying, especially if there is a history of traumatic experiences like sexual or physical abuse, as well as a history of loneliness, abandonment or emotional neglect. If you are someone that struggles with an Eating Disorder, know that your behavior is most probably aiming to protect you from the ghosts and monsters of your past. You don’t have to face them alone. If you or someone you know may be struggling with these feelings, encourage seeking professional help and emotional support. The only way out is through.
References:
- Allison, K. C., Grilo, C. M., Masheb, R. M., and Stunkard, A. J. (2007). High self-reported rates of neglect and emotional abuse, by persons with binge eating disorder and night eating syndrome. Behav. Res. Ther. 45, 2874–2883. doi: 10.1016/j.brat.2007.05.007
- Kaur J, Dang AB, Gan J, An Z and Krug I (2022) Night Eating Syndrome in Patients With Obesity and Binge Eating Disorder: A Systematic Review. Front. Psychol. 12:766827. doi: 10.3389/fpsyg.2021.766827
- Latzer, Y.; Edelstein-Elkayam, R.; Rabin, O.; Alon, S.; Givon, M.; Tzischinsky, O. The Dark and Comforting Side of Night Eating: Women’s Experiences of Trauma. Psychiatry Int. 2024, 5, 15–26. https://doi.org/10.3390/psychiatryint5010002
- Latzer, Y., and Tzischinsky, O. (2012a). “Night eating syndrome and other eating disorders,” in Night Eating Syndrome: Research, Assessment, and Treatment, eds J. D. Lundgren, K.C. Allison, and A. J. Stunkard (New York, NY: Guilford), 108–126.
- Stunkard, A. J., and Allison, K. C. (2003). Two forms of disordered eating in obesity: binge eating and night eating. Int. J. Obes. 27, 1–12. doi: 10.1038/sj.ijo.0802186