Psychopathology and treatment of night eating syndrome: a review

Personality traits and night eating syndrome in women with bulimia nervosa and binge eating disorder

PURPOSE

Previous research suggests that eating disorders may be associated with certain personality profiles; however, there is limited research investigating associations with night eating syndrome (NES). This research suggests harm avoidance personality trait is higher in NES individuals than in the general population, however, evidence of associations with other personality traits is inconsistent. To understand which personality traits are associated with NES symptoms, the current study aimed to improve understanding of the relationship between NES symptoms and a range of personality traits, addressing limitations in the earlier literature in this area by controlling for common confounders.

METHODS

Baseline data were analysed from an outpatient psychotherapy trial for 111 women with bulimia nervosa or binge eating disorder. Pre-treatment measures of personality traits (measured with the Temperament and character inventory-revised) and NES symptoms (measured with the Night eating questionnaire) were used. Regression analyses tested associations between these variables, adjusting for potential confounders, including age and ethnicity.

RESULTS

Low cooperativeness scores were associated with greater NES symptoms in the multivariable model (mean difference: - 0.10, 95% confidence intervals: - 0.20 to - 0.01, p = 0.033). There was weak evidence of associations between both high harm avoidance and low self-directedness personality traits and greater NES symptoms.

CONCLUSIONS

This study adds to the limited research measuring associations between a range of personality traits and NES, addressing limitations of previous research. Weak evidence for an association between high harm avoidance and low self-directedness and increased NES symptoms was found. A novel association was found between low cooperativeness and greater NES symptoms. Further research is needed to validate its presence in those with and without comorbid eating disorders and to examine the relative change in NES, eating disorder symptoms and personality scores in treatments focusing on cooperativeness.

LEVEL OF EVIDENCE

Level IV (cross-sectional data from a randomised controlled trial, CTB/04/08/139).

Depression symptoms and night eating in young adulthood

PURPOSE

We estimated cross-sectional and longitudinal associations between depression symptoms and night eating in young adults.

METHODS

Data were drawn from a longitudinal investigation of students age 12-13 years at inception in 1999-2000, in Montreal, Canada. Depression symptoms were measured with the Depressive Symptoms Scale (DSS) 20 times from age 12 to 17, and with the Major Depression Inventory (MDI) post-high school at ages 20 and 24. Night eating was measured at age 24. The association between depression symptoms and night eating was estimated in multivariable logistic regression models adjusted for sex, age and mother university-educated.

RESULTS

9% of 829 participants (n = 77) reported night eating. In cross-sectional analysis, the adjusted odds ratio (OR) estimate for MDI scores (range 0-50) was 1.04 (1.01, 1.07). In longitudinal analyses, the OR estimates were 1.75 (1.20, 2.55) for DSS scores (range 1-4) and 1.03 (1.002, 1.06) for the MDI.

CONCLUSIONS

Depression symptoms are associated with night eating in young adults cross-sectionally and possibly longitudinally. Treatment of depression symptoms may be important in preventing night eating, a core symptom of the Night Eating Syndrome.

LEVEL OF EVIDENCE

Level III, cohort analytic study.

Associations between night eating syndrome and metabolic parameters in pregnant women

Objective:

In this study, we aimed to evaluate the incidence of night eating in pregnancy and the relationship between night eating scores and nutritional status, insulin resistance, and lipid profile in pregnant women.

Materials and Methods:

In this study, 148 pregnant women who presented to the Gynecology and Obstetrics Clinics at Konya Training and Research Hospital in Konya were divided into two groups according to their night eating scores. These two groups were compared in terms of their nutritional attitudes and metabolic parameters.

Results:

Comparisons of participants meeting night eating syndrome (NES) scores versus women without NES indicated that patients with NES exhibited fever hunger at breakfast time, more breakfast skipping (p<0.05) than those without NES. Also homeostatic model assessment insulin resistance, insulin, and high-density lipoprotein cholesterol parameters were significantly higher in pregnant women in the NES group (p<0.05). Also, correlations were found between higher night eating questionnaire total scores and higher HbA1c, insulin resistance, insulin, and more breakfast skipping.

Conclusion:

The results of this study suggest that night eating symptoms during pregnancy may increase and this is able to effect glucose metabolism.

Disordered eating and obesity: associations between binge-eating disorder, night-eating syndrome, and weight-related comorbidities

Binge-eating disorder (BED) and night-eating syndrome (NES) are two forms of disordered eating associated with overweight and obesity. While these disorders also occur in nonobese persons, they seem to be associated with weight gain over time and higher risk of diabetes and other metabolic dysfunction. BED and NES are also associated with higher risk of psychopathology, including mood, anxiety, and sleep problems, than those of similar weight status without disordered eating. Treatments are available, including cognitive behavior therapy (CBT), interpersonal psychotherapy, lisdexamfetamine, and selective serotonin reuptake inhibitors (SSRIs) for BED; and CBT, SSRIs, progressive muscle relaxation, and bright light therapy for NES.

