A nurse is assessing three patients diagnosed respectively with anorexia nervosa, bulimia nervosa, and binge eating disorder. Which clinical manifestation best differentiates bulimia nervosa from the other two disorders?

Presence of recurrent episodes of binge eating followed by compensatory behaviors such as self-induced vomiting or laxative use.

Recurrent episodes of binge eating without compensatory purging behaviors.

Severe restriction of caloric intake leading to significant weight loss and amenorrhea.

Emotional distress focused on fear of fatness with maintained or above normal weight.