A nurse is observing a group therapy session. Which of the following client statements should the nurse identify as an indication of bulimia nervosa?

"I only use the laxatives when I am feeling constipated."

"I have binged and purged for years without my family or friends knowing."

"I feel an emotional high during my binge-purge episodes."

"I find that I can only eat in front of other people if I have exercised first."