Craving fullness: a fullness-seeking phenotype that blurs the line between binge eating disorder and food addiction
by Vera I. Tarman & David A. Wiss
There’s a clinical pattern showing up in eating disorder and addiction settings that current diagnostic frameworks don’t capture well: craving fullness. This describes a subset of patients whose compulsive eating is organized around the pursuit of extreme gastric distension rather than the taste of any specific food. In some cases, the food isn’t even hedonic — the reinforcer is the internal state of being maximally full. This fullness-seeking phenotype sits at the overlap of binge eating disorder and food addiction, and it may involve tolerance-like escalation in volume over time, withdrawal-like distress when stopping short, and gut-brain reward dynamics that look more like substance use than classic disordered eating. Patients describe needing to feel full more than needing a specific food, and they often report that progressively larger volumes are required to reach the same internal sense of relief. Craving fullness isn’t a new diagnosis. It’s a clinically observed configuration that helps explain why some patients don’t respond fully to either eating disorder or addiction treatment alone, and why integrating both frameworks may matter for this group.
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Abstract
Food addiction and binge eating disorder show striking clinical overlap that current diagnostic frameworks do not fully capture. In binge eating disorder samples, Yale Food Addiction Scale-defined food addiction has been reported in roughly half of participants. Higher symptom severity is associated with greater impairment. Within this overlap, clinicians frequently observe a subset of patients whose compulsive eating is organized around the pursuit of extreme fullness rather than palatability for specific trigger foods.
Compulsive high-volume eating (CHVE) refers to recurrent, distressing episodes of consuming dangerously large volumes of food, often to the point of marked gastric distension. In some cases, the food is low-caloric or non-hedonic, and the dominant motivator is the interoceptive target state of extreme fullness rather than taste. This Perspectives article focuses on fullness-seeking as a high-volume pattern within binge eating disorder phenomenology that has received little attention in the food addiction literature. It extends prior work that framed volume addiction within compulsive high-volume eating as a public health issue.
The focus here is clinical formulation, not the public health case. Evidence from reward learning, gut-brain signaling, gastrointestinal physiology, and neuroendocrinology suggests that this pattern may be rooted in binge eating disorder. It may identify a subset of patients with addiction-like dynamics. These cases may be better addressed when addiction-informed concepts and tools are integrated. It offers a physiologically grounded lens for combining eating disorder and addiction frameworks in a more coherent clinical approach.
