The core defining features of bulimia nervosa (BN) are repeated binge eating episodes and inappropriate compensatory (e.g. purging) behavior. Previous studies suggest an abnormal postprandial response in the satiety-signaling peptide cholecystokinin (CCK) in persons with BN. It is unknown whether this altered response persists following remission or if it may be a potential target for the development of clinical treatment strategies. To examine the nature of this altered response, this study assessed whether CCK normalizes following remission from BN (RBN). This study prospectively evaluated the plasma CCK response and corresponding eating behavior-related ratings (e.g. satiety, fullness, hunger, urge to binge and vomit) in individuals with BN-purging subtype (n=10), RBN-purging subtype (n =14), and healthy controls (CON, n=13) at baseline, +15, +30, and +60 minutes following the ingestion of a standardized liquid test meal. Subject groups did not significantly differ in CCK response to the test meal. A significant relationship between CCK response and satiety ratings was observed in the RBN group (r=.59, p<.05 two-tailed). A new and unanticipated finding in the BN group was a significant relationship between CCK response and ratings of “urge to vomit” (r=.86, p < .01, two-tailed). Unlike previous investigations CCK response did not differ in BN and CON groups. Thus the role of symptom severity remains an area of further investigation. Additionally, findings suggest that in this sample, CCK functioning following remission from BN-purging subtype is not different from controls. It remains unknown whether or not CCK functioning may be a protective or liability factor in the stabilization and recovery process. Replication studies utilizing a larger sample size are needed to further elucidate the role of CCK in recovery from BN and its potential target of related novel treatment strategies.

The utility of nursing theory as a framework to understand, explain, and propose nursing research is essential to knowledge development. The purpose of this column is to provide an examination of the Roy adaptation model as a basis for knowledge development in bulimia nervosa. This chronic and debilitating disorder is complex, poorly understood, and characterized by repeated binge eating and purging episodes. A careful examination of the major concepts and theoretical linkages of the Roy adaptation model in relationship to bulimia nervosa is necessary to determine the value of this framework to generate future knowledge and research for practice.

CME Educational Objectives 1. Outline the core clinical features of bulimia nervosa (BN). 2. Describe the concerns surrounding the DSM-IV criteria for BN. 3. Understand the rationale for changes in the diagnostic criteria for BN as recommended for DSM-5 . Bulimia nervosa, a disorder first introduced as “bulimia” in the Diagnostic and Statistical Manual of Mental Disorders, Third Edition , 1 is characterized by recurrent binge eating episodes followed by inappropriate compensatory behaviors (such as, self-induced vomiting, laxative abuse, excessive exercising, and fasting) to prevent weight gain. The disorder is more common in females than in males, with onset typically in adolescence and young adulthood. 2