Recurrent episodes of binge eating followed by inappropriate compensatory behaviors.

Choice A rationale:

Eating large amounts of food when not feeling physically hungry is not a characteristic of bulimia nervosa. While individuals with bulimia nervosa do experience episodes of binge eating, this behavior is not dependent on physical hunger.

Choice B rationale:

Recurrent episodes of binge eating followed by inappropriate compensatory behaviors are indeed a characteristic of bulimia nervosa. Binge eating involves consuming a large amount of food in a short period, accompanied by a sense of lack of control. The compensatory behaviors, such as vomiting, laxative use, or excessive exercise, are aimed at counteracting the perceived consequences of the binge eating, such as weight gain.

Choice C rationale:

Persistent eating of nonnutritive, nonfood substances, known as pica, is not a characteristic of bulimia nervosa. Pica is a separate eating disorder that involves the consumption of non-food items such as hair, paper, or soil.

Choice D rationale:

Recurrent purging behavior to influence weight or shape is more closely associated with the eating disorder anorexia nervosa. While purging behaviors like vomiting or using laxatives can also occur in bulimia nervosa, they are not specific to it.