Volume addiction: introducing a novel phenotype within compulsive high volume eating.

Most accounts of disordered eating and food addiction focus on hedonic, calorie-dense intake. However, many patients describe an urgent drive to feel profoundly full, sometimes achieved through enormous volumes of low-calorie foods or fluids. This presentation centers on amount rather than food type, and differs from binge eating disorder's 2-h consumption criterion. Current diagnostic systems (DSM, ICD) do not recognize this volume-seeking presentation, and scientific literature rarely treats gastric volume as a primary reinforcer. Water-load studies show individuals with bulimia nervosa and binge-eating disorder consume substantially greater volumes before reporting satiation and display abnormal gastric myoelectrical activity compared to controls. Animal studies demonstrate that gastric stretch receptors and vagal responses are plastic and can alter satiety and intake. Gut hormones, such as ghrelin, leptin, insulin, and GLP-1s, and their interactions with reward circuitry link visceral signals to feeding behavior. Neuroimaging studies reveal altered reward responses to food cues and volume. Together, these findings suggest volume itself is a meaningful, measurable dimension warranting clinical and scientific attention. This article synthesizes these strands to propose compulsive high-volume eating (CHVE) as a distinct construct, defined by recurrent, distressing episodes where gastric distension serves as the central motivator. Within CHVE, I propose a "volume-addiction" subtype characterized by craving, tolerance, and loss of control focused on fullness. While current evidence is indirect, sufficient data exists to justify identification and study of this phenotype to target research and develop more effective treatments for food-addicted individuals who struggle specifically with volume intake.