6 The host of symptoms associated with NES makes the syndrome best conceptualized as a combination of eating, sleeping, mood, and stress disorder features. Finally, an awareness and ability to recall evening or nocturnal ingestions must be present this criterion is necessary to differentiate NES and Sleep Related Eating Disorder (SRED), a disorder in which nocturnal ingestions occur without awareness and are unable to be recalled. In addition, an individual must experience at least three of the five following features: morning anorexia (defined as absence of morning appetite) a strong urge to eat between dinner and sleep onset and/or during nocturnal awakenings insomnia at least four to five times per week a belief that eating is necessary to initiate or return to sleep and depressed mood that worsens during evening hours. 5 According to proposed criteria, an individual must first endorse evening hyperphagia (consumption of at least 25% of daily intake after the evening meal) and/or ≥ 2 nocturnal ingestions (defined as waking up at night to eat) per week. NES is not listed in the DSM-IV-TR, 4 although a consensus regarding its core diagnostic criteria was recently reached by a panel of NES experts (First International Night Eating Symposium, April 28, 2008). 3 The diagnostic criteria of NES have been varied and disputed in the literature. NES has been attributed to a delay in the circadian rhythm of eating, characterized by appetite suppression during morning hours and appetite increase during evening hours. Conceptualization and clinical characteristics
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