New data on psychological traits and sleep profiles of patients affected by nocturnal eating

OBJECTIVE

Nocturnal eating behavior is shared by patients affected by a parasomnia, sleep-related eating disorder (SRED), and several eating disorders such as night eating syndrome (NES) and binge-eating disorder (BED); however, the differential clinical features of these patients have been poorly studied, with persisting difficulties in defining the borders between these pathologies. The aim of this study was to evaluate polysomnographic and personality characteristics of nocturnal eaters to further differentiate the syndromes.

METHODS

During a period of six months, consecutive patients complaining of nocturnal eating were asked to participate to the study. Twenty-four patients who were found to eat during the polysomnographic recording (PSG) study, and gender-matched control subjects were included. All subjects underwent a full-night video-PSG study and a psychometric assessment including the Eating Disorder Inventory (EDI-2), the self-rating Bulimic Investigatory Test-Edinburgh (BITE), the Temperament and Character Inventory (TCI), and the Barratt Impulsivity Scale (BIS).

RESULTS

Nocturnal eaters showed a mild reduction in sleep efficiency and duration due to a moderate sleep fragmentation, whereas the percentage of each sleep stage was not significantly affected. Nocturnal eaters scored higher at many subscales of the EDI-2, at the BITE symptoms subscale, and at the BIS attentional impulsivity subscale.

CONCLUSION

The psychological characteristics found in our patients with NES seem to be typical for patients affected by eating disorders, and support the hypothesis that the nocturnal behavior of these individuals is due to an eating disorder; however, specific traits also allow differentiation of NES from BED.

Optimal management of night eating syndrome: challenges and solutions

Night Eating Syndrome (NES) is a unique disorder characterized by a delayed pattern of food intake in which recurrent episodes of nocturnal eating and/or excessive food consumption occur after the evening meal. NES is a clinically important disorder due to its relationship to obesity, its association with other psychiatric disorders, and problems concerning sleep. However, NES often goes unrecognized by both health professionals and patients. The lack of knowledge regarding NES in clinical settings may lead to inadequate diagnoses and inappropriate treatment approaches. Therefore, the proper diagnosis of NES is the most important issue when identifying NES and providing treatment for this disorder. Clinical assessment tools such as the Night Eating Questionnaire may help health professionals working with populations vulnerable to NES. Although NES treatment studies are still in their infancy, antidepressant treatments and psychological therapies can be used for optimal management of patients with NES. Other treatment options such as melatonergic medications, light therapy, and the anticonvulsant topiramate also hold promise as future treatment options. The purpose of this review is to provide a summary of NES, including its diagnosis, comorbidities, and treatment approaches. Possible challenges addressing patients with NES and management options are also discussed.

Bridging the gap between education and appropriate use of benzodiazepines in psychiatric clinical practice

More than half a century after their discovery, benzodiazepines (BDZs) still represent one of the largest and most widely prescribed groups of psychotropic compounds, not only in clinical psychiatry but also in the entire medical field. Over the last two decades, however, there has been an increased focus on the development of antidepressants and antipsychotics on the part of the pharmaceutical industry, clinicians, and researchers, with a reduced interest in BDZs, in spite of their widespread clinical use. As a consequence, many psychiatric residents, medical students, nurses, and other mental health professionals might receive poor academic teaching and training regarding these agents, and have the false impression that BDZs represent an outdated chapter in clinical psychopharmacology. However, recent advances in the field, including findings concerning epidemiology, addiction risk, and drug interactions, as well as the introduction of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition with related diagnostic changes, strongly encourage an updated appraisal of the use of BDZs in clinical practice. During a recent thematic event convened with the aim of approaching this topic in a critical manner, a group of young Italian psychiatrists attempted to highlight possible flaws in current teaching pathways, identify the main clinical pros and cons regarding current use of BDZs in clinical practice, and provide an updated overview of their use across specific clinical areas and patient populations. The main results are presented and discussed in this review.

Night Eating Syndrome in Major Depression and Anxiety Disorders

INTRODUCTION

The purpose of this study is to investigate the prevalence and the clinical features of night eating syndrome (NES) in patients with depression and anxiety disorders.

METHOD

The study was conducted at Bakırköy State Hospital for Mental Health and Neurological Disorders. Three-hundred out-patients who had major depression (MD), panic disorders (PD), general anxiety disorders (GAD) and obsessive-compulsive disorders (OCD) participated in the study. The semi-structured socio-demographic form, the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), Night Eating Questionnaire, and NES Evaluation Questionnaire were implemented.

RESULTS

In our sample, the prevalence of the NES was 15.7% (n=47). NES frequency was significantly higher in the patients diagnosed with major depression (MD 22%, GAD 7.8%, OCD 12.5%, PD 14%). Smoking, presence of past suicide attempts, rates of antipsychotic drugs use, and average scores of body mass index (BMI) were significantly higher in the patients who had NES. In this sample, depression, BMI, and smoking were found to be determinants of NES.

CONCLUSION

This study shows that NES may be frequently observed in patients admitted to psychiatric clinics, especially in those with major depression. Evaluation of NES in psychiatric patients may help the treatment of the primary psychopathology and prevent the adverse effects, like weight gain, which may reduce the quality of life.

Prevalence and clinical significance of night eating syndrome in university students

PURPOSE

Most studies of night eating syndrome (NES) fail to control for binge eating, despite moderate overlap between the two conditions. Establishing the independent clinical significance of NES is imperative for it to be considered worthy of clinical attention. We compared students with and without NES on eating disorder symptomatology, quality of life, and mental health, while exploring the role of binge eating in associations.

METHODS

Students (N = 1,636) ages 18-26 years (M = 20.9) recruited from 10 U.S. universities completed an online survey including the Night Eating Questionnaire (NEQ), Eating Disorder Examination-Questionnaire (EDE-Q), Project Eating Among Teens, and the Health-Related Quality of Life-4. NES was diagnosed according to endorsement of proposed diagnostic criteria on the NEQ. Groups (NES vs. non-NES) were compared on all dependent variables and stratified by binge eating status in secondary analyses.

RESULTS

The prevalence of NES in our sample was 4.2%; it decreased to 2.9% after excluding those with binge eating. Body mass index did not differ between groups, but students with NES were significantly more likely to have histories of underweight and anorexia nervosa. In students with NES, EDE-Q scores were significantly higher; purging, laxative use, and compulsive exercise were more frequent; quality of life was reduced; and histories of depression, attention-deficit/hyperactivity disorder, and self-injury were more common. Binge eating did not account for all of these differences; the presence of it and NES was associated with additive risk for psychopathology on some items.

CONCLUSIONS

NES may be a distinct clinical entity from other DSM-5 eating disorders.

Personality Traits in Obesity Associated with Binge Eating and/or Night Eating

Specific personality traits, as assessed by the Temperament and Character Inventory (TCI), have been identified in individuals with obesity, but their association with binge and/or night eating has scarcely been reported. Indeed, our systematic search of Medline (1987 to 2013) yielded only five studies on the issue. Taken together, they suggest that personality traits do not have any significant role in determining body mass index, and therefore obesity class. However, obese individuals, in comparison with normal weight individuals, do seem to have a distinctive personality profile, characterized by low self-directedness and cooperativeness, and obese individuals with binge eating show lower self-directedness than those without. Moreover obese individuals with binge eating and/or night eating share a temperament profile characterized by high novelty-seeking and harm-avoidance, two traits also observed in other eating disorder categories and in clinical depression. Future longitudinal studies are needed to investigate the role of personality traits in the onset of binge eating and night eating in obese individuals, and to clarify their influence, if any, on treatment outcomes. Such information will enable us to determine whether the evaluation of personality traits should be included in the comprehensive assessment of obese individuals.

Successful Treatment with Agomelatine in NES: A Series of Five Cases

The NES is an emerging disease in eating behavior that combines eating disorders, sleep, mood and stress. In recent years, the NES is becoming more interested in close association with obesity and depression.

In the present study we have followed for 12 weeks 5 patients (2 males and 3 females) with NES and comorbid depression treated with agomelatine (25 mg / day for the first two weeks, then 50 mg / day), an antidepressant similar of melatonin.

At the end of the three months of treatment, it was found an improvement in symptoms characteristic of the NES, as assessed by a reduction an average of the NEQ (from 31 to 22.8), improved mood, mean values ​​reduced by 23, 2 to 13.2 on the HAM-D, weight reduction, an average of 3.6 kg reduction in average weekly awakenings from 12 to 6.4 and the time of snoring and motion detected polysomnography. The serum chemistry values ​​remained stable and there were no reported adverse events.

The present study showed that the treatment with agomelatine has improved the symptoms of NES and mood, decrease of body weight, reduce, albeit not in an optimal manner, the number of awakenings per night with a reduction of movement time and snoring . Of course, these preliminary data need to be confirmed by controlled trials on a larger sample.

The night-eating syndrome and obesity

The rising prevalence of obesity is a global concern. Eating behaviour and circadian rhythm are proving to be important factors in the aetiology of obesity. The night-eating syndrome (NES) is characterized by increased late-night eating, insomnia, a depressed mood and distress. It is evident that prevalence is higher among weight-related populations than the general community. The exact relationship between this syndrome and obesity remains unclear. The reasons for the discrepancies found in the literature likely include varying diagnostic criteria and a wide range of study population characteristics. NES does not always lead to weight gain in thus certain individuals may be susceptible to night-eating-related weight gain. Weight loss through surgical and behavioural treatments has shown success in diminishing symptoms. The increasing literature associating obesity with circadian imbalances strengthens the link between the NES and obesity. Circadian genes may play a role in this syndrome. This review will examine different aspects of obesity in the context of the NES.

Treatment of night eating syndrome

Although treatment research for NES remains limited, several options are available for patients whose symptoms require clinical attention. Pharmacotherapy has received the most empirical support of the proposed treatments. Controlled trials are needed to confirm the initial results from pilot studies with CBT, behavioral therapy, and phototherapy, and an extended controlled trial of progressive muscle relaxation would be useful. In their comprehensive review of the field, Striegel-Moore and colleagues have questioned the clinical utility of NES as a diagnostic entity and stress the very limited nature of treatment studies to date. Research in this field has to provide a systematic examination of the approaches described here, as well as others yet to be identified. This pursuit seems warranted given that persons suffering with the cluster of symptoms identified as NES are approaching health care providers for relief and are often frustrated by the lack of recognition of this syndrome. Future studies should test a wider variety of medications that would target serotonin or the circadian timing of eating. Additionally, trials comparing and combining medication treatments and CBT (or progressive muscle relaxation alone) would also be useful in addressing which treatment should be used as a first line treatment. With NES being considered for inclusion as a Feeding and Eating Condition Not Elsewhere Classified (FEC-NEC) in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, it is likely that more clinical attention and studies will address these important issues in the coming years.

Night eating syndrome: an overview

Objectives

The purpose of this review is to outline the nosographic characteristics of NES and the most reliable ethiopathogenetic theories in relation to the most recent evidence in the literature.

Key findings

The night eating syndrome (NES) is a disorder occurring at the stated time, that does not meet the criteria for any specific eating disorder. NES is characterized by a reduced feeding during the day, evening hyperphagia accompanied by frequent nocturnal awakenings associated with conscious episodes of compulsive ingestion of food and abnormal circadian rhythms of food and other neuroendocrine factors. Frequently it is associated with obesity and depressed mood. We highlight the therapeutic possibilities of some drugs, especially selective serotonin re-uptake inhibitors (SSRIs), which reduce the hyperactivity of the serotonin transporter in NES and significantly improve the clinical picture of this disease.

Conclusions

Night eating syndrome is of importance clinically because of its association with obesity. The recognition and effective treatment of NES may be an increasingly important way to treat a subset of the obese population. Treatment of the syndrome, however, is still in its infancy. One clinical trial has reported efficacy with the SSRI sertraline. Other treatments, such as the anticonvulsant topiramate, phototherapy, and other SSRIs, may also offer future promise. Particularly useful would be studies involving brain scans (magnetic resonance imaging or single-photon emission computed tomography) of patients with NES compared with the healthy population, to investigate more thoroughly the possible alterations involved in the pathogenesis of NES.

The validity and clinical utility of night eating syndrome

OBJECTIVE

To review the empirical literature for evidence in support of inclusion of Night Eating Syndrome (NES) in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders.

METHOD

Based on a literature search using PubMed, 47 empirical studies of NES were identified.

RESULTS

The literature reflects use of varying definitions; progress has been made toward reliable measurement of night eating symptoms; evidence regarding a differentiation of NES from "normalcy" or from other eating disorders is based largely on samples of convenience; only one controlled treatment study has been published.

DISCUSSION

There are limited data supporting the clinical utility and validity of NES; several options regarding the inclusion of NES in DSM-V are discussed.

Transtornos alimentares e padrão circadiano alimentar: uma revisão

Este artigo tem como objetivo revisar aspectos relacionados a transtornos alimentares e suas relações com as alterações no ritmo circadiano. Realizou-se uma busca sistematizada das informações nas bases de dados PubMed usando os seguintes descritores: eating disorders, circadian rhythm, night eating syndrome, binge eating disorder e sleep patterns. Os transtornos alimentares, como a síndrome do comer noturno e o transtorno da compulsão alimentar periódica, têm sido considerados e relacionados a um atraso no ritmo circadiano da ingestão alimentar e saciedade prejudicada. Os ritmos circadianos são aqueles que apresentam um período de 24 h, como, por exemplo, o ciclo sono-vigília, temperatura corporal, atividade e comportamento alimentar. Distúrbios provocados pelas alterações nos horários de sono/vigília influenciam o apetite, a saciedade e, consequentemente, a ingestão alimentar, o que parece favorecer o aumento desses transtornos. Percebe-se que o comportamento alimentar pode ser influenciado por ritmos circadianos. Porém, mais estudos e o maior conhecimento sobre a ritmicidade alimentar podem contribuir com o melhor entendimento do comportamento alimentar atual, atuando na prevenção e/ou tratamento de transtornos alimentares.