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Objective To propose criteria for diagnosis of the night eating syndrome (NES). Method An international research meeting was held in April 2008, and consensus criteria for NES diagnosis were determined. Results The core criterion is an abnormally increased food intake in the evening and nighttime, manifested by (1) consumption of at least 25% of intake after the evening meal, and/or (2) nocturnal awakenings with ingestions at least twice per week. Awareness of the eating episodes is required, as is distress or impairment in functioning. Three of five modifiers must also be endorsed. These criteria must be met for a minimum duration of 3 months. Discussion These criteria help standardize the definition of NES. Additional aspects of the nosology of NES yet to be fully elaborated include its relationship to other eating and sleep disorders. Assessment and analytic tools are needed to assess these new criteria more accurately.

Debate continues regarding the nosological status of binge eating disorder (BED) as a diagnosis as opposed to simply reflecting a useful marker for psychopathology. Contention also exists regarding the specific criteria for the BED diagnosis, including whether, like anorexia nervosa and bulimia nervosa, it should be characterized by overvaluation of shape/weight. The authors compared features of eating disorders, psychological distress, and weight among overweight BED participants who overvalue their shape/weight (n = 92), BED participants with subclinical levels of overvaluation (n = 73), and participants in an overweight comparison group without BED (n = 45). BED participants categorized with clinical overvaluation reported greater eating-related psychopathology and depression levels than those with subclinical overvaluation. Both BED groups reported greater overall eating pathology and depression levels than the overweight comparison group. Group differences existed despite similar levels of overweight across the 3 groups, as well as when controlling for group differences in depression levels. These findings provide further support for the research diagnostic construct and make a case for the importance of shape/weight overvaluation as a diagnostic specifier. Keywordsovervaluation; binge eating disorder; obesity; body image; diagnosis Binge eating disorder (BED), a research category in the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994), is characterized by recurrent binge eating without extreme compensatory weight-control behaviors. The BED research diagnosis is more common than the two formal eating disorder et al., 2006) that is associated with heightened psychiatric comorbidity, psychosocial impairment, and medical problems (Hudson et al., 2007) and is a distinct familial phenotype in obese persons (Hudson et al., 2006).As we move toward the development of the DSM-V (Brown & Barlow, 2005), a pressing question regarding the BED research diagnosis is whether revisions or additions to its criteria would improve the construct (Masheb & Grilo, 2000. Included in the DSM-IV criteria for AN and BN, but not for BED, is the presence of overvaluation of shape and weight, or the "undue influence of body weight or shape on self-evaluation" (American Psychiatric Association, 1994, p. 545). Although patients with BED appear to have similar levels of overvaluation of shape and weight as those with BN and AN (Wilfley, Schwartz, Spurrell, & Fairburn, 2000), little empirical attention has been given to the potential utility of such a body-image related cognitive criterion or specifier for this research diagnostic construct.Two recent studies have specifically examined the significance of shape/weight overvaluation in BED. Hrabosky, Masheb, White, and Grilo (2007) assessed 399 patients with BED using the investigator-based Eating Disorder Examination (EDE; Fairburn & Cooper, 1993) and found that overvaluation significantly predicted degree of eating-...

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O'REARDON, JOHN P., BRENDA L. RINGEL, DAVID F. DINGES, KELLY COSTELLO ALLISON, NAOMI L. ROGERS, NICOLE S. MARTINO, ALBERT J. STUNKARD. Circadian eating and sleeping patterns in the night eating syndrome. Obes Res. 2004;12:1789 -1796. Objective: To compare the eating and sleep-wake patterns of persons with the night eating syndrome (NES) with those of matched control subjects. Research Methods and Procedures: Forty-six overweight/ obese NES subjects (mean age 43.3 Ϯ 9.8 years; 32 women) and 43 similar controls (mean age 39.0 Ϯ 11.0 years; 28 women) wore wrist actigraphs for 7 days and completed sleep and food diaries at home. Results: There was no difference between the total energy intake of the NES and the control subjects, but the pattern of energy intake differed greatly. Relative to control subjects, the temporal pattern of food intake of night eaters was delayed. Food intake after the evening meal, as a proportion of the 24-hour intake, was more than 3-fold greater in NES subjects than in controls (34.6 Ϯ 10.1% vs. 10.0 Ϯ 6.9%, p ϭ 0.001). NES subjects had sleep onset, offset, and total sleep duration times comparable with those of controls. NES subjects reported more nocturnal awakenings than did controls (1.5 Ϯ 1.0 per night vs. 0.5 Ϯ 0.5; p Ͻ 0.001), and their actigraphically monitored arousals occurred earlier during sleep (at 128 minutes after sleep onset vs. 193 minutes, p ϭ 0.01). NES subjects consumed food on 74% of the awakenings vs. 0% for the controls. Discussion: The pattern of cumulative energy intake of the night eaters suggests a phase delay in energy consumption relative to sleep-wake times. NES may involve a dissociation of the circadian control of eating relative to sleep.

The authors compared eating patterns, disordered eating, features of eating disorders, and depressive symptoms in persons with binge eating disorder (BED; n = 177), with night eating syndrome (NES; n = 68), and in an overweight comparison group without BED or NES (comparison; n = 45). Participants completed semistructured interviews and several established measures. Depressive symptoms were greater in the BED and NES groups than in the comparison group. NES participants ate fewer meals during the day and more during the night than BED and comparison participants, whereas BED participants ate more during the day than the comparison participants. BED participants reported more objective bulimic and overeating episodes, shape/weight concerns, disinhibition, and hunger than NES and comparison participants, whereas NES participants reported more eating pathology than comparison participants. This evaluation provides strong evidence for the distinctiveness of the BED and NES constructs and highlights their clinical significance.

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.