Craving in eating disorders: Mapping the concept through a systematic review

Craving, long considered a hallmark of addictive disorders, has increasingly been recognized as a clinically significant phenomenon in eating disorders (ED). Yet, its conceptualization, measurement, and role in ED pathology remain inconsistent and fragmented. This review aimed to map existing knowledge through a systematic review.

Searches were conducted in July 2025 in Embase, PsycInfo, and Web of Science. Eligible records were peer-reviewed studies including adults clinically diagnosed with ED. Fifty studies and fifteen reviews met the inclusion criteria.

Most studies examined bulimia nervosa (BN) and binge-eating disorder (BED), while anorexia nervosa (AN) and non-food-related cravings (e.g., exercise, vomiting, purging) were rarely addressed. Definitions of craving varied, sometimes conflating strong desire with loss of control or subsequent behaviors. Theoretical models were inconsistent, often borrowed from addiction research, and rarely integrated neurobiological findings. Craving assessment relied mainly on visual analogue scales (VAS) and the Food Cravings Questionnaire (FCQ), with limited use of qualitative, psychophysiological, or neurocognitive methods. Interventions specifically targeting craving were scarce. Cue exposure therapy (including virtual reality), neurofeedback, and non-invasive brain stimulation-repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS)-showed encouraging but mixed effects. Across ED, craving was consistently associated with binge eating, with trait craving emerging as a stronger predictor than state craving.

Craving is central yet conceptually elusive in ED. Establishing a consensual definition, developing theory-driven and transdiagnostic assessment tools, and expanding research beyond food and binge-related disorders are priorities to advance understanding and improve interventions.