Q: I'm a middle aged female with an extremely stressful job, and although I eat very little during the day, I just can't seem to control my craving for food at night.  I also rarely get a good night's sleep and have been gaining weight.  I really need to do something about this-what is causing these problems, and how can I break these awful habits?

A: You may be suffering from an eating disorder known as night-eating syndrome (NES).  This disorder is characterized by a lack of appetite in the morning, overeating at night, and waking to eat in the middle of the night and affects about 1.5% of women and men, according to 2007 statistics from the National Institute of Mental Health.

Individuals with NES are susceptible to depression, obesity, substance abuse, and other problems.  Their productivity is often affected, as they are unable to maintain healthy sleeping and eating patterns, and they often feel guilt, shame, and out of control as a result

Although most people snack at night, those with NES eat a majority of their food during the evening.  They experience little or no hunger in the morning, but tend to overeat at dinner or after dinner. For people with NES, falling and staying asleep may be challenging, so a snack may be used to help, and it isn't uncommon for individuals with this condition to wake up at least once in the middle of the night.

High-achieving women may be especially susceptible to NES, as they tend to use all of their energy taking care of their work and family and either don't have the time or the desire to take care of themselves until the evening.  When they finally do eat, they may overcompensate, often with foods that are high in carbohydrates.

An NES eating pattern often develops gradually.  It may start with skipping an occasional breakfast or lunch, but over time, habits are established.  NES patterns may begin when people feel they have lost control of their lives-when they go away to college, start a new job, relocate, marry, divorce, start a family or go through some other life-changing event.

As with other eating disorders, causes may also be genetic.  Most of us wake up with a relatively high level of insulin that stimulates us to eat in the morning.  When we eat carbohydrates, typically at breakfast, they stimulate secretion of insulin, providing the brain with tryptophan, which is needed to make the feel-good neurotransmitter serotonin.  For those with NES, insulin levels are often inverted, perhaps stimulating them to eat more carbohydrates at night.  We do not yet know whether this is a cause or a result of NES eating patterns.

Dieting may also be a factor.  Hunger triggers the need to eat in all of us, but those who restrict food intake during the day become accustomed to ignoring hunger-until it returns with greater intensity at night.  As they learn to ignore hunger, they may also fail to distinguish when they are full.  Even though they eat little during the day, they end up eating more overall than they typically would if they didn't diet.

Successful treatment of NES usually requires a combination of therapies and begins with education about the disorder, including identifying eating cues and becoming aware of personal eating patterns. Nutrition assessment and therapy, group therapy for ongoing support, behavioral therapy, and stress management can also be used as part of the treatment process.  Exercise or other physical activity and online learning can help strengthen skills during recovery.

Above all, it is important to remember that NES is not simply a bad habit that results from lack of will power or control.  It is a potentially debilitating disorder and should be treated as one.  Working with professionals to help gain control over this disorder can help patients regain control over their lives.


Stuart Koman, Ph.D., is president and CEO of Walden Behavioral Care in Waltham, Massachusetts; a principal at the Executive Performance Group; and a senior clinical advisor to the Public Consulting Group. Before that time, he was president of Charles River Health Management, a psychiatric contract management division of Community Care, Inc., and served as a member of the Governing Board of the American Psychological Association's practice division from 1992 to 2000. Koman is also an author and co-editor of the Handbook of Adolescents and Family Therapy.