Disentangling the links between gastric emptying and binge eating v. purging in eating disorders using a case-control design

Pamela K. Keel, Lisa A. Eckel, Britny A. Hildebrandt, Alissa A. Haedt-Matt, Daryl J. Murry, Jonathan Appelbaum, David C. Jimerson

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


Background Prior work supports delayed gastric emptying in anorexia nervosa and bulimia nervosa (BN) but not binge-eating disorder, suggesting that neither low body weight nor binge eating fully accounts for slowed gastric motility. Specifying a link between delayed gastric emptying and self-induced vomiting could offer new insights into the pathophysiology of purging disorder (PD). Methods Women (N = 95) recruited from the community meeting criteria for DSM-5 BN who purged (n = 26), BN with nonpurging compensatory behaviors (n = 18), PD (n = 25), or healthy control women (n = 26) completed assessments of gastric emptying, gut peptides, and subjective responses over the course of a standardized test meal under two conditions administered in a double-blind, crossover sequence: placebo and 10 mg of metoclopramide. Results Delayed gastric emptying was associated with purging with no main or moderating effects of binge eating in the placebo condition. Medication eliminated group differences in gastric emptying but did not alter group differences in reported gastrointestinal distress. Exploratory analyses revealed that medication caused increased postprandial PYY release, which predicted elevated gastrointestinal distress. Conclusions Delayed gastric emptying demonstrates a specific association with purging behaviors. However, correcting disruptions in gastric emptying may exacerbate disruptions in gut peptide responses specifically linked to the presence of purging after normal amounts of food.

Original languageEnglish (US)
Pages (from-to)1947-1954
Number of pages8
JournalPsychological medicine
Issue number5
StatePublished - Apr 7 2023


  • Bulimia Nervosa
  • Purging disorder
  • binge eating
  • gastric emptying
  • medication

ASJC Scopus subject areas

  • Applied Psychology
  • Psychiatry and Mental health


